New Hampshire Medicaid Wellness Incentive Program (NHWIP)

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).

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.

Participants randomly assigned to the incentive arm, will receive cash incentives for engaging in healthy lifestyle behaviors.

Participants randomly assigned to the no incentives arm, will not receive cash incentives for engaging in healthy lifestyle behaviors.

Each participant walks as many ft as possible at a brisk pace. The amount of feet covered in 6 minutes is documented.

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.

At each assessment and during the incentive quit cycles, carbon monoxide level is measured to confirm smoking abstinence or not.

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

Bianco CL, Pratt SI, Ferron JC, Brunette MF. Electronic Cigarette Use During a Randomized Trial of Interventions for Smoking Cessation Among Medicaid Beneficiaries with Mental Illness. J Dual Diagn. 2019 Jul-Sep;15(3):184-191. doi: 10.1080/15504263.2019.1620400. Epub 2019 Jun 6.

Brunette MF, Pratt SI, Bartels SJ, Scherer EA, Sigmon SC, Ferron JC, Santos M, Williams GE, Kosydar S, Wolfe RS, Lotz D, Capuchino K. Randomized Trial of Interventions for Smoking Cessation Among Medicaid Beneficiaries With Mental Illness. Psychiatr Serv. 2018 Mar 1;69(3):274-280. doi: 10.1176/appi.ps.201700245. Epub 2017 Nov 15.