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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.
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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control: W34 | No Intervention | Members receiving the Control intervention for the W34 (3- to 6-year-old well visit) gap will not receive a mailer. | |
| Information only: W34 | Experimental | 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: W34 | Experimental | Informational W34 mailer and incentive to close gap |
|
| Control: LSC | No Intervention | Members receiving the Control intervention for the LSC (lead screening in children) gap will not receive a mailer. | |
| Information only: LSC | Experimental | Informational LSC mailer and incentive to close gap |
|
| Incentives: LSC | Experimental |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Financial Incentives | Behavioral | Incentives for gap closure. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of care gaps closed | 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. | 6 months, from the date of randomization until end-of-year (i.e., December 31, 2018) |
| Proportion of care gaps closed | 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. | 18 months, from the date of randomization until December 31, 2019 |
| Measure | Description | Time Frame |
|---|---|---|
| Health care expenditure during study - Total claims | (dollars) | 6 months, from the date of randomization until end-of-year |
| Health care expenditure following study - Total claims | Total claims (dollars) |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Massachusetts Institute of Technology | Cambridge | Massachusetts | 02139 | United States |
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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.
|
| Control: IMA | No Intervention | No mailer for IMA (immunizations) gap |
| Information only: IMA | Experimental | Informational IMA mailer |
|
| Incentives: IMA | Experimental | Informational IMA mailer and incentive |
|
| Control: CDC | No Intervention | No mailer for CDC (clinical diabetes care) gap |
| Information only: CDC | Experimental | Informational CDC mailer |
|
| Incentives: CDC | Experimental | Informational CDC mailer and incentive |
|
| Control: CCS | No Intervention | No mailer for CCS (cervical cancer screening) |
| Information only: CCS | Experimental | Informational CCS mailer |
|
| Incentives: CCS | Experimental | Informational CCS mailer and incentive |
|
| Control: AWC | No Intervention | No mailer for AWC (adolescent well-care visit) gap |
| Information only: AWC | Experimental | Informational AWC mailer |
|
| Incentives: AWC | Experimental | Informational AWC mailer and incentive |
|
| Information | Behavioral | Information on care gap and closure process. |
|
| 12 months, from December 31 2018 - December 31 2019 |
| Outpatient visits during study | Number of outpatient visits | 6 months, from the date of randomization until end-of-year |
| Outpatient visits following study | Number of outpatient visits | 12 months, from December 31 2018 - December 31 2019 |
| Inpatient visits during study | Number of inpatient visits | 6 months, from the date of randomization until end-of-year |
| Inpatient visits following study | Number of inpatient visits | 12 months, from December 31 2018 - December 31 2019 |
| Prescriptions during study | Number of prescriptions | 6 months, from the date of randomization until end-of-year |
| Prescriptions following study | Number of prescriptions | 12 months, from December 31 2018 - December 31 2019 |