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Research Questions

  1. Will a small financial incentive motivate people with hypertension to see a doctor?
  2. Will educational materials alone motivate people with hypertension to see a doctor?
  3. Do patients receiving the incentive see improvement in their blood pressure?
  4. Are racial/ethnic groups motivated differently by educational materials or financial incentives?
  5. Is payment an effective strategy to close racial/ethnic gaps in hypertension?

In 2009, CIGNA Healthcare and RAND partnered in an initiative that examined the extent to which small financial incentives for patients can motivate physician visits and reduce racial/ethnic disparities in hypertension (HTN). The aims were (1) To assess whether a one-time $15 patient financial incentive, along with educational materials sent to patients, would be effective in motivating individuals with HTN to see their personal physician, compared with educational materials only or no intervention; (2) to determine if patient incentives encourage the control of or improvement in BP for high-risk individuals relative to educational materials only or no intervention; and (3) to assess whether patient incentives and educational materials are differentially effective across racial/ethnic groups in motivating physician visits and improving BP control and whether these differential effects lead to a reduction in racial/ethnic disparities in HTN. The initiative had a significant effect on those who had not seen a physician in over a year. Although individuals with systolic blood pressure (SBP) between 120 and 139 or diastolic blood pressure (DBP) between 80 and 89 at baseline demonstrated significant and sustainable reductions in SBP over time, the initiative did not have a differential impact on lowering blood pressure over time by race/ethnicity. The report also includes evaluations of the initiative by patients and physicians.

Key Findings

Patient Financial Incentives Have Demonstrable Effects

  • A one-time $15 patient financial incentive, along with educational materials sent to patients, increased visits for patients.
  • Patients who hadn't seen a physician in over a year saw the biggest effect from the incentive.
  • Patients recieving payments made appointments more quickly - more saw their doctors within 3 months than those in the other groups.
  • Individuals with slightly elevated blood pressure at the start of the study demonstrated significant and sustainable reductions in systolic blood pressure over time.

But Some Uncertainties Remain

  • The financial incentive and educational materials did not result in a reduction in racial and ethnic disparities.
  • Individuals with slightly elevated blood pressure may have benefited from the educational materials alone; this association should be the focus of future study.

Recommendations

Recommendations for Future Quality Improvement Initiatives

  • Capitalize on future expansion of the electronic medical record to tailor future initiatives to individuals most likely to respond.
  • Tailor messaging based on the stage of the patient's condition and changes over time.
  • Align incentives more closely with medical condition.
  • Make tools to track health available in a form compatible with today's technology.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Summative Evaluation

  • Chapter Three

    Member Feedback

  • Chapter Four

    Physician Feedback

  • Chapter Five

    CIGNA Leadership Feedback

  • Chapter Six

    Summary and Implications for Quality Improvement Initiatives

  • Appendix A

    Informational Letters, Educational Materials, and Costs of Implementation

  • Appendix B

    Study Population and Randomization to Study Arm

  • Appendix C

    Study Participant Interview Protocols

  • Appendix D

    Physician Survey

  • Appendix E

    CIGNA Leadership Interview Protocol

  • Appendix F

    Analyses

  • Appendix G

    Continuity of Care Results

This work was sponsored by CIGNA Healthcare. The research was conducted in RAND Health, a unit of the RAND Corporation.

This report is part of the RAND Corporation technical report series. RAND technical reports may include research findings on a specific topic that is limited in scope or intended for a narrow audience; present discussions of the methodology employed in research; provide literature reviews, survey instruments, modeling exercises, guidelines for practitioners and research professionals, and supporting documentation; or deliver preliminary findings. All RAND reports undergo rigorous peer review to ensure that they meet high standards for research quality and objectivity.

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