Financial Incentives for Care Gaps
- Conditions
- Delivery of Health Care
- Interventions
- Behavioral: Financial IncentivesBehavioral: Information
- Registration Number
- NCT03715907
- Lead Sponsor
- Massachusetts Institute of Technology
- Brief Summary
This project seeks to understand how individuals respond to financial incentive programs for wellness care. In a randomized controlled trial among customers with care gaps, the investigators will experimentally compare the impacts of incentives for gap closure (gift cards), information on existing gaps (mailers), and no intervention. The research objectives are to assess how responsive individuals are to incentives for, and to information about, existing care gaps; and to assess spillovers from incentives onto other care. In addition, impacts on downstream utilization will be studied, which may be impacted if financial incentives are effective at increasing wellness visits.
- Detailed Description
Setting and sample:
The study will be conducted among individuals enrolled in an insurance plan offered by an insurance company in the state of Nebraska.
The sample will include a subset of individuals eligible for a program designed to improve delivery of care by incentivizing individuals and their dependents to fill "care gaps" - gaps in recommended care.
Interventions:
The design will entail two overarching interventions for each incentivized care gap: Incentives, and Information Only. In addition, there will be a control that receives neither.
* Incentives. Individuals receiving the Incentives intervention for a given care gap will receive a mailer informing them of that gap, and that they are eligible for a gift card if they close that care gap.
* Information Only. Individuals receiving the Information Only intervention for a given care gap will receive a mailer informing them of that gap, but without information on the incentives available.
* Control. Individuals receiving the Control intervention for a given care gap will not receive a mailer.
All individuals will be made whole following the intervention period, regardless of treatment status; i.e. members will be compensated for closing incentivized care gaps regardless of whether they were informed of their eligibility to do so.
The specific Incentivized Care Gaps include: W34, LSC, IMA, CDC Eye Exam and/or CDC Hba1c Screening, CCS, and AWC.
Randomization:
A separate letter is sent for each care gap, so that individuals may receive more than one letter. The investigators will randomize which letters are sent.
The process will be as follows: every individual with a care gap in the sample (a care-gap, beneficiary pair) will be randomly assigned a study status: financial incentive, information only, or no letter. When it comes time to send mailers for each care gap, mailers will be sent according to the intersection of eligibility and care gap-specific treatment assignment. E.g. if at mailing time a participant is eligible for only cervical cancer screening (CCS), that participant will receive the CCS intervention (Control, Information Only, or Incentives) as pre-assigned. If the participant is also eligible for an adolescent well-visit (AWC) incentive based on her dependent's age and visit status, the participant will also receive the AWC intervention as pre-assigned; this intervention may be the same or different from her CCS intervention.
Analysis:
The investigators will compare the number and rate of care-gap closure at 6 and 18 months following the initial mailing. The investigators will also conduct heterogeneity analysis according to baseline characteristics of the population.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 8042
- Is a partner organization member in the region of study
- Has a care gap in one of the six target areas
- Participating in another select high-intensity wellness intervention provided by the partner organization
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- FACTORIAL
- Arm && Interventions
Group Intervention Description Incentives: IMA Financial Incentives Informational IMA mailer and incentive Incentives: W34 Information Informational W34 mailer and incentive to close gap Incentives: IMA Information Informational IMA mailer and incentive Information only: CDC Information Informational CDC mailer Incentives: W34 Financial Incentives Informational W34 mailer and incentive to close gap Information only: W34 Information Members receiving the Information Only intervention for the W34 care gap will receive a mailer informing them of that gap, but not of financial incentives for closing the care gap. Incentives: LSC Financial Incentives Members receiving the Incentives intervention for the LSC care gap will receive a mailer informing them of the gap and eligibility for a gift card if they close the gap. Incentives: AWC Financial Incentives Informational AWC mailer and incentive Information only: LSC Information Informational LSC mailer and incentive to close gap Incentives: CCS Information Informational CCS mailer and incentive Incentives: LSC Information Members receiving the Incentives intervention for the LSC care gap will receive a mailer informing them of the gap and eligibility for a gift card if they close the gap. Information only: IMA Information Informational IMA mailer Information only: CCS Information Informational CCS mailer Incentives: CDC Financial Incentives Informational CDC mailer and incentive Incentives: CDC Information Informational CDC mailer and incentive Incentives: CCS Financial Incentives Informational CCS mailer and incentive Information only: AWC Information Informational AWC mailer Incentives: AWC Information Informational AWC mailer and incentive
- Primary Outcome Measures
Name Time Method Proportion of care gaps closed 18 months, from the date of randomization until December 31, 2019 Care gap closure for all care gaps. A care gap is considered closed for an individual or dependent who had not received recommended care (i.e. who had a care gap) at the time of enrollment at the time they receive the recommended care. For example, if a dependent child has not received lead screening (LSC) at the time of enrollment, the LSC care gap is considered closed once the child receives a lead screening.
- Secondary Outcome Measures
Name Time Method Health care expenditure following study - Total claims 12 months, from December 31 2018 - December 31 2019 Total claims (dollars)
Health care expenditure during study - Total claims 6 months, from the date of randomization until end-of-year (dollars)
Outpatient visits during study 6 months, from the date of randomization until end-of-year Number of outpatient visits
Prescriptions during study 6 months, from the date of randomization until end-of-year Number of prescriptions
Outpatient visits following study 12 months, from December 31 2018 - December 31 2019 Number of outpatient visits
Inpatient visits during study 6 months, from the date of randomization until end-of-year Number of inpatient visits
Inpatient visits following study 12 months, from December 31 2018 - December 31 2019 Number of inpatient visits
Prescriptions following study 12 months, from December 31 2018 - December 31 2019 Number of prescriptions
Trial Locations
- Locations (1)
Massachusetts Institute of Technology
🇺🇸Cambridge, Massachusetts, United States