Financial Incentives for Care Gaps
Study Details
Study Description
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.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
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.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| No Intervention: Control: W34 Members receiving the Control intervention for the W34 (3- to 6-year-old well visit) gap will not receive a mailer. |
|
| Experimental: Information only: W34 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. |
Behavioral: Information
Information on care gap and closure process.
|
| Experimental: Incentives: W34 Informational W34 mailer and incentive to close gap |
Behavioral: Financial Incentives
Incentives for gap closure.
Behavioral: Information
Information on care gap and closure process.
|
| No Intervention: Control: LSC Members receiving the Control intervention for the LSC (lead screening in children) gap will not receive a mailer. |
|
| Experimental: Information only: LSC Informational LSC mailer and incentive to close gap |
Behavioral: Information
Information on care gap and closure process.
|
| Experimental: Incentives: LSC 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. |
Behavioral: Financial Incentives
Incentives for gap closure.
Behavioral: Information
Information on care gap and closure process.
|
| No Intervention: Control: IMA No mailer for IMA (immunizations) gap |
|
| Experimental: Information only: IMA Informational IMA mailer |
Behavioral: Information
Information on care gap and closure process.
|
| Experimental: Incentives: IMA Informational IMA mailer and incentive |
Behavioral: Financial Incentives
Incentives for gap closure.
Behavioral: Information
Information on care gap and closure process.
|
| No Intervention: Control: CDC No mailer for CDC (clinical diabetes care) gap |
|
| Experimental: Information only: CDC Informational CDC mailer |
Behavioral: Information
Information on care gap and closure process.
|
| Experimental: Incentives: CDC Informational CDC mailer and incentive |
Behavioral: Financial Incentives
Incentives for gap closure.
Behavioral: Information
Information on care gap and closure process.
|
| No Intervention: Control: CCS No mailer for CCS (cervical cancer screening) |
|
| Experimental: Information only: CCS Informational CCS mailer |
Behavioral: Information
Information on care gap and closure process.
|
| Experimental: Incentives: CCS Informational CCS mailer and incentive |
Behavioral: Financial Incentives
Incentives for gap closure.
Behavioral: Information
Information on care gap and closure process.
|
| No Intervention: Control: AWC No mailer for AWC (adolescent well-care visit) gap |
|
| Experimental: Information only: AWC Informational AWC mailer |
Behavioral: Information
Information on care gap and closure process.
|
| Experimental: Incentives: AWC Informational AWC mailer and incentive |
Behavioral: Financial Incentives
Incentives for gap closure.
Behavioral: Information
Information on care gap and closure process.
|
Outcome Measures
Primary Outcome Measures
- 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.
- 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
- 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)
- Outpatient visits during study [6 months, from the date of randomization until end-of-year]
Number of outpatient visits
- 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 during study [6 months, from the date of randomization until end-of-year]
Number of prescriptions
- Prescriptions following study [12 months, from December 31 2018 - December 31 2019]
Number of prescriptions
Eligibility Criteria
Criteria
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
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Massachusetts Institute of Technology | Cambridge | Massachusetts | United States | 02139 |
Sponsors and Collaborators
- Massachusetts Institute of Technology
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 1805348624