Delivery of Health Care
Conditions
Keywords
Professional Practice Gaps
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.
Interventions
BEHAVIORALFinancial Incentives
Incentives for gap closure.
BEHAVIORALInformation
Information on care gap and closure process.
Sponsors
Massachusetts Institute of Technology
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Is a partner organization member in the region of study * Has a care gap in one of the six target areas
Exclusion criteria
* Participating in another select high-intensity wellness intervention provided by the partner organization
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of care gaps closed | 6 months, from the date of randomization until end-of-year (i.e., December 31, 2018) | 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
| Measure | Time frame | Description |
|---|---|---|
| Prescriptions following study | 12 months, from December 31 2018 - December 31 2019 | Number of prescriptions |
| Health care expenditure during study - Total claims | 6 months, from the date of randomization until end-of-year | (dollars) |
| Health care expenditure following study - Total claims | 12 months, from December 31 2018 - December 31 2019 | Total claims (dollars) |
| 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 |
| Outpatient visits during study | 6 months, from the date of randomization until end-of-year | Number of outpatient visits |
Countries
United States
Outcome results
None listed