Assessing the Impact of myHealth Rewards New Hire Enrollment Emails

• Sponsor: Geisinger Clinic (Other)
• Overall Status: Completed
• CT.gov ID: NCT04047342
• Collaborator: (none)
• Enrollment: 824
• Location: 1
• Actual Duration (Months): 11.5
• Patients Per Site Per Month: 71.5

Study Details

Study Description

Brief Summary

The purpose of the study is to evaluate, prospectively, the potential impact, on myHealth Rewards wellness program enrollment prior to the 2019 November submission deadline, of sending different messages via email to Geisinger Health Plan (GHP) members who have just been hired.

Condition or Disease	Intervention/Treatment	Phase
Health Promotion; Wellness Programs	Behavioral: Welcome email; Behavioral: Loss frame

Detailed Description

The myHealth Rewards wellness program managed by GHP rewards those GHP members who carry their insurance through employment at Geisinger with reduced health insurance premiums over the course of the following year, if members register for the program and have their health measures on file by the enrollment deadline and are then able to meet their health goals by the respective due date. In spite of the potential savings to health plan members and the wellness program's potential to motivate engagement in healthy activities (with consequent improvement in health outcomes), about 23% of eligible existing GHP members did not enroll during the primary 2019 enrollment period, even after receiving promotional email communications and reminders. Therefore, the current study was developed to test whether a revised version of a standard welcome email is more effective than the standard email in increasing myHealth Rewards login and enrollment rates. The standard welcome email is what would typically be sent by GHP to encourage enrollment among new hires; it mentions the benefits of enrollment (maintaining good health and saving money on insurance premiums), the average premium savings, the ease of the registration process, and the deadline for registering and having health measures on file, plus it provides registration steps and hyperlinks for registering and finding free health screenings where health measures can be collected and registered at one convenient time and location. The loss frame email recommends that GHP members not "throw away" a precise monetary amount in savings by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. It is hypothesized that, on average, the loss frame email will increase enrollment compared with the standard email, among this population of new hires for whom this is only the second time that they have been informed about myHealth Rewards. Findings will help inform how best to increase enrollment in a wellness program among health plan members who are new to the system.

Study Design

• Study Type: Observational
• Actual Enrollment: 824 participants
• Observational Model: Case-Control
• Time Perspective: Prospective
• Official Title: Assessing the Impact of myHealth Rewards Program-related Communications on New Hire Enrollment
• Actual Study Start Date: Jul 16, 2019
• Actual Primary Completion Date: Dec 20, 2019
• Actual Study Completion Date: Jul 1, 2020

Arms and Interventions

Arm	Intervention/Treatment
Standard welcome email The standard welcome email mentions the benefits of enrollment (maintaining good health and saving money on insurance premiums), the average premium savings, the ease of the registration process, and the deadline for registering and having health measures on file, plus it provides registration steps and hyperlinks for registering and finding free health screenings where health measures can be collected and registered at one convenient time and location.	Behavioral: Welcome email; Email
Loss frame email The loss frame email recommends that GHP members not "throw away" a precise dollar amount in savings (over $2,000) by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. This intervention frames the status quo as a state from which recipients, via inaction, are slated to forfeit a sizable and precise monetary amount to which they should otherwise feel entitled (via loss aversion and the endowment effect). People tend to be risk-seeking in the domain of losses; therefore, this intervention is hypothesized to increase enrollment in the hope of achieving zero loss by meeting program goals, as opposed to a sure loss via inaction.	Behavioral: Welcome email; Email; Behavioral: Loss frame; Email; Other Names: Endowment effect

Outcome Measures

Primary Outcome Measures

1. Number of People Enrolled Within 7 Days [7 days]

   Enrollment in the myHealth Rewards program (yes/no) within 7 full days of the beginning of the intervention for each cohort (i.e., when the emails are first sent within each weekly new hire cohort). Data will be aggregated across cohorts, including the July 16 cohort and every subsequent cohort through the week prior to reminder emails scheduled to be sent out in October, 2019.

2. Number of People Who Logged in to the Program Within 7 Days [7 days]

   Logging into the myHealth Rewards program (yes/no) within 7 full days of the beginning of the intervention for each cohort (i.e., when the emails are first sent within each weekly new hire cohort). Data will be aggregated across cohorts, including the July 16 cohort and every subsequent cohort through the week prior to reminder emails scheduled to be sent out in October, 2019.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Inclusion Criteria:

• Any Geisinger new hire, regardless of benefits status, who started on or after July 1, 2019 and before November 30, 2019

Exclusion Criteria:

• Existing Geisinger employees hired prior to July 1, 2019

• New hires who do not have an email address on file

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Geisinger	Danville	Pennsylvania	United States	17822

Sponsors and Collaborators

• Geisinger Clinic

Investigators

• Principal Investigator: Amir Goren, PhD, Geisinger Clinic

Study Documents (Full-Text)

• Study Protocol and Statistical Analysis Plan - Dec 7, 2020

More Information

Publications

None provided.

• Responsible Party: Geisinger Clinic
• ClinicalTrials.gov Identifier: NCT04047342
• Other Study ID Numbers: 2019-0586
• First Posted: Aug 6, 2019
• Last Update Posted: Jan 7, 2021
• Last Verified: Jan 1, 2021

• Individual Participant Data (IPD) Sharing Statement: Yes
• Plan to Share IPD: Yes
• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No
• Keywords provided by Geisinger Clinic: Prospect theory

Study Results

Participant Flow

Recruitment Details	New employees received emails from July 16, 2019 to October 8, 2019. Enrollment data was gathered until December 20, 2019.
Pre-assignment Detail	7 employees were excluded from analysis, as they registered before the emails were sent (e.g., after learning about the program during new hire orientation).

Arm/Group Title	Standard Welcome Email	Loss Frame Email
Arm/Group Description	The standard welcome email mentions the benefits of enrollment and the deadline for registering and having health measures on file, plus it provides registration steps and hyperlinks for registering and finding free health screenings. Welcome email: Email	The loss frame email recommends that Geisinger Health Plan (GHP) members not "throw away" a precise dollar amount in savings (over $2,000) by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. Welcome email: Email Loss frame: Email
Period Title: Overall Study
STARTED	409	415
COMPLETED	409	415
NOT COMPLETED	0	0

Baseline Characteristics

Arm/Group Title	Standard Welcome Email	Loss Frame Email	Total
Arm/Group Description	The standard welcome email mentions the benefits of enrollment and the deadline for registering and having health measures on file, plus it provides registration steps and hyperlinks for registering and finding free health screenings. Welcome email: Email	The loss frame email recommends that GHP members not "throw away" a precise dollar amount in savings (over $2,000) by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. Welcome email: Email Loss frame: Email	Total of all reporting groups
Overall Participants	409	415	824
Age (Count of Participants)
<=18 years	0 0%
Between 18 and 65 years	0 0%
>=65 years	0 0%
Sex: Female, Male (Count of Participants)
Female	0 0%
Male	0 0%
Race and Ethnicity Not Collected (Count of Participants)
Count of Participants [Participants]	0 0%
Region of Enrollment (participants) [Number]
United States	409 100%	415 100%	824 100%

Outcome Measures

1. Primary Outcome

Title	Number of People Enrolled Within 7 Days
Description	Enrollment in the myHealth Rewards program (yes/no) within 7 full days of the beginning of the intervention for each cohort (i.e., when the emails are first sent within each weekly new hire cohort). Data will be aggregated across cohorts, including the July 16 cohort and every subsequent cohort through the week prior to reminder emails scheduled to be sent out in October, 2019.
Time Frame	7 days

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Standard Welcome Email	Loss Frame Email
Arm/Group Description	The standard welcome email mentions the benefits of enrollment and the deadline for registering and having health measures on file, plus it provides registration steps and hyperlinks for registering and finding free health screenings. Welcome email: Email	The loss frame email recommends that GHP members not "throw away" a precise dollar amount in savings (over $2,000) by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. Welcome email: Email Loss frame: Email
Measure Participants	409	415
Count of Participants [Participants]	131 32%	130 31.3%

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Standard Welcome Email, Loss Frame Email
	Comments
	Type of Statistical Test	Superiority
	Comments
Statistical Test of Hypothesis	p-Value	.828
	Comments	We used an a priori threshold of p < .05.
	Method	Regression, Logistic
	Comments
Method of Estimation	Estimation Parameter	Odds Ratio (OR)
	Estimated Value	0.97
	Confidence Interval	(2-Sided) 95%; 0.72 to 1.30
	Parameter Dispersion	Type: Value:
	Estimation Comments

2. Primary Outcome

Title	Number of People Who Logged in to the Program Within 7 Days
Description	Logging into the myHealth Rewards program (yes/no) within 7 full days of the beginning of the intervention for each cohort (i.e., when the emails are first sent within each weekly new hire cohort). Data will be aggregated across cohorts, including the July 16 cohort and every subsequent cohort through the week prior to reminder emails scheduled to be sent out in October, 2019.
Time Frame	7 days

Outcome Measure Data

Analysis Population Description

This data was not collected due to administrative error.

Arm/Group Title	Standard Welcome Email	Loss Frame Email
Arm/Group Description	The standard welcome email mentions the benefits of enrollment and the deadline for registering and having health measures on file, plus it provides registration steps and hyperlinks for registering and finding free health screenings. Welcome email: Email	The loss frame email recommends that GHP members not "throw away" a precise dollar amount in savings (over $2,000) by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. Welcome email: Email Loss frame: Email
Measure Participants	0	0

Adverse Events

Time Frame	No adverse events were evaluated.
Adverse Event Reporting Description	We only received aggregate information about email engagement with no individual-level information collected (including those for adverse events).
Arm/Group Title	Standard Welcome Email		Loss Frame Email
Arm/Group Description	The standard welcome email mentions the benefits of enrollment and the deadline for registering and having health measures on file, plus it provides registration steps and hyperlinks for registering and finding free health screenings. Welcome email: Email		The loss frame email recommends that GHP members not "throw away" a precise dollar amount in savings (over $2,000) by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. Welcome email: Email Loss frame: Email
All Cause Mortality
	Standard Welcome Email		Loss Frame Email
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)
Serious Adverse Events
	Standard Welcome Email		Loss Frame Email
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)
Other (Not Including Serious) Adverse Events
	Standard Welcome Email		Loss Frame Email
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/0 (NaN)		0/0 (NaN)

Limitations/Caveats

For this study, we only received data about engagement with the email (specifically, only enrollment). Individual patients were not identified and demographic information such as age, sex, or gender were not collected.

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.