Engagement with Health Risk Assessments and Commitment to Healthy Behaviors in Michigan’s Medicaid Expansion Program

Abstract

Background: Health risk assessments (HRAs) and healthy behavior incentives are increasingly used by state Medicaid programs to promote enrollees’ health. Objective: To evaluate enrollee experiences with HRAs and healthy behavior engagement in the Healthy Michigan Plan (HMP), a state Medicaid expansion program. Design: Telephone survey conducted in Michigan January–October 2016. Participants: A random sample of HMP enrollees aged 19–64 with ≥ 12 months of enrollment, stratified by income and geographic region. Main Measures: Self-reported completion of an HRA, reasons for completing an HRA, commitment to a healthy behavior, and choice of healthy behavior. Key Results: Among respondents (N = 4090), 49.3% (95% CI 47.3–51.2%) reported completing an HRA; among those with a primary care provider (PCP) (n = 3851), 85.2% (95% CI 83.5–86.7%) reported visiting their PCP during the last 12 months. Most enrollees having a recent PCP visit reported discussing healthy behaviors with them (91.1%, 95% CI 89.6–92.3%) and were more likely to have completed an HRA than enrollees without a recent PCP visit (52.7%, 95% CI 50.5–52.8% vs. 36.2%, 95% CI 31.7–41.1%; p < 0.01). Among enrollees completing an HRA, nearly half said they did it because their PCP suggested it (45.9%, 95% CI 43.2–48.7%), and most reported it helped their PCP understand their health needs (89.7%). Awareness of financial incentives was limited (28.1%, 95% CI 26.3–30.0%), and very few reported it as the primary reason for HRA completion (2.5%, 95% CI 1.8–3.4%). Most committed to a healthy behavior (80.7%, 95% CI 78.5–82.8%), and common behaviors chosen were nutrition/diet (57.2%, 95% CI 54.2–60.2%) and exercise/activity (52.6%, 95% CI 49.5–55.7%). Conclusions: In the Healthy Michigan Plan, PCPs appeared influential in enrollees’ completion of HRAs and healthy behavior engagement, while knowledge of financial incentives was limited. Additional study is needed to understand the relative importance of financial incentives and PCP engagement in impacting healthy behaviors in state Medicaid programs.