New Hampshire Medicaid Wellness Incentive Program

Study Overview
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Brief Summary
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The New Hampshire Medicaid Wellness Incentive Program (WIP) will address both the health disparity and increased costs by providing incentivized health promotion programs to overweight or obese and/or tobacco-smoking Medicaid beneficiaries receiving services at New Hampshire's 10 regional Community Mental Health Centers (CMHCs).

Detailed Description
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In the New Hampshire Medicaid Wellness Incentive Program, multiple program options will fall into two categories: (1) Supported Fitness and Weight Management and (2) Supported Smoking Cessation. Eligible participants are able to participate in 1 or both of the programs. The program options for Supported Fitness and Weight Management are: 1. Fitness Club Membership for 12 months, 2. Fitness Club Membership plus weekly meetings with a Health Mentor for 12 months (In SHAPE), 3. Weight Watchers Membership for 12 months, 4. In SHAPE plus Weight Watchers for 12 months. The options for Supported Smoking Cessation are: 1. Prescriber meeting to discuss smoking cessation treatment options, 2. Prescriber meeting plus NH State Tobacco Helpline, 3. Prescriber meeting plus Telephone-based Cognitive Behavioral Therapy for Smoking Cessation. Vouchers for memberships to community fitness centers and formal weight loss programs will be provided, as well as incentives for participation and positive outcomes. An equipoise stratified randomization design will be used to preserve the research benefits of randomization while maintaining the highly valued opportunity for consumer choice. Research assessments will be conducted at baseline, 3 months, 6 months, 9 months, and 12 months.

Official Title
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New Hampshire Medicaid Wellness Incentive Program

Conditions
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Tobacco Dependence, Obesity, Mental Illness

Intervention / Treatment
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* Behavioral: NH Medicaid Incentives Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for smoking intervention and weight management intervention: Participants must be Medicaid recipients receiving mental health treatment at one of the participating study sites in New Hampshire. 18 years or older Additional Inclusion Criteria for smoking intervention only: *Smoking 5 or more cigarettes a day or a carbon monoxide level of 5 or higher at screening. Additional Inclusion Criteria for weight management only: *Body Mass Index of 30 or higher or 25 or higher and sedentary lifestyle. Exclusion Criteria for both interventions: Diagnosis of dementia or terminal illness (expected to result in death in 1 year or less) Nursing home Inability to speak or understand English Additional exclusion Criteria for weight management only: Previous participation in the In SHAPE program Active eating disorder diagnosis Pregnancy Additional exclusion Criteria for smoking intervention only: *Active alcohol or drug dependence with use in the past 30 days

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Incentives<br>Participants randomly assigned to the incentive arm, will receive cash incentives for engaging in healthy lifestyle behaviors. | Behavioral: NH Medicaid Incentives Program<br> <br> |
| Experimental: No Incentives<br>Participants randomly assigned to the no incentives arm, will not receive cash incentives for engaging in healthy lifestyle behaviors. | Behavioral: NH Medicaid Incentives Program<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Weight | Weight obtained using a scale at each assessment. | Baseline, 3 months, 6 months, 9 months, 12 months and 1 year post program follow up | 
| Change in the 6 minute walk test | Each participant walks as many ft as possible at a brisk pace. The amount of feet covered in 6 minutes is documented. | Baseline, 3 months, 6 monhts, 9 months, 12 months, and 1 year post program completion follow up | 
| Change in Days of Abstinence-Timeline follow back interview for tobacco smokers | A timeline follow back interview is completed for the smoking cessation intervention to identify days of abstinence within the assessment period as well as amount of cigarettes smoked. | Baseline, 3 months, 6 months, 9 months, 12 months, and 1 year post program completion follow up | 
| Change in Carbon Monoxide Level | At each assessment and during the incentive quit cycles, carbon monoxide level is measured to confirm smoking abstinence or not. | Baseline, 3 months, 6 months, 9 months, 12 months, and 1 year post program completion follow up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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obesity, tobacco dependence, smoking cessation, mental health, cardiovascular disease