Incentives for Primary Care Use in a Safety Net Setting

Incentives for Primary Care Use: A Randomized Controlled Trial in a Safety Net Setting

A randomized controlled trial (RCT) of incentives for an initial primary care visit within 6 months of enrollment in a health care coverage program. Study subjects are drawn from a low-income adult population that gains coverage and access to community-based primary care services under a program administered by an academic safety-net hospital. The investigators will offer financial incentives to encourage an initial primary care visit within 6 months of enrollment and evaluate whether the primary care visit altered subsequent health seeking behavior and influenced patient satisfaction and other outcomes such as self-reported health status.

Study Overview

• Status: Completed
• Conditions: Health Care Utilization; Primary Care Physician; Uninsured
• Intervention / Treatment: Behavioral: 0 dollars group; Behavioral: 25 dollars group; Behavioral: 50 dollars group

Detailed Description

A randomized controlled trial (RCT) of incentives for an initial primary care visit within 6 months of enrollment in a health care coverage program. Study subjects are drawn from a low-income adult population that gains coverage and access to community-based primary care services under a program administered by an academic safety-net hospital. The investigators will offer financial incentives to encourage an initial primary care visit within 6 months of enrollment and evaluate whether the primary care visit altered subsequent health seeking behavior and influenced patient satisfaction and other outcomes such as self-reported health status.

Incentives should steer patients in their decision to seek primary care, reduce barriers to care, and ultimately improve patient health and reduce utilization and costs through their relationship with a PCP. This study is the first of its kind to incentivize low-income patients. This population has the greatest need for health care and exerts the greatest pressure on the United States' safety net system. Furthermore, the safety net population is the target of policies such as Medicaid eligibility expansions, yet urban safety net patients are largely understudied. These patients are rarely given the opportunity to participate in research, and when they are the subjects of measures to reduce health care utilization, they are the subject of policies using negative incentives such as those that introduce cost sharing for using ED services.1 Alternatively, safety net providers invest in case management systems to reduce utilization. The proposed study is a departure from prior measures to reduce utilization among low-income patients by focusing on patients and using positive incentives. The study borrows from the principles of behavioral economics to motivate patients towards primary care utilization. Once in the primary care system, The investigators will test whether primary care contact reduces more expensive forms (e.g., inpatient, ED) of health care.

The investigators will compare outcomes of patients assigned in the highest incentive group ($50) to patients assigned to the modest incentive group ($25) and to patients assigned to usual care (no incentive, but assignment to a PCP). The investigators will also compare incentive patients ($50, $25) to a contemporaneous group of patients that enroll in the safety net clinic at the same time.

• Study Type: Interventional
• Enrollment (Actual): 1228
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years to 64 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Adults between ages 21-64 years
• No prior enrollment in VCC for the past 12 months
• English or Spanish speaking, and
• Can be contacted by mail and telephone (preferably) or willing to be interviewed in person.

Exclusion Criteria:

• Unable to be contacted by phone/mail
• Cannot provide consent
• No longer located in catchment area

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Contemporaneous Control; This group is our 'usual care' control group. They were not contacted for an interview and were not offered an incentive to visit their primary care physician.
Active Comparator: $0 group; This group completed a baseline interview but was not offered any incentive if they visited their primary care physician.	Behavioral: 0 dollars group; Those assigned to the $0 group will not receive an incentive for visiting their PCP.
Experimental: $25 group; This group completed a baseline interview and was offered $25 they visited their primary care physician within 6 months.	Behavioral: 25 dollars group; Those assigned to the $25 group will receive $25 if they visit their PCP within 6 months of study enrollment.
Experimental: $50 group; This group completed a baseline interview and was offered $50 they visited their primary care physician within 6 months.	Behavioral: 50 dollars group; Those assigned to the $50 group will receive $50 if they visit their PCP within 6 months of study enrollment.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The number of Primary Care Physician visits will be assessed using medical claims record data.	The number of primary care visits to a primary care physician will be collected from medical claims record data.	This will be assessed in the 6 months following study enrollment.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The time to a Primary Care Physician will be assessed using medical claims record data.	The time to a primary care visits to a primary care physician will be collected from dates available in the medical claims record data.	This will be assessed in the 6 months following study enrollment.

Collaborators and Investigators

• Sponsor: Virginia Commonwealth University
• Collaborators: Agency for Healthcare Research and Quality (AHRQ)
• Investigators: Principal Investigator: Cathy Bradley, Phd, PI

Study record dates

Study Major Dates

• Study Start: January 1, 2014
• Primary Completion (Actual): November 8, 2016
• Study Completion (Actual): November 8, 2016

Study Registration Dates

• First Submitted: September 28, 2016
• First Submitted That Met QC Criteria: October 3, 2016
• First Posted (Estimate): October 4, 2016

Study Record Updates

• Last Update Posted (Actual): June 12, 2018
• Last Update Submitted That Met QC Criteria: June 11, 2018
• Last Verified: June 1, 2018

More Information

Terms related to this study

• Other Study ID Numbers: HM20000002; 1R01HS022534 (U.S. AHRQ Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO