When Is a Carrot Really a Stick?

We’ve been writing about companies that are using incentive programs to get employees to participate in wellness programs quite a bit here at Incentive over the past year or so, and with good reason: with health care costs skyrocketing, anything that can keep insurance costs down provides a potential return-on-investment that is getting harder to ignore. (You’ll see wellness addressed again in our April issue.)

Now, it seems the administrators of West Virginia’s Medicaid program have come to the same conclusion. A pilot program in three counties began this year, offering Medicaid enrollees who participate in wellness initiatives like attending health improvement programs substantial extra benefits. These range from house calls to stop-smoking and weight-loss programs to mental health counseling to—perhaps most valuable of all—unlimited free monthly prescriptions, rather than the four normally covered. Those who do not sign the pledge to do their best to stay healthy—following their doctor’s advice, getting regular checkups and the like—get standard Medicaid coverage.

Of course, this raises the question, in at least some experts and doctors’ eyes, of whether indigent West Virginians are being offered an incentive to stay healthy, or punished with worse medical care for failing to take care of themselves. After all, its one thing for a company to offer American Express gift certificates to employees who fill out a health survey and follow up with wellness programs, as Incentive’s parent company does. It’s quite another to say to an elderly person on a fixed income, “Sorry, you’ve got to choose which four of those five prescriptions you’re going to fill this month.”

Honestly, I’m having trouble figuring out where I come down on this particular question. The benefits offered are clearly over and above what West Virginia provides now, and if this was a private company’s health care program, I’d be all for it. But Medicaid is special: it’s the safety net we provide the poorest and most vulnerable among us. Is it right to use their poverty to force them to live the way we want them to, regardless of how good it is for them?

I’d be interested in hearing what you think.