Financial incentives have successfully pushed Minnesota doctors to press their diabetes and hypertension patients to make lifestyle changes and improve their health.
So HealthPartners and the Hazelden Betty Ford Foundation decided to try the reward-based approach on a tougher population — patients in residential treatment for drug and alcohol addictions.
The health insurer and the treatment organization announced results this week and found that financial incentives for Hazelden improved key measures of progress in patients at its adult facility in Center City and its youth facility in Plymouth.
After meeting only two of seven goals in 2013 — and having to repay HealthPartners a predetermined sum for missing the other five — Hazelden met all seven goals in 2014. Patients were more likely to report excellent care, more likely to attend 12-step meetings after residential treatment and less likely to need readmission to Hazelden’s residential facilities.
Hazelden has long advocated the 12-step approach to recovery. Its leaders were excited to find that the financial incentives resulted in more patients using this approach after they were discharged from residential treatment. In 2013, 39 percent of adults attended three or more 12-step meetings in the first six weeks after they were discharged. In 2014? It rose to 42.3 percent.
“One of the strongest predictors of our substance use [treatment] outcomes is the frequency of 12-step meeting attendance,” said Audrey Klein, lead author of the report, which was published in the Journal of Hospital Administration.
Klein, executive director of Hazelden’s Butler Center for Research, cautioned that the report was a raw look at the effect of financial incentives on substance abuse care. It lacked deeper statistical analysis to prove that the incentives themselves made a difference, or any comparison group of patients whose care wasn’t guided by providers with the same incentives.
The results were nonetheless encouraging. Insurers and business groups such as the Minnesota Health Action Group have already reported success with rewards to clinics that get their diabetic patients to quit smoking and improve their blood pressure and blood sugar levels.
But then, one could imagine that providers would have tougher challenges in improving results for patients hooked on drugs or alcohol.
Interestingly, the new approach involved penalties rather than rewards — with HealthPartners clawing back as much as 5 percent of its payments for residential care if Hazelden fell short of any goals. (Psychological research shows that the threat of losing money is often more persuasive to people than rewards.)
No matter the patient, Klein said incentives work if they focus doctors on the right changes in their practices. “Folks with addiction aren’t any different than folks with other illnesses. The more you optimize treatment … the more your patients will benefit.”