Financial Incentive Programs Research Articles

Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation

Reward-based programs to decrease smoking prevalence are more commonly accepted than deposit-based programs and lead to higher rates of sustained abstinence from smoking.

Measuring the effect of pay-for-performance financial incentives on hospital efficiency in the military health system

ABSTRACTThe U.S. military health system implemented a pay-for-performance financial incentive program in 2007 in an effort to stimulate patient quality, access, and satisfaction improvements. This study measures the effect of the monetary incentive model on hospital efficiency and outcomes. Using a retrospective, quasi-experimental design, the empirical analysis incorporates data envelopment analysis with time windows and difference-in-differences estimation. Hospitals are evaluated in the U.S. Army, Air Force, and Navy during the period of 2001–2012. The results indicate a statistically significant reduction in technical efficiency for the hospitals that received pay-for-performance financial incentives. The healthcare policy implications of this study are applicable in light of the national healthcare debate and may assist healthcare policy makers in determining the efficacy and associated trade-offs of pay-for-performance financing models.

Nationwide expansion of a financial incentive program on fruit and vegetable purchases among Supplemental Nutrition Assistance Program participants: A cost-effectiveness analysis

High prices remain a formidable barrier for many people, especially those of low socioeconomic status, to adopt a healthier diet. The Food, Conservation, and Energy Act of 2008 mandated the U.S. Department of Agriculture (USDA) to conduct a pilot study to assess the impact of making fruits and vegetables more affordable for households in the Supplemental Nutrition Assistance Program (SNAP). Based on the USDA final report of the Healthy Incentives Pilot (HIP), a large-scale randomized trial in 2011–2012 that provided 30% rebate on targeted fruits and vegetables to 7500 study participants enrolled in the SNAP, we constructed a decision model to evaluate the cost-effectiveness of an expansion of the HIP to all SNAP households nationwide. The estimated life-time per capita costs of the HIP to the Federal government is $1323 in 2012 U.S. dollars, and the average gains in quality-adjusted life expectancy to a SNAP participant is 0.082 quality-adjusted life year (QALY), resulting in an incremental cost-effectiveness ratio (ICER) of $16,172 per QALY gained. Sensitivity analysis using Monte Carlo simulations indicates a 94.4% and 99.6% probability that the estimated ICER would be lower than the cost-effective threshold of $50,000 and $100,000 per QALY gained, respectively. Moreover, the estimated ICER of the HIP expansion tends to be competitive in comparison to other interventions that aimed at promoting fruit/vegetable intake among adult population. Findings from this study suggest that a nationwide expansion of the HIP is likely to nudge SNAP households towards purchasing and consuming more targeted fruits and vegetables. However, diet behavior modification is proportional to price change. When people's actual eating behaviors and what dietary guidelines recommend differ by several folds, even a 30% rebate closes just a small fraction of that gap and has limited beneficial impact on participants' weight management, disease prevention, and health-related quality of life.

The Impact of Rurality on 30-Day Preventable Readmission, Illness Severity, and Risk of Mortality for Heart Failure Medicare Home Health Beneficiaries.

To examine the impact of rurality on 30-day preventable readmission, and the illness severity and risk of mortality for 30-day preventable readmissions. We analyzed heart failure Medicare beneficiaries who received home health services for postacute care after hospital discharge in 2009. The study was a cross-sectional design with the unit of analysis as the home health episode for postacute care. Data sources included the following: Medicare Beneficiary Summary File, Medicare Provider Analysis Review, Outcome Assessment Information Set, Home Health Agency Research Identifiable File, and Area Health Resources File. The dependent variables were 30-day preventable readmission, and the extreme/major level of illness severity and of risk of mortality for a 30-day preventable readmission. The key independent variable was rurality defined as remote rural, adjacent rural, and micropolitan areas, with urban areas in the reference group. Home health beneficiaries in remote rural areas had 27% lower 30-day preventable readmission than those in urban areas. Home health beneficiaries in adjacent rural areas were 33% less likely to have high illness severity at readmission due to a preventable condition than those in urban areas. Geographical location affects preventable readmission and illness severity of preventable readmission. Patients' geographic location along with patients' risk factors should be taken into consideration in the risk adjustment model for the financial incentive program that penalizes home health agencies with high preventable readmissions.

The Impact of School-Based Financial Incentives on Teachers’ Strategic Moves: A Descriptive Analysis

Background Prior research has found that teacher dissatisfaction with low salaries is one reason for teacher turnover. Accordingly, policy makers have championed financial incentives as a way of increasing teachers’ job satisfaction and making the teaching profession and specific schools more attractive to current and potential teachers. Despite the enthusiasm for such incentive policies, empirical evidence of their effects on teacher mobility is mixed. Purpose In this study, we contribute to the extant literature on teacher financial incentives by shifting focus from the probability of teacher turnover to investigate how incentives, particularly school-based incentives, structure teachers’ patterns of mobility within districts. We explore the effects of financial incentives on teacher mobility patterns in the context of Denver's Professional Compensation System for Teachers (“ProComp”), one of the most prominent alternative teacher compensation reforms in the nation. Setting Denver Public Schools, Denver, Colorado. Population Denver Public Schools classroom teachers employed in the district any time during 2006–2010, who were eligible to participate in the financial incentive program (regardless of whether they did), and who made at least one voluntary within-district move during the study period (n = 989). Program Since 2006, Denver's ProComp program has offered teachers a variety of school-based and individual financial incentives. Specifically, in addition to incentives offered to teachers for their individual accomplishments, ProComp provides incentives of over $2,400 each for teachers that teach in top performing schools, high growth schools, and hard-to-serve schools. Because ProComp offers substantial incentives to teachers on the basis of school characteristics, it holds the potential to incentivize “strategic moves” to schools with more school-based incentives. Research Design The study employs a descriptive statistical research design. Data Collection and Analysis We use Denver Public Schools administrative data from 2005–2006 to 2009–2010 to estimate a series of conditional logit models predicting teachers’ moves as a function of their ProComp participation and the value of school-based incentives at the schools they leave and the schools they could potentially transfer to. Findings Our findings suggest ProComp participants tend to make more strategic moves to high value schools than their non-ProComp peers. However, these moves tend to be to schools that have high performance and growth in achievement, rather than to schools that receive incentives for serving low-income populations. Conclusions Results suggest that school-based ProComp incentives do influence strategic moves, albeit in ways not necessarily consistent with the program's intent, calling into question the ability of ProComp to attract teachers to low-income schools under its current structure.

Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation

BackgroundFinancial incentives promote many health behaviors, but effective ways to deliver health incentives remain uncertain. MethodsWe randomly assigned CVS Caremark employees and their relatives and friends to one of four incentive programs or to usual care for smoking cessation. Two of the incentive programs targeted individuals, and two targeted groups of six participants. One of the individual-oriented programs and one of the group-oriented programs entailed rewards of approximately $800 for smoking cessation; the others entailed refundable deposits of $150 plus $650 in reward payments for successful participants. Usual care included informational resources and free smoking-cessation aids. ResultsOverall, 2538 participants were enrolled. Of those assigned to reward-based programs, 90.0% accepted the assignment, as compared with 13.7% of those assigned to deposit-based programs (P<0.001). In intention-to-treat analyses, rates of sustained abstinence from smoking through 6 months were higher with eac...

Financial incentives in health: New evidence from India's Janani Suraksha Yojana

This paper studies the health effects of one of the world's largest demand-side financial incentive programmes—India's Janani Suraksha Yojana. Our difference-in-difference estimates exploit heterogeneity in the implementation of the financial incentive programme across districts. We find that cash incentives to women were associated with increased uptake of maternity services but there is no strong evidence that the JSY was associated with a reduction in neonatal or early neonatal mortality. The positive effects on utilisation are larger for less educated and poorer women, and in places where the cash payment was most generous. We also find evidence of unintended consequences. The financial incentive programme was associated with a substitution away from private health providers, an increase in breastfeeding and more pregnancies. These findings demonstrate the potential for financial incentives to have unanticipated effects that may, in the case of fertility, undermine the programme's own objective of reducing mortality.

Public health: The case for pay to quit.

A randomized controlled trial of four financial-incentive programmes for smoking cessation finds that reward-based schemes lead to sustained abstinence, but low public acceptability of such schemes threatens their adoption.

Development of the Health Incentive Program Questionnaire (HIP-Q) in a cardiac rehabilitation population.

The purpose of this study was to develop a questionnaire to facilitate the design of acceptable financial health incentive programs. A multiphase psychometric questionnaire development method was used. Theoretical and literature reviews and three focus groups generated a pool of content areas and items. New items were developed to ensure adequate content coverage. Field testing was conducted with a convenience sample of cardiac rehabilitation (CR) patients (n = 59) to establish face and construct validity (p = 0.021) and reliability (intraclass coefficients = 0.42–0.87). The final questionnaire is comprised of 23 items. This questionnaire builds on previous attempts to explore acceptability by sampling a wider range of instrumental and affective attitudes and by measuring the effect of program features on the likelihood of incentive program participation. Future research is now needed to examine whether tailoring incentives to preferences assessed by the questionnaire improves uptake and effectiveness.

Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation

BackgroundFinancial incentives promote many health behaviors, but effective ways to deliver health incentives remain uncertain.MethodsWe randomly assigned CVS Caremark employees and their relatives and friends to one of four incentive programs or to usual care for smoking cessation. Two of the incentive programs targeted individuals, and two targeted groups of six participants. One of the individual-oriented programs and one of the group-oriented programs entailed rewards of approximately $800 for smoking cessation; the others entailed refundable deposits of $150 plus $650 in reward payments for successful participants. Usual care included informational resources and free smoking-cessation aids.ResultsOverall, 2538 participants were enrolled. Of those assigned to reward-based programs, 90.0% accepted the assignment, as compared with 13.7% of those assigned to deposit-based programs (P<0.001). In intention-to-treat analyses, rates of sustained abstinence from smoking through 6 months were higher with each of the four incentive programs (range, 9.4 to 16.0%) than with usual care (6.0%) (P<0.05 for all comparisons); the superiority of reward-based programs was sustained through 12 months. Group-oriented and individual-oriented programs were associated with similar 6-month abstinence rates (13.7% and 12.1%, respectively; P=0.29). Reward-based programs were associated with higher abstinence rates than deposit-based programs (15.7% vs. 10.2%, P<0.001). However, in instrumental-variable analyses that accounted for differential acceptance, the rate of abstinence at 6 months was 13.2 percentage points (95% confidence interval, 3.1 to 22.8) higher in the deposit-based programs than in the reward-based programs among the estimated 13.7% of the participants who would accept participation in either type of program.ConclusionsReward-based programs were much more commonly accepted than deposit-based programs, leading to higher rates of sustained abstinence from smoking. Group-oriented incentive programs were no more effective than individual-oriented programs. (Funded by the National Institutes of Health and CVS Caremark; ClinicalTrials.gov number, NCT01526265.)

Factors Influencing Participation in Financial Incentive Programmes of Health Insurance Funds. Results of the Study 'German Health Update'

The statutory health insurance can offer their insured incentive programmes that will motivate for healthy behaviour through a financial or material reward. This study will show results about what factors influence financial incentive programme participation (BPT) including all sorts of statutory health insurance funds and taking into account gender differences. For the cross-sectional analysis, data were used from 15,858 participants in the study 'Germany Health Update' (GEDA) from 2009, who were insured in the statutory health insurance. The selection of potential influencing variables for a BPT is based on the "Behavioural Model for Health Service Use" of Andersen. Accordingly, various factors were included in logistic regression models, which were calculated separately by gender: predisposing factors (age, education, social support, and health awareness), enabling factors (income, statutory health insurance fund, and family physician), and need factors (smoking, fruit and vegetable consumption, sports, body mass index, and general health status). In consideration of all factors, for both sexes, BPT is associated with age, health awareness, education, use of a family physician, smoking, and sports activities. In addition, income, body mass index, and diet are significant in women and social support and kind of statutory health insurance fund in men. It is found that predisposing, enabling and need factors are relevant. Financial incentive programmes reach population groups with greatest need less than those groups who already have a health-conscious behaviour, who receive a reward for this. In longitudinal studies, further research on financial incentive programmes should investigate the existence of deadweight effects and whether incentive programmes can contribute to the reduction of the inequity in health.

Long-term Effect of Hospital Pay for Performance on Mortality in England

Background A pay-for-performance program based on the Hospital Quality Incentive Demonstration was introduced in all hospitals in the northwest region of England in 2008 and was associated with a short-term (18-month) reduction in mortality. We analyzed the long-term effects of this program, called Advancing Quality. Methods We analyzed 30-day in-hospital mortality among 1,825,518 hospital admissions for eight conditions, three of which were covered by the financial-incentive program. The hospitals studied included the 24 hospitals in the northwest region that were participating in the program and 137 elsewhere in England that were not participating. We used difference-in-differences regression analysis to compare risk-adjusted mortality for an 18-month period before the program was introduced with subsequent mortality in the short term (the first 18 months of the program) and the longer term (the next 24 months). Results Throughout the short-term and the long-term periods, the performance of hospitals in...

Financial incentive policies at workplace cafeterias for preventing obesity--a systematic review and meta-analysis (Protocol).

BackgroundVarious studies are currently investigating ways to prevent lifestyle-related diseases and obesity among workers through interventions using incentive strategies, including price discounts for low-fat snacks and sugar-free beverages at workplace cafeterias or vending machines, and the provision of a free salad bar in cafeterias. Rather than assessing individual or group interventions, we will focus on the effectiveness of nutrition education programs at the population level, which primarily incorporate financial incentive strategies to prevent obesity. This paper describes the protocol of a systematic review that will examine the effectiveness of financial incentive programs at company cafeterias in improving dietary habits, nutrient intake, and obesity prevention.Methods/designWe will conduct searches in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO. Interventions will be assessed using data from randomized control trials (RCTs) and cluster RCTs. However, if few such trials exist, we will include quasi-RCTs. We will exclude controlled before-and-after studies and crossover RCTs. We will assess food-based interventions that include financial incentive strategies (discount strategies or social marketing) for workplace cafeterias, vending machines, and kiosks. Two authors will independently review studies for inclusion and will resolve differences by discussion and, if required, through consultation with a third author. We will assess the risk of bias of included studies according to the Cochrane Collaboration’s “risk of bias” tool.DiscussionThe purpose of this paper is to outline the study protocol for a systematic review and meta-analysis that will investigate the effectiveness of population-level, incentive-focused interventions at the workplace cafeteria that aim to promote and prevent obesity. This review will give an important overview of the available evidence about the effectiveness of incentive-based environmental interventions to improve obesity prevention in the workplace and will guide future research in nutrition education and health promotion globally.Systematic review registrationPROSPERO CRD42014010561

The Impact of Implementing a Financial Incentive Program for Viral Suppression on the Clinic Environment: A Qualitative Substudy of HPTN 065

AIDS Research and Human RetrovirusesVol. 30, No. S1 Financial IncentivesThe Impact of Implementing a Financial Incentive Program for Viral Suppression on the Clinic Environment: A Qualitative Substudy of HPTN 065Elizabeth Greene, Theresa Gamble, Elizabeth E. Tolley, Allison P. Pack, Jill Stanton, Jamilah Taylor, Victoria Shelus, Jason Leider, Wafaa El-Sadr, Bernard Branson, and for the HPTN 065 Study TeamElizabeth GreeneFHI 360, Durham, NC, United StatesSearch for more papers by this author, Theresa GambleFHI 360, Durham, NC, United StatesSearch for more papers by this author, Elizabeth E. TolleyFHI 360, Durham, NC, United StatesSearch for more papers by this author, Allison P. PackFHI 360, Durham, NC, United StatesSearch for more papers by this author, Jill StantonFHI 360, Durham, NC, United StatesSearch for more papers by this author, Jamilah TaylorFHI 360, Durham, NC, United StatesSearch for more papers by this author, Victoria ShelusFHI 360, Durham, NC, United StatesSearch for more papers by this author, Jason LeiderJacobi Medical Center, New York, NY, United StatesSearch for more papers by this author, Wafaa El-SadrColumbia University Mailman School of Public Health, ICAP, New York, NY, United StatesHarlem Hospital, New York, NY, United StatesSearch for more papers by this author, Bernard BransonCenters for Disease Control and Prevention, Atlanta, GA, United StatesSearch for more papers by this author, and for the HPTN 065 Study TeamSearch for more papers by this authorPublished Online:30 Oct 2014https://doi.org/10.1089/aid.2014.5195.abstractAboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"The Impact of Implementing a Financial Incentive Program for Viral Suppression on the Clinic Environment: A Qualitative Substudy of HPTN 065." AIDS Research and Human Retroviruses, 30(S1), pp. A104–A105FiguresReferencesRelatedDetailsCited byPerspectives of HIV Clinic Staff on the Implementation of a Client Financial Incentives Program Targeting Viral SuppressionJournal of the Association of Nurses in AIDS Care, Vol. 28, No. 5 Volume 30Issue S1Oct 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Elizabeth Greene, Theresa Gamble, Elizabeth E. Tolley, Allison P. Pack, Jill Stanton, Jamilah Taylor, Victoria Shelus, Jason Leider, Wafaa El-Sadr, Bernard Branson, and for the HPTN 065 Study Team.The Impact of Implementing a Financial Incentive Program for Viral Suppression on the Clinic Environment: A Qualitative Substudy of HPTN 065.AIDS Research and Human Retroviruses.Oct 2014.A104-A105.http://doi.org/10.1089/aid.2014.5195.abstractPublished in Volume: 30 Issue S1: October 30, 2014PDF download

Effect of a novel financial incentive program on operating room efficiency.

Operating room (OR) turnaround times (TATs) and on-time first-case starts (FCSs) are commonly used measures of OR efficiency. Prolonged TATs and late FCSs occur frequently at academic medical centers. To test the hypothesis that establishing a financial incentive program (FIP) for OR teams would improve efficiency, leading to decreased TATs and improved on-time FCSs. Prospective study to evaluate the effect of an FIP on OR efficiency between March 1, 2013, and December 31, 2013, at a freestanding academic trauma hospital. Participants were all OR team members and included anesthesiologists, certified registered nurse anesthetists, nurses, and technicians. Operating room efficiency awareness education was conducted before FIP implementation beginning in February 2013. Each eligible OR team member achieving a TAT of 60 minutes or less or an on-time FCS was awarded 1 point. Reports listing individual performances were posted. Pay bonuses were awarded for achieving 1 of 3 progressive point totals in any month. Outcomeswere TAT, whichwas defined as “wheels out” to “wheels in,” and on-time FCS, which was defined as “wheels in” within 6 minutes of the scheduled start time. Before FIP implementation, the mean TAT varied between 77 and 83 minutes, with only 18%to 26%of TATs being 60 minutes or less; on-time FCSs averaged 29% to 34%. After FIP implementation, on-time FCSs improved from 31% to 64%(P < .001), and TATs of 60 minutes or less increased from 24%to 52%(P < .001). The cost of a 2-month FIP was $8340. We saved 13 minutes per TAT, for an estimated savings of $177 000.We estimate an additional savings of $33 000 for on-time FCSs, for a total hospital savings of $210 000. A novel FIP improved OR efficiency. Given the small amount of money involved, it seems unlikely that financial incentives were solely responsible. Effectively communicating the importance of TATs and on-time FCSs and publishing individual results more likely increased staff awareness. Teamwork created by linking assignment of points to a team result likely contributed to success.

The intended and unintended consequences of quality improvement interventions for small practices in a community-based electronic health record implementation project.

Despite the rapid rise in the implementation of electronic health records (EHR), commensurate improvements in health care quality have not been consistently observed. To evaluate whether the implementation of EHRs and complementary interventions-including clinical decision support, technical assistance, and financial incentives-improved quality of care. The study included 143 practices that implemented EHRs as part of the Primary Care Information Project-a long-standing community-based EHR implementation initiative. A total of 71 practices were randomized to receive financial incentives and quality feedback and 72 were randomized to feedback alone. All practices received technical assistance and had clinical decision support in their EHR. Using data from 2009 to 2011, we estimated measure-level fixed effects models to evaluate the association between exposure to clinical decision support, technical assistance, financial incentives, and quality of care. Associations were estimated separately for 4 cardiovascular measures that were rewarded by the financial incentive program and 4 measures that were not rewarded by incentives. Financial incentives for quality were consistently associated with higher performance for the incentivized measures [+10.1 percentage points at 18 mo of exposure (approximately +22%), P<0.05] and lower performance for the unincentivized measures [-8.3 percentage points at 12 mo of exposure (approximately -20%), P<0.05]. Technical assistance was associated with higher quality for the unincentivized measures, but not for the incentivized measures. Technical assistance and financial incentives-alongside EHR implementation-can improve quality of care. Financial incentives for quality may not result in similar improvements for incentivized and unincentivized measures.

Long-Term Effect of Hospital Pay for Performance on Mortality in England

BackgroundA pay-for-performance program based on the Hospital Quality Incentive Demonstration was introduced in all hospitals in the northwest region of England in 2008 and was associated with a short-term (18-month) reduction in mortality. We analyzed the long-term effects of this program, called Advancing Quality.MethodsWe analyzed 30-day in-hospital mortality among 1,825,518 hospital admissions for eight conditions, three of which were covered by the financial-incentive program. The hospitals studied included the 24 hospitals in the northwest region that were participating in the program and 137 elsewhere in England that were not participating. We used difference-in-differences regression analysis to compare risk-adjusted mortality for an 18-month period before the program was introduced with subsequent mortality in the short term (the first 18 months of the program) and the longer term (the next 24 months).ResultsThroughout the short-term and the long-term periods, the performance of hospitals in the incentive program continued to improve and mortality for the three conditions covered by the program continued to fall. However, the reduction in mortality among patients with these conditions was greater in the control hospitals (those not participating in the program) than in the hospitals that were participating in the program (by 0.7 percentage points; 95% confidence interval [CI], 0.3 to 1.2). By the end of the 42-month follow-up period, the reduced mortality in the participating hospitals was no longer significant (−0.1 percentage points; 95% CI, −0.6 to 0.3). From the short term to the longer term, the mortality for conditions not covered by the program fell more in the participating hospitals than in the control hospitals (by 1.2 percentage points; 95% CI, 0.4 to 2.0), raising the possibility of a positive spillover effect on care for conditions not covered by the program.ConclusionsShort-term relative reductions in mortality for conditions linked to financial incentives in hospitals participating in a pay-for-performance program in England were not maintained.

Design of incentive programs for accelerating penetration of energy-efficient appliances

Incentives are policy tools that sway purchase, retail stocking, and production decisions toward energy-efficient products. Incentives complement mandatory standards and labeling policies by accelerating market penetration of products that are more energy efficient than required by existing standards and by preparing the market for more stringent future mandatory requirements. Incentives can be directed at different points in the appliance׳s supply chain; one point may be more effective than another depending on the technology׳s maturity and market penetration. This paper seeks to inform future policy and program design by categorizing the main elements of incentive programs from around the world. We identify advantages and disadvantages of program designs through a qualitative overview of incentive programs worldwide. We find that financial incentive programs have greater impact when they target highly efficient technologies with a small market share, and that program designs depend on the market barriers addressed, the target equipment, and the local market context. No program design is inherently superior to another. The key to successful program design and implementation is a thorough understanding of the market and identification of the most important local obstacles to the penetration of energy-efficient technologies.

Examining Potential Residential Participation in Financial Incentives to Mitigate Impervious Surface Effects in Howard County, Maryland

Maryland passed legislation to reduce impervious surface effects and stormwater runoff by mandating a remediation fee for ten of its counties. Along with the fee, mandated counties may use funds generated to encourage residents to follow stormwater Best Management Practices (BMPs). This study uses Maryland's Howard County as a case study to examine the potential participation of its residents in financial incentives for the BMPs of rain gardens, cisterns, and permeable pavers. A survey was issued to gauge potential participation of homeowners (n=110), and results were then compared to participation numbers in three similar already implemented financial incentive programs. Results revealed low expected participation of Howard County homeowners in the three examined practices. Barriers that prevent homeowners from considering participation in such practices and the catalysts that could drive higher participation in financial incentives for those practices in the future were exposed.

Combined Heat and Power: A Technology Whose Time Has Come

On October 29, 2012, Hurricane Sandy blew through the largely populated areas of New Jersey, New York, and Connecticut. It was, at the time, the largest storm in the region’s history. While many areas lost electricity from the electrical grid, the few buildings equipped with Combined Heat and Power (“CHP”) remained lit and heated. For example, many residential and commercial facilities lost power for days after the storm, but natural gas powered CHP systems at the Co-Op City apartment complex and New York University, Fairfield University, and Princeton University kept their buildings functioning. According to Ross Tomlin, an employee of Gulf Coast Clean Energy Application Center of the Department of Energy, “because CHP relies on natural gas delivered through underground pipelines, [the systems] can weather just about any storm.” But minimizing the effects of natural disasters is only one of CHP’s many benefits. CHP is the process of capturing heat from existing heat sources, such as boilers, and using the heat to power energy sources, such as steam-powered turbines, to create electricity, hot water, and heat. The technology not only reduces energy costs through efficiency—at least twenty to thirty percent more efficient than separate heat and power systems—but it also protects the environment by burning less fuel, and thus reducing greenhouse gas emissions and air pollution. While this technology has seen continued barriers over the years, one company, Recycled Energy Development (“RED”), recognized that “the US lags far behind the world leaders when it comes to producing energy through [CHP]” and has taken steps to utilize the technology. The average increase in energy costs for households between 2001 and 2012 was forty-three percent. This increase in energy costs affects consumers and businesses alike, with electricity costs topping many businesses’ lists of expenses. America undeniably faces a severe energy crisis both in the private sector, due to rising energy costs, and in the public sector, due to gridlock in government. Among the many green energy technologies currently available, CHP is “the least sexy” and considered “a ‘homeless’ suite of technologies” when compared to solar, wind, and hydropower energy systems. Recently, however, the federal government gave CHP a second look as it attempted to educate state governments and companies about the benefits of the CHP technology. The severe lack of effective and efficient state government incentive programs is hindering the CHP technology from reaching its full potential of providing cheap, sustainable power to businesses. This Comment will argue that, given the policy benefits of the CHP technology, the federal government should create an organization to establish and monitor a CHP legislative blueprint with three financial incentive program options; states should establish two of those three financial incentive programs; and states should include CHP in their Renewable Portfolio Standards. This Comment will analyze the financial barriers hindering effective widespread use of CHP among private sector companies, examine current effective and ineffective state financial incentive programs, and determine which financial incentive regulations the federal government should include in the legislative blueprint. Because this is mainly a state law issue, no “one size fits all” approach will suffice; however, a legislative blueprint can educate state legislatures about the financial incentives that can be put in place to allow for effective and widespread use of the CHP technology. Such a legislative blueprint must include: 1) a rebate for installed costs of the technology, 2) a feed-in tariff to entice companies to re-funnel excess power through the grid system, and 3) a provision of grants to companies who successfully complete CHP installations. Section II includes a background discussion of the CHP technology that will help facilitate an understanding of how the technology works and what financial incentives previously existed. Section III includes an analysis of financial incentives, illustrated by state examples that will help analyze how the incentives operate. Section IV includes an analysis of states with little financial incentive programs and demonstrates why it hinders the CHP technology. Section V discusses the proposed solution to this problem, as introduced above.