CIGNA Healthcare
Mid-Atlantic
Hypertension
Asian, African American, Latino

Project

Patients are offered financial incentives to make an appointment with their doctor.

Patients are sent a letter with hypertension education materials, a wallet-size blood pressure health record, and an offer to receive a $15 gift card if they visit their doctor within the next two months.

A second mailing goes to patients who have not scheduled an appointment within four months of the first mailing. Participating physicians receive a letter introducing the initiative and its goals, educational materials on plain language communication with patients, and a copy of the materials being sent to their patients. The prepaid debit cards are mailed to patients as soon as a claim for the doctor visit is received by the health plan.

Rationale

Insured, low-income minority populations may be motivated to visit their physician and improve their hypertension self-management through financial incentives. These incentives may be effective even if the amount is relatively small, especially if the incentives offset barriers to care such as the costs of transportation and childcare. By motivating patients to see their physician, this study may improve both short- and long-term health outcomes. Encouraging patients to make an appointment with their doctor and providing education materials can potentially help convince a patient that he or she has an active and important role in his or her own health. This increased motivation may improve health outcomes by increasing disease self-management behaviors, treatment adherence, and physician-patient communication.

Summary Results

Patient-directed financial incentives paired with educational materials significantly increased the percentage of patients who had a primary care visit at 3 months after implementation (33.8% vs 31.1% of controls), particularly for patients who had not seen a physician in over a year and for those with moderately high hypertension. However, the incentives plus education were not significantly more effective than patient education alone (33.8% vs 34.0% at 3 months). A significantly greater percentage of patients receiving education only had a physician visit at 6 months (53.5% vs 50.8%) and at 12 months (67.9% vs 64.0%). Despite the increase in visits, this intervention did not improve clinical outcomes.

Publications

Principal Investigators

• Kathryn Pierce, BSN, MBA (Director of Clinical Quality, CIGNA  HealthCare)
• Laurie Martin, ScD, MPH (Associate Policy Researcher, RAND Corporation)