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Can Medicaid Packages Help Boost Patient Engagement?

Indiana's reformed Medicaid program gives a real world example of how patient responsibility could boost patient engagement with healthcare.

- Boosting patient responsibility for their own healthcare – particularly financial responsibility – may have a positive effect on patient engagement levels.

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In a first-year analysis of Indiana’s Medicaid program, Healthy Indiana Program (HIP) 2.0, researchers have found that those patients who bear more responsibility for their health finances tend to be more engaged with their healthcare.

HIP 2.0 offers Medicaid beneficiaries two program options. The first option is a basic option, which includes standard wellness coverage, no vision or dental coverage, and requires no beneficiary contribution to a health spending account called a Personal Wellness and Responsibility (POWER) account.

The second option is HIP Plus, which includes vision and dental coverage and requires patients to contribute to their POWER accounts.

The researchers reported that most beneficiaries chose HIP Plus, showing a desire to engage with a wider breadth of care and coverage options. Nearly 70 percent of beneficiaries chose to participate in HIP Plus, which includes 65 percent of members whose household incomes are 23 percent or less of the state federal poverty level, or about $228 monthly income.

Notable, however, is the effect the HIP Plus program had on patient engagement and behavior.

The researchers found that those who had HIP Plus, bearing a stronger financial burden for their healthcare through the self-funded POWER account, had higher levels of patient engagement.

“To date, experience with HIP 2.0 indicates that health plan members who pay for Plus are accessing their benefits and are more actively engaging in their care,” the researchers reported.

Those participating in HIP Plus had higher rates of preventative screenings, including breast cancer screenings and cervical cancer screenings.

“While the proportion of members getting these preventive screenings still has room for improvement, there is a noticeable difference between Plus and Basic,” the researchers explained. “Increased use of preventive care and other services, especially relative to HIP Basic, may be due to the greater incentives to obtain preventive care in the Plus option.”

Plus members are also more likely to seek care in ambulatory settings and seek follow-up care, which is critical for maintaining positive care outcomes.

HIP Plus also appears to reduce medication non-adherence, with 72 percent of Plus members utilizing their drug prescription coverage included in the package. To compare, only 49 percent of Basic members have used their drug prescription coverage.

The researchers suggest that these results of higher patient engagement are a direct result of the increased financial responsibility Plus members bear.

“Although the body of literature on the impact and effectiveness of consumer incentives and personal responsibility in health care is still evolving, there are some early findings that support the approach HIP takes to better engage members in their care,” the research team explained.

“HIP engages Indiana Medicaid members in their care, encouraging members to receive recommended preventive care, to access care in the most appropriate settings, and to think about the cost of care,” the continued. “To achieve these goals, HIP uses a variety of financial incentives to drive consumer engagement and decision-making.”

The researchers suggest that the very existence of the POWER account is another driver of patient engagement, primarily through patient empowerment.

Because the POWER account works similarly to a healthcare debit care, patients feel empowered in making their own decisions on how they spend their money for their own healthcare.

“The debit card gives members a sense of responsibility for paying directly from their accounts,” the research team explained. “Furthermore, the cost transparency features—the monthly POWER account statements and the ability to track account debits and balances in real-time online as well as after a payment was made with the debit card—empower members to better manage the funds in their POWER accounts.”

Overall, this research indicates that patient engagement does not start and end with the care encounter, nor does it solely lay with how the provider communicates with the patient outside of the office.

Instead, it shows the considerable influence factors like healthcare coverage play in boosting patient engagement. In this case, the HIP 2.0 Medicaid package drives patients toward better engagement because it boosts patient responsibility for their healthcare.

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