The Burrill Report


It makes sense to pay people to stay healthy because it will save healthcare costs in the long run. That is the thinking behind the Patient Protection and Affordable Care Act—that spending on prevention today will save on healthcare costs tomorrow.

A new $100 million program, recently announced by the U.S. Department of Health and Human Services www.hhs.gov/, will allow states to offer incentives to Medicaid enrollees who adopt healthy behaviors, such as quitting smoking or losing weight.

“Keeping people healthy is an important goal of the Affordable Care Act,” says HHS Secretary Kathleen Sebelius. “One way to reach that goal is to encourage all Americans to make better choices about diet, exercise, and smoking to avoid potentially disastrous outcomes down the road like heart disease, cancer, or diabetes.”

States may apply to the Centers for Medicare & Medicaid Services for grants to fund programs that demonstrate changes in health risk and outcomes, including the adoption of healthy behaviors.

Research has shown that one way to encourage people to embark on difficult changes in unhealthy habits is to offer economic incentives to those who reach stated goals. With that in mind, CMS will encourage states to adopt such strategies as rewarding Medicaid enrollees who meet goals established for them such as weight loss, smoking cessation or diabetes prevention or control. Rewards could range from direct cash incentives, gift cards to grocery stores and other retailers, reduced Medicaid program fees, or offering services not normally available through Medicaid.

“With the right incentives, we believe that people can change their behaviors and stop smoking or lose weight,” says CMS Administrator Donald Berwick. “Not only can preventive programs help to improve individuals’ health, by keeping people healthy we can also lower the nation's overall health care costs.”

Preventing an increase in the number of people with chronic health conditions is a key goal of the Affordable Care Act, passed almost a year ago. The new program focuses on those behaviors that can cause some of the most critical chronic conditions affecting millions of Americans—tobacco use, overeating, and physical inactivity.

Despite a decline in tobacco use, one in five American adults and teenagers still use tobacco. It is responsible for more than 430,000 deaths each year and for every person who dies from a smoking-related disease, about 20 more people have at least one serious illness related to smoking.

An estimated 26.7 percent of adults in the U.S. reported being obese in 2009, up 1.1 percentage points since 2007, and approximately 300,000 deaths per year may be attributable to obesity. In 2008, the annual healthcare cost of obesity in the United States was estimated to be as high as $147 billion a year.

More than one-third of adults have two or more of the major risk factors for heart disease, a leading cause of morbidity, mortality, and health care utilization and spending. Diabetes is the seventh leading cause of death in the United States and accounted for $116 billion in total U.S. healthcare system costs in 2007, and almost 24 million Americans have diabetes, including 5.7 million who don't know they have the disease. This includes about 186,300 people younger than 20 years who have type 1 or type 2 diabetes.

Commercial insurance program experience has shown that financial incentives can be effective in the short run for simple preventive care and distinct behavioral goals, but this demonstration will attempt to identify the most effective strategies for major, long-term changes in unhealthy habits.

“We are hopeful that these approaches will help to sustain patients’ behavior change over their lifetime, especially in the areas of physical activity, nutrition, and smoking cessation,” says Berwick. “We need to take aggressive steps to help give everyone the tools they need to improve their health.”



March 04, 2011
http://www.burrillreport.com/article-getting_rewarded_to_stay_well.html