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. * 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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
8,042
Incentives for gap closure.
Information on care gap and closure process.
Massachusetts Institute of Technology
Cambridge, Massachusetts, United States
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.
Time frame: 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.
Time frame: 18 months, from the date of randomization until December 31, 2019
Health care expenditure during study - Total claims
(dollars)
Time frame: 6 months, from the date of randomization until end-of-year
Health care expenditure following study - Total claims
Total claims (dollars)
Time frame: 12 months, from December 31 2018 - December 31 2019
Outpatient visits during study
Number of outpatient visits
Time frame: 6 months, from the date of randomization until end-of-year
Outpatient visits following study
Number of outpatient visits
Time frame: 12 months, from December 31 2018 - December 31 2019
Inpatient visits during study
Number of inpatient visits
Time frame: 6 months, from the date of randomization until end-of-year
Inpatient visits following study
Number of inpatient visits
Time frame: 12 months, from December 31 2018 - December 31 2019
Prescriptions during study
Number of prescriptions
Time frame: 6 months, from the date of randomization until end-of-year
Prescriptions following study
Number of prescriptions
Time frame: 12 months, from December 31 2018 - December 31 2019
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