Patricia Alexander knew she needed a mammogram but just couldn’tfind the time.

“Every time I made an appointment, something would come up,”said Alexander, 53, who lives in Moreno Valley, Calif.

Over the summer, her doctor’s office, part of Vantage MedicalGroup, promised her a $25 Target gift card if she got the exam.Alexander, who’s insured through Medi-Cal, California’s version ofthe Medicaid program for lower-income people, said that helpedmotivate her to make a new appointment — and keep it.

Health plans, medical practices and some Medicaid programs areincreasingly offering financial incentives to motivate Medicaidpatients to engage in more preventive care and make healthier lifestyle choices.

They are following the lead of private insurers and employersthat have long rewarded people for healthy behavior such asquitting smoking or maintaining weight loss. Such changes inhealth-related behavior can lower the cost of care in the longrun.

“We’ve seen incentive programs be quite popular in the insurancemarket, and now we are seeing those ramp up in the Medicaid spaceas well,” said Robert Saunders, research director at the MargolisCenter for Health Policy at Duke University.

Medicaid patients who agree to be screened for cancer, attendhealth-related classes or complete health risk surveys can get giftcards, cash, gym memberships, pedometers or other rewards. They mayalso get discounts on their out-of-pocket health care costs orbonus benefits such as dental care.

Under the Affordable Care Act, 10 states received grantstotaling $85 million to test the use of financial rewards as a wayto reduce the risk of chronic disease among their Medicaidpopulations. During the five-year demonstration, states used theincentives to encourage people to enroll in diabetes prevention,weight management, smoking cessation and other preventive programs.The states participating were California, Connecticut, Hawaii,Minnesota, Montana, Nevada, New Hampshire, New York, Texas andWisconsin.

Medi-Cal, for example, offered gift cards and nicotinereplacement therapy to people who called the state’s smokingcessation line. Minnesota’s Medicaid program handed out cash topeople who attended a diabetes prevention class and completedbloodwork.

An evaluationof these programs, released in April, showed that incentives helppersuade Medicaid beneficiaries to take part in such preventiveactivities. Participants said gift cards and other rewards alsohelped them achieve their health goals. But the evaluators weren’table to show that the programs prevented chronic disease or savedMedicaid money. That’s in part because those benefits could takeyears to manifest, according to the evaluation.

Overall, research on the effectiveness of financial incentivesfor the Medicaid population has been mixed. A report this year by the Center on Budget and Policy Prioritiesfound that they can induce people to keep an appointment or attenda class but are less likely to yield long-term behavior changes,such as weight loss. And in some cases, the report said, incentivesare given to people to get exams they would have gotten anyway.

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Kaiser Health News is a nonprofit news servicecovering health issues. It is an editorially independent program ofthe Kaiser Family Foundation that is not affiliated with KaiserPermanente.

The center’s report also found that penalties, including onesthat limit coverage for people who don’t engage in healthfulbehaviors, were not effective. Instead, they can result inincreased use of emergency rooms by restricting access to otherforms of care, the report said.

Some of the biggest factors preventing Medicaid patients fromadopting healthful behaviors are related not to medical care but totheir circumstances, said Charlene Wong, a pediatrician and healthpolicy researcher at Duke University.

That makes administering incentive programs more complicated.Even recruiting and enrolling participants has been a challenge forsome states that received grants through the Affordable CareAct.

“The thing that is most likely to help Medicaid beneficiariesutilize care appropriately is actually just giving them access tothat care — and that includes providing transportation and childcare,” said Hannah Katch, one of the authors of the report by theCenter on Budget and Policy Priorities. Another barrier is beingable to take time off work to go to the doctor.

But health plans are eager to offer patients financialincentives because it can bring their quality scores up and attractmore enrollees. And medical groups, which may receive fixedpayments per patient, know they can reduce their costs — andincrease their profits — if their patients are healthier.

Providing incentives to plans and medical groups has created abusiness opportunity for some companies. Gift Card Partners hasbeen selling gift cards to Medicaid health plans for about fiveyears, said CEO Deb Merkin. She said health insurers that serveMedicaid patients want to improve their quality metrics, and theycan do that by giving incentives and getting patients to thedoctor.

“It is things like that that are so important to get them to dothe right thing so that it saves money in the long run,” shesaid.

Agilon Health, based in Long Beach, Calif., runs incentiveprograms and other services for several California medical groupsthat care for Medi-Cal patients. The medical groups contract withthe company, which provides gift cards to patients who getmammograms, cervical cancer exams or childhood immunizations.People with diabetes also receive gift cards if they get their eyesexamined or blood sugar checked. And the company offers bonuses todoctors if their Medicaid patients embrace healthier behaviors.

The incentives for patients are “massively important for theMedicaid population, because the gaps in care are historically soprevalent,” said Ron Kuerbitz, CEO of Agilon. Those gaps are a bigfactor pushing up costs for Medicaid patients, because if theydon’t get preventive services, they may be more likely to needcostlier specialty care later, Kuerbitz said.

Emma Alcanter, who lives in Temecula, Calif., received a giftcard from her doctor’s office after getting a mammogram late thissummer. Alcanter, 56, had noticed a lump in her breast but waitedabout two years before getting it checked, despite reminders fromher doctor’s office. “I was scared they were going to find cancer,”she said.

Alcanter finally decided to get screened after her firstgrandchild was born. The gift card was an added bonus, and Alcantersaid it showed her doctors cared about her. Her mammogram revealedthat the lump wasn’t cancer, and she plans to use the gift card tobuy a present for her grandson.

Kaiser Health News is a nonprofit news servicecovering health issues. It is an editorially independent program ofthe Kaiser Family Foundation that is not affiliated with KaiserPermanente.