Supporting Members with Chronic and Behavioral Comorbidities in Arizona
A Spotlight on Wellth and Health Choice Arizona
November 30, 2021

Members with behavioral health conditions account for the largest share of hospital readmission payments in Medicaid-enrolled populations—with 19.4% of all Medicaid readmissions associated with members with mental & behavioral health disorders.


Complex populations with serious mental illness and other comorbid conditions often struggle with consistent care plan adherence, resulting in adverse outcomes and increased hospitalization risk. In fact, studies show that when individuals with behavioral health conditions fail to reach over 80% adherence are 49% more likely to have an inpatient hospitalization and a 54% increase in inpatient charges.

Seeking to improve outcomes for Medicaid-enrolled members with comorbid behavioral health conditions, Health Choice Arizona (HCA) partnered with Wellth to strengthen adherence by empowering members to form health habits.

The challenges of treating comorbid chronic behavioral and physical health conditions

While the prolonged COVID-19 pandemic exacerbated the mental health of individuals across America, for individuals with chronic conditions, the already high risk of comorbid mental health disorders—combined with the stresses of the pandemic—meant that already vulnerable populations were at even greater risk for behavioral health conditions. Furthermore, because many behavioral and chronic conditions are exacerbated by similar risk factors (i.e. certain social determinants of health) and may have treatment regimens or side effects that actually worsen the other condition, treating either condition for these individuals becomes increasingly difficult.

Unfortunately, without treating both the medical and the mental health conditions, neither condition is likely to improve.

Leaders at HCA wanted to provide a better way to support members facing mental illness while continuing to address members' existing comorbid chronic conditions. Working with Wellth, HCA outlined the following goals for its new program:

  • Improve care plan engagement
  • Improve medication adherence, measured by PDC
  • Reduce high-cost utilization
  • Improve clinical lab values (A1c)
  • Build a foundation for program expansion in years to come

The new program leveraged Wellth's easy-to-use solution, which applies behavioral economics to motivate healthy habit formation using daily reminders, behavior reinforcements, and financial incentives. These reminders and incentives proved to be effective in increasing adherence, showing that members want to be healthy; they just need a nudge in the right direction. As one member shared with HCA:

"The reminder that comes tells me exactly when I have to take my medications. It has been a good thing on both sides. When you're taking meds three times a day and you take as many as I do, it can get a little confusing. With the Wellth check giving me a reminder for my new med, that's just groovy. I would change not one thing. If it ain't broke don't fix it. And it is not broken, I couldn't ask for a better program. It's easy to follow."

The power of incentives in impacting behavior, and social determinants of health

In addition to improving adherence, the HCA Wellth program gave members an opportunity to earn rewards that could help address social determinants—an important factor for Medicaid-enrolled populations. Of the HCA members enrolled in Wellth, almost 50% chose to use rewards to pay for groceries and food, with the rest using the rewards to address household needs, transportation, and other necessities.

While the incentives themselves play an important role by providing a catalyst and motivator for change, HCA's members repeatedly report that the merit of the program lies in the intrinsic motivation built.

As members are able to better self-manage their comorbid behavioral and chronic conditions, they feel healthier, happier, and more empowered to independently develop good habits and routines moving forward.

The best part about the program is that it's helping me remember to take my meds on a consistent basis, which has always been a problem for me. I am taking it more consistently than I ever have, and I have a routine. I never made a concerted effort before. Thats the best part for me. The reward is nice... it's nice to have a little something extra, but that's not why I'm doing it. I am just glad that this is helping keep me on track.

Building this intrinsic motivation to make healthy choices is key in the long-term success of the HCA program, allowing members autonomy in caring for their health and building self-esteem as they set and achieve their health goals. Furthermore, many members, as they successfully master basic medication and care plan adherence, choose to build other healthy habits, too—even without the added benefits of additional incentives. As one member shared upon completing the HCA program with Wellth:

Before Wellth, I wasn't attentive to my health habits. I've been taking medications for 30 years but now it seems like without thought I'm being more serious. Now that I'm on Wellth, I always to try to take my medications on time and beat the reminder at 8 o'clock. I've been doing pretty well. You guys are working so hard to make sure people you don't know are in perfect shape like it's your own family. I'm even walking around more, I stopped drinking soda. I'm trying to keep my sugar levels under control.

Supporting individuals with chronic and behavioral comorbidities

The HCA partnership with Wellth ultimately set out to support members with behavioral health conditions and chronic health conditions in better managing both—and it succeeded.

HCA Wellth members saw an 80% decrease in inpatient days, and a 15% decrease in ED days, within the first two months of the program. Furthermore, with the app and the help of a live, empathy-driven member support team, members found the motivation needed to manage their two or more comorbid conditions—including behavioral health conditions—and improve their lives.

Getting paid to take my meds is great, but Wellth has also given me more energy, made me more productive, and just made my life better in general. I have more motivation overall and it has helped me so much with my depression. I was able to take on a second job, where could barely work at all before. The biggest struggle is just remembering to take the meds honestly, but that's easier, now that I have Wellth.

-HCA member enrolled in Wellth

The best part of this program is that the Wellth team has been very understanding, If I am depressed and I don't check-in that day, they will call me and ask "hey, what do we need to help you with?" I've been able to take my medications more often so I actually have the confidence to go get a job.

-HCA member enrolled in Wellth