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Are Cash Incentives Effective in Driving Patient Motivation?

Newly-insured patients visited their PCPs for the first time for as little as $25, proving that cash incentives can drive patient motivation.

Cash incentives are helpful in driving patient motivation.

Source: Thinkstock

By Sara Heath

- Cash incentives as little as $25 can be effective in increasing patient motivation and encouraging patients to visit a primary care provider, according to one new study.

The report, published in the most recent issue of Health Affairs, explored the use of cash incentives in driving patient motivation to visit the primary care provider. Researchers Cathy J. Bradley and David Neumark investigated how cash incentives can affect low-income patients who were newly insured under the Affordable Care Act’s coverage expansion.

The healthcare industry has generally accepted that primary care visits can support chronic disease management and preventive care. Primary care visits can prevent conditions from worsening and from causing severe events that require expensive hospitalizations. Access to a PCP is also useful for getting rid of the emergency department safety net that many uninsured patients use when they cannot access primary care.

Simply offering primary care access is not tied to reducing ED use and costs. Patients must utilize primary care to yield those positive results. However, the initial primary care visit is not always easy for patients who are newly-insured.

“Health insurance and other coverage programs provide access to care but might not overtly encourage patients to seek primary care,” Bradley and Neumark explained. “A primary care visit within the first six months of enrollment could address long-ignored or emerging health care needs, and it provides an alternative to using the ED.”

Patients may be unfamiliar with the healthcare landscape and feel daunted by visiting a provider. Additionally, patients who are not experiencing any symptoms might find a PCP visit unnecessary. Other patients might lack the time needed to visit the primary care office.

Cash incentive programs hold a lot of promise in closing these gaps, Bradley and Neumark posited.

“A cash incentive may generate a desired behavioral response for a relatively small price,” the pair wrote. “Moreover, low-income populations may be more responsive to cash incentives, compared to other populations.”

Bradley and Neumark tested their cash incentive theory on an expansive patient population, offering three levels of incentives – $0, $25, and $50. These patients were also paid $10 to fill out a baseline health survey.

The researchers also tapped a control group of over 400 patients. These patients did not fill out the questionnaire and did not receive any education about navigating the primary care landscape. The researchers examined this control group to investigate whether education drove patients in the $0 incentive group to access primary care despite their lack of cash prize.

Within six months, 77 percent of the $50 incentive group and 74 percent of the $25 incentive group had visited their primary care provider. Sixty-eight percent of the $0 incentive group also visited their primary care provider.

Patients in the $25 incentive group were 36 percent more likely than the $0 incentive group to visit their PCP. Similarly, the $50 incentive group was 56 percent more likely to visit their PCP than the $0 group. Combined, participants receiving a cash incentive were more than twice as likely as the $0 group to visit a PCP within the six-month test period.

These results align with previous reports stating that cash incentives are effective in driving patient motivation. In studies about medication adherence and smoking cessation, researchers have found that the larger the incentive, the better the results.

In addition to finding success with small cash incentives, the researchers recognized that educating newly-insured patients about the importance of primary care was effective at driving motivation.

Sixty-eight percent of patients receiving $0 in cash incentives still took the time to access their primary care provider, compared to 61 percent of the patients who experienced no interactions with the study administrators.

This modest improvement emphasized an alternative strategy for driving primary care utilization apart from using cash incentives.

“The findings suggest that interaction with a health care program coordinator who orients low-income enrollees to relevant program processes may also produce the desired result with no prospect of an incentive,” Bradley and Neumark said.

Bradley and Neumark will next investigate the clinical effects of PCP utilization amongst this population. The pair noted that they wanted to understand how primary care access can cut unnecessary hospitalizations and healthcare costs, and future data will reveal those trends.

“These data will allow us to determine whether primary care visits reduced ED, inpatient, and outpatient utilization and their associated costs and improved patient self-reported health status,” the pair concluded.