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Washington, D.C., United States (KaiserHealth) – A federal grant program authorized in the health overhaul law is offering states $100 million to reward Medicaid recipients who make an effort to quit smoking or keep their weight, blood pressure or cholesterol levels in check.

The grant program is meant to encourage states, many of which are under pressure to cut Medicaid costs, to experiment with an uncertain approach to wellness: offering incentives for healthy behavior.

“Medicaid is almost the sweet spot for financial rewards,” said George Loewenstein, a behavioral economist at Carnegie Mellon University who has studied the effect of financial incentives on behavior. Medicaid recipients, he explains, are economically disadvantaged and have more to gain from incentives.

Loewenstein, however, is dubious about whether incentives, especially those tied to weight loss, could really work. He’s not alone.

Behavioral incentive programs have shown some promise in specific settings, but they are largely untested in the Medicaid population.

The federal dollars for Medicaid incentives reflect a sharpening emphasis on the role of preventive health in targeting the underlying causes of chronic disease, a central pillar of the Obama administration’s health care agenda. States have until May 2 to submit their final proposals to the Centers for Medicare & Medicaid Services for funding, and a number have indicated an interest.

And while states have some flexibility about how they design their incentives, federal guidelines provide a basic profile. Medicaid enrollees who demonstrate a commitment to improving their health will be eligible to receive financial rewards such as coupons or gift certificates. For those who are overweight or trying to quit smoking, that commitment might take the form of weight management classes or tobacco cessation counseling. States are encouraged to provide rewards “on a tiered basis” for attempts at participation, “actual behavior change,” and “achievement of health goals.”

Chronic conditions such as diabetes, bad cholesterol and high blood pressure account for more than 75 percent of the $2.5 trillion the U.S. spends annually on health care, according to data from the Department of Health and Human Services. Cigarette smoking, 10 percent more prevalent among Medicaid enrollees than the population at large, cost Medicaid programs an average of $607 million in 2004, according to the National Center for Health Statistics, and is also the leading preventable cause of death in the U.S.

States Have Mixed Results

To date, a few states have tried transplanting the corporate wellness model to Medicaid, with mixed results. State health officials seem to agree that participation from health care providers and other community organizations, often a challenge, was critical in making their programs work.

West Virginia’s approach, which provides an enhanced coverage plan with added benefits to Medicaid enrollees who agree to adhere to healthy behaviors, has been widely criticized by health advocates.

Idaho, which launched an incentive program in 2007, offers $200 in vouchers to Medicaid enrollees who consult with a doctor about losing weight or quitting smoking. Recipients can use the vouchers for gym memberships, weight management programs, nutrition counseling and tobacco cessation products. Tobacco counseling courses are offered free of charge through public health districts in the state. Idaho is now enrolling about 1,500 new Medicaid participants each year.

According to Tom Kearns, who manages Idaho’s Preventive Health Assistance initiative, participants have written in with positive feedback – but the state doesn’t have data to show whether the incentives are cost-effective or have a large-scale impact on participants’ behavior.

“There’s a lot of challenges in tracking the outcomes of this long-term,” Kearns said. “Ultimately we’d like to have a large enough population to track.”

The state has worked hard to find partners who are willing to accept its vouchers and so far has more luck with community groups, such as the YMCA, than private companies.

Florida has also tried using incentives in its Medicaid managed care pilot program.

The program allows Medicaid enrollees living in five counties to earn up to $125 worth of credits each fiscal year in exchange for their compliance with certain “healthy behaviors,” like getting a flu shot or adhering to a prescribed drug regimen. Participants can redeem the credits at participating pharmacies for over-the-counter products such as bandages and diapers.

But logistical setbacks have dampened the impact of the incentives. At first, few were aware that the program even existed, and some pharmacies refused to accept the Medicaid credits. Several hundred people have received credits for participating in a diabetes or hypertension disease management program since 2006, but as of February, only two individuals were on the record for having attended a smoking cessation course, and six individuals have been credited for entering a weight management or exercise program.

“There’s a question about whether this is really incentivizing anything … that link is very dubious,” said Greg Mellowe, policy director at the consumer advocacy group Florida CHAIN. Most of the credits distributed through Florida’s rewards program in the past five years, Mellowe contends, were awarded for routine visits and immunizations that Medicaid recipients would have sought anyway – and not for significant behavioral changes.

Research On Incentives Is Inconclusive

Research is scant on the effects of incentive programs on mitigating chronic diseases. A smattering of studies have shown that complex behavioral programs with built-in incentives can sometimes produce short-term results-if the incentives are large enough. A 2009 study published in the New England Journal of Medicine found that a program offering people $750 to quit smoking: 15 percent of participants eligible for a reward managed to quit, compared with 5 percent of participants who enrolled in a traditional tobacco cessation program.

A similar study about incentive-based weight loss programs, published by some of the same researchers in the Journal of the American Medical Association, was less optimistic. That study found that financial rewards did help participants lose more weight temporarily, but the losses weren’t fully sustained in the end.

Few behavioral studies have attempted to determine whether people who receive the incentives are able to maintain their short-term success long term – the ultimate goal of incentive-based prevention program. Fewer attempts have been made to address how the design of an incentive program should be adjusted according to the demographics of the target population, such as insuring that low-income participants have transportation to get to appointments and classes.

“In and of itself, without health education and other forms of engagement, it seems to fall short,” said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities. “The incentives are never going to be enormous because it’s never going to be affordable.”

– Provided by Kaiser Health News.

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Keenesburg, CO, United States (AHN) – Twenty-five lions from circuses in South America are now in their new home in Colorado. The unprecedented rescue mission has been a celebrated success, but the work of rehabilitation and long-term care for the animals has only begun.

Lions ranging from 3-month old cubs to an elderly 15-year-old are at the Wild Animal Sanctuary, feeling grass for the first time under their paws. The lions were saved in Bolivia, which recently enacted a nationwide ban against animals in circuses.

A specially-made 32-hectare enclosure will house the animals, which can no longer survive on their own in the wild.

The sanctuary, located about 30 miles from Denver, built the facility, as well as a heated building that will help to acclimate the animals to Colorado’s colder climate. The building has grass, trees and natural light.

The lions were saved from abusive conditions. With video footage and photos, rescuers reported the animals living malnourished, dehydrated, on top of one another eight to a cage, or confined in a make-shift trailer since birth.

The animals arrived at the sanctuary late Wednesday night, after a British non-profit, Animal Defenders International, successfully worked with Bolivian officials and the U.S. military to undertake the largest air lift of its kind.

The huge effort received financial support from Bolivian companies such cargo carrier Transportes Aereos Bolivianos, and celebrities such as Bob Barker and Jorja Fox.

Rescuers in Bolivia had provided immediate medical attention to the lions and built up the strength of the animals to ensure a safe flight. Now, the long-term rehabilitation has begun in earnest.

“Their new lives will really begin there, so we just need to get them there and that is the real challenge,” ADI president Jan Creamer had said as preparations were underway last month.

The Wild Animal Sanctuary, which specializes in caring for large carnivores, is seeking contributions to help cover the $8,000 required to feed and house one lion in a year. It is receiving financial support under an agreement with ADI.

The rescue was the latest in the growing worldwide effort to protect animals used in entertainment, an industry where lions are commonly de-fanged and de-clawed, and elephants shackled and electrically shocked with metal-tipped hooks. In the past year alone, an undercover report revealed cruel practices by Ringling Bros., while in Spain’s Catalonia region, bullfighting was banned.

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Join Gary Null as he interviews the world’s foremost holistic animal care experts about what causes diseases in animals and what cures them naturally. Find out the best food for your pets, the number and type of vaccines your pet really needs and how to treat their common illnesses holistically. Amazon.com
Anti-aging expert Gary Null believes that pets deserve the best natural care available. In this 110-minute video, Null interviews a host of holistic Doctors … More >>

Gary Null’s Natural Pet Care

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Do you presently have an internet site? Do you speculate why it is not creating you any money? You keep putting up grand content, magnificent writing samples and articles but still you have a zero balance. Well maybe you need to enlarge your apparent horizon. By contracting up for pay per click associate sites you will make money at a faster pace. Cash will reach your site when you simply maintain it. Google Adsense is the most accepted Pay per click programs. The site takes care of the advertisements for you.

New advertisements and banners will be placed in open spaces of your site when you sign up with Google Adsense. When ever a visitor visits your site and clicks on the ad you get a referral payment immediately. Google looks after the placement of ads while you can look after enhancing the traffic towards your site. When you join Google Adsense they will help you to promote your site and give you advice on the ways to increase traffic to your site. One of the best ways to increase traffic is to attract through proper use of correct keywords. But the keywords which you choose is wrong then you will have visitors running away from your site. But when you join Google Adsense they will help you with this. Google ad words will help you in choosing the correct keywords to increase your traffic. But beware that google charges you for this service. Make sure that it is worth it or else your profits might be eaten up by the ad words program. Google Adsense signing up will assure you that only appropriate ads will be placed on your website. For example you have a pet care site then products or ad related to that topic will only be placed on your site. Remember that obscure and an ad which has no relation to your page does not impress the reader or even enhance your earnings.

Google Adsense is only a single example of search engines which pay you per click. There are hundreds of such sites which offer pay per click scheme. Yet another famous search engine is Yahoo publisher. The functions of this search engine are also similar to Google Adsense. The search engine which you choose will depend on you. You will have to weight the pros and cons of several search engines and then select the best one which suits you. But if you have more than one site then you can try more than one search engine and go with the one which works better for you. So do a good research work and select the search engine so that your computer also becomes a money making machine.

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So how do you go about creating pet supply business online? Well, you could go down the road of outsourcing everything such as the website design and creation, content for your website and finding products to sell, but this means that you have to know exactly what you want your online pet business to be like in advance and this is going to take an awful lot of time and effort, and quite a few dollars too.

This can seem a daunting task and rightly so.

The great news is that, all of the hard work and stress of creating an online pet business has been taken out of your hands and been taken care of by professionals. Everything has been bundled into a package that you just have to install onto your computer and promote your products.

Upon signing up for your online pet supply business, you will immediately be supplied with a free start-up kit that will include your own pet supply store website along with a whole host of different pet products in a wide variety of categories. If you are wondering about storing and shipping your pet supplies, that is taken care of by a third party so you don’t have to worry about that part of your pet business.

Along with your store and inventory, there are numerous guides on starting up your pet store, online marketing techniques, financing and cash flow and general business information. There is also free marketing consultation so you won’t feel alone in trying to get your pet business up and running.

As with any business, it will take some time to get fully functional and because online marketing is so huge, the more that you promote your business, the more lucrative it will become. Do you want to create a secondary income, or is your goal to make job busting profits and eventually financial freedom? It’s up to you.

The great thing about this online business, is that once you have it working nicely for you, you can basically let it run itself and create a virtual passive income. Obviously you have to keep on top of things, but for a few hours work a week, you will have an online pet business that will be working for you 24 hours a day, 7 days a week.

Time to do what you want when you want.

Author: Martin Loader
Article Source: EzineArticles.com
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