Increasing Medication Adherence Through Physician Incentives and Messaging

The goal of this project is to increase patient adherence to medication using communications and incentives for physicians. The investigators are partnering with a health insurance company, Humana Inc, to design and implement an incentives program for physicians whose patients increase their medication adherence for oral diabetes medication, hypertension (ACEI or ARB) medication, and/or cholesterol (statins) medication. The investigators will use behavioral economics to explore the best way to communicate the incentives to the physicians.

Study Overview

• Status: Completed
• Conditions: Medication Adherence
• Intervention / Treatment: Other: Increasing Medication Adherence through Physician Incentives and Messaging

Detailed Description

Traditional economics would suggest that the best way to maximize adherence would be to give physicians financial incentives to improve adherence to all relevant drugs, and that communications to physicians should emphasize all of the relevant drugs. Behavioral economics suggests theory suggests that if you emphasize everything, then you are effectively emphasizing nothing. Behavioral econonmics would suggest to maximize adherence one should give physicians financial incentives for improving adherence for a small number of relevant drugs, and communications to physicians should emphasize a small number of the relevant drugs. This allows physicians to focus their energy and reduces the probability that they will give up because they're overwhelmed, or in other words, avoid the phenomenon called metric fatigue.

Humana has already implemented an incentives program for physicians, and the investigators will work with them to design a program that just focuses on medication adherence. Physicians targeted for this pilot could also be enrolled in another Humana incentives program, but this incentives program will act independently of the other.

There are two treatment dimensions the investigators will test via random assignment at the practice level:

1. Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.
2. Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes.

In a previous study to increase uptake of colonoscopies among employees at a partner firm, the investigators found that using a post it note to catch the attention of the employee statistically significantly increased colonoscopy uptake over a control group. The investigators will also employ an eye catching method in the proposed pilot. When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. They will be encouraged to include the patient sheet in their chart as a reminder to discuss medication adherence with their patient the next time they see them. For half of our arms, the investigators will make the patient sheets a bright, non-white, color, in order to futher draw the physicians' attention to that specific paper in their chart.

Our experimental arms will be:

1. Comprehensive incentives + comprehensive communication
2. Comprehensive incentives + comprehensive communication + printed on bright non-white paper
3. Focused incentives + focused communication (one for all three drug classes)
4. Focused incentives + focused communication + printed on bright non-white paper (one for all three drug classes)
5. Comprehensive communiation
6. Comprehensive communication + printed on bright non-white paper
7. Control arm: no communication + no incentives

The investigators hypothesize that physicians who receive focused incentives and focused communications will have more patients with increased medication adherence than physicians who receive comprehensive incentives and comprehensive communications. The investigators also hypothsize that physicians who receive patient sheets using bright, non-white paper will have more patients with increased medication adherence than physicians who receive plain white patient sheets.

• Study Type: Interventional
• Enrollment (Actual): 734
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Kentucky
    • Louisville, Kentucky, United States, 40202
      • Humana, Inc

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Physician in the Humana network
• Treats Humana Medicare Advantage Members
• Has Humana Medicare Advantage members who are taking at least one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and/or cholesterol (statins) medication, and who are less than 80% adherent.

Exclusion Criteria:

• Practices with more than 10 physicians

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

11

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Comprehensive incentives + comprehensive communication; Physicians are given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication.	Other: Increasing Medication Adherence through Physician Incentives and Messaging; There are two treatments: Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.; Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes. When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.; Other Names: Adherence
Experimental: Comp incentives + comp communication + non-white paper; Physicians are given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication, and their patient reports are printed on non-white bright colored paper.	Other: Increasing Medication Adherence through Physician Incentives and Messaging; There are two treatments: Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.; Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes. When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.; Other Names: Adherence
Experimental: Focused incentives + focused com for oral diabetes medication; Physicians are given financial incentives for improving patient medication adherence for oral diabetes medication.	Other: Increasing Medication Adherence through Physician Incentives and Messaging; There are two treatments: Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.; Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes. When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.; Other Names: Adherence
Experimental: Foc incentives + foc comm for Diabetes + non-white paper; Physicians given financial incentives for improving patient medication adherence for oral diabetes medication and patient reports are printed on bright non-white paper.	Other: Increasing Medication Adherence through Physician Incentives and Messaging; There are two treatments: Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.; Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes. When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.; Other Names: Adherence
Experimental: Focused incentives + focused comm for hypertension meds; Physicians are given financial incentives for improving patient medication adherence for hypertension (ACEI or ARB) medication.	Other: Increasing Medication Adherence through Physician Incentives and Messaging; There are two treatments: Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.; Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes. When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.; Other Names: Adherence
Experimental: Foc incentives + comm for hypertension meds + non-white paper; Physicians are given financial incentives for improving patient medication adherence for hypertension (ACEI or ARB) medication with patient reports on non-white paper.	Other: Increasing Medication Adherence through Physician Incentives and Messaging; There are two treatments: Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.; Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes. When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.; Other Names: Adherence
Experimental: Focused incentives + focused comm for cholesterol meds; Physicians given financial incentives for improving patient medication adherence for cholesterol (statins) medication.	Other: Increasing Medication Adherence through Physician Incentives and Messaging; There are two treatments: Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.; Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes. When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.; Other Names: Adherence
Experimental: Foc incentives +comm for cholesterol meds + non-white paper; Physicians given financial incentives for improving patient medication adherence for cholesterol (statins) medication and patient reports are printed on non-white paper.	Other: Increasing Medication Adherence through Physician Incentives and Messaging; There are two treatments: Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.; Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes. When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.; Other Names: Adherence
Experimental: Comprehensive communiation; Physicians are given communication emphasizing the importance of improving adherence to all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication.	Other: Increasing Medication Adherence through Physician Incentives and Messaging; There are two treatments: Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.; Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes. When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.; Other Names: Adherence
Experimental: Comprehensive communication + non-white paper; Physicians are given communication emphasizing the importance of improving adherence to all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication and patient reports are printed on non-white paper.	Other: Increasing Medication Adherence through Physician Incentives and Messaging; There are two treatments: Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.; Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes. When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.; Other Names: Adherence
Experimental: Control Arm; Physicians and their patient adherence is tracked, but they receive no intervention.	Other: Increasing Medication Adherence through Physician Incentives and Messaging; There are two treatments: Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.; Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes. When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. For half of the arms, the investigators will make the patient sheets a bright, non-white, color, in order to further draw the physicians' attention to that specific paper in their chart.; Other Names: Adherence

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Medication Adherence	The investigators will see how the treatment arms affect the targeted physicians' patients medication adherence for oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication.	Up to two years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Demographic Controls for Physicians	The investigators will see if our targeted physicians' demographic controls affect their patients' medication adherence rates before and after treatment.	Up to two years
Demographic Controls for Patients	The investigators will see how demographic controls for patients affect our targeted physicians' patients' medication adherence.	Up to 2 years

Collaborators and Investigators

• Sponsor: National Bureau of Economic Research, Inc.
• Collaborators: Humana Inc.

Study record dates

Study Major Dates

• Study Start: June 1, 2012
• Primary Completion (Actual): February 1, 2014
• Study Completion (Actual): March 1, 2014

Study Registration Dates

• First Submitted: May 16, 2012
• First Submitted That Met QC Criteria: May 18, 2012
• First Posted (Estimate): May 22, 2012

Study Record Updates

• Last Update Posted (Estimate): October 23, 2015
• Last Update Submitted That Met QC Criteria: October 22, 2015
• Last Verified: October 1, 2015

More Information

Terms related to this study

• Keywords: diabetes; hypertension; medication adherence; statins; cholesterol
• Other Study ID Numbers: 007