Getting physical: UF to test if financial incentives improve health, lower costs

April 23, 2012

GAINESVILLE, Fla. — Joining a gym to log in hours on the elliptical or hiring a nutritionist for guidance are good ideas to shed pounds but typically too pricey for people with low incomes, as are many programs geared toward boosting wellness.

To address that issue, University of Florida researchers have received a $9.9 million grant from the Centers for Medicare and Medicaid Services and the Texas State Health and Human Services Commission to test whether increasing access to wellness services could improve the health of patients already facing physical and mental health conditions.

Study subjects who take part in the Texas Wellness Incentives and Navigation project will receive a small stipend to pay for items such as gym memberships, tools to quit smoking or even a simple bathroom scale. They also will work closely with a navigator who will help them set goals and identify health risks, said Elizabeth Shenkman, director of the UF Institute for Child Health Policy and the grant’s primary investigator.

“We know that patients with co-morbid physical and mental health conditions are at particularly high risk for a shortened lifespan, a sedentary lifestyle and alcohol use. They also are at risk for high health expenditures because they are hospitalized or use the emergency room often,” said Shenkman, who also serves as chairwoman of the UF College of Medicine department of health outcomes and policy. “Some of these folks have conditions such as asthma, diabetes and chronic obstructive pulmonary disease combined with depression or other mental health problems. The improved healthy lifestyle can help people better manage their physical health conditions and also have a positive effect on their mental health.”

For each year of the three-year study, participants will receive a $1,150 debit card to use on various wellness services and products, based on the plan each makes with his or her personal navigator.

Using a counseling technique called motivational interviewing, navigators will coach participants and help them determine what services they need and what steps they need to take to achieve a healthy lifestyle. Participants will meet with their navigators once a month.

“The utilization of motivational interviewing has been shown to be effective in improving patient engagement in and commitment to the treatment process in numerous clinical contexts, including in health care settings,” said Carson Ham, a UF psychologist and expert on motivational interviewing.

The researchers are developing an electronic form that will not only help assess patients’ risks and needs but also will be coded to provide links to resources in the specific areas where patients live.

“Many of these patients have transportation issues that affect their access to services, too,” Shenkman said.

The study is one of 10 the Centers for Medicare and Medicaid Services recently funded to assess how helpful financial incentives are in promoting wellness. After the studies are complete, the most effective projects will be used as models for the rest of the country.

Keeping in mind the ability to serve as a model, UF researchers are working in concert with three health plans in Houston that handle Medicaid. The navigators are working with patients through the three health plans as part of the grant.

“We want the project to take place in a context where it could be implemented in other settings,” Shenkman said.

To measure the success of the study, researchers will examine several key outcomes, such as whether it reduces visits to the emergency room. They also will monitor participant’s blood pressure and cholesterol levels and total health care expenditures. If health benefits and cost savings are achieved, hiring health navigators and providing small stipends for wellness up front could save money down the road by keeping patients out of hospitals, Shenkman said.

“We are very excited about this partnership with the health plans, to really test a novel program and see what works best,” Shenkman said. “This is a phenomenal opportunity.”