Financial Incentives for Care Gaps

Financial Incentives for Care Gaps: A Randomized Controlled Trial

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.

Study Overview

• Status: Completed
• Conditions: Delivery of Health Care
• Intervention / Treatment: Behavioral: Information; Behavioral: Financial Incentives

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 Type: Interventional
• Enrollment (Actual): 8042
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Cambridge, Massachusetts, United States, 02139
      • Massachusetts Institute of Technology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Single

Number of Arms

18

Arms and Interventions

Participant Group / 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: Information; Information on care gap and closure process.; Behavioral: Financial Incentives; Incentives for gap closure.
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: Information; Information on care gap and closure process.; Behavioral: Financial Incentives; Incentives for gap closure.
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: Information; Information on care gap and closure process.; Behavioral: Financial Incentives; Incentives for gap closure.
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: Information; Information on care gap and closure process.; Behavioral: Financial Incentives; Incentives for gap closure.
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: Information; Information on care gap and closure process.; Behavioral: Financial Incentives; Incentives for gap closure.
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: Information; Information on care gap and closure process.; Behavioral: Financial Incentives; Incentives for gap closure.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of care gaps closed	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.	6 months, from the date of randomization until end-of-year (i.e., December 31, 2018)
Proportion of care gaps closed	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.	18 months, from the date of randomization until December 31, 2019

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Health care expenditure during study - Total claims	(dollars)	6 months, from the date of randomization until end-of-year
Health care expenditure following study - Total claims	Total claims (dollars)	12 months, from December 31 2018 - December 31 2019
Outpatient visits during study	Number of outpatient visits	6 months, from the date of randomization until end-of-year
Outpatient visits following study	Number of outpatient visits	12 months, from December 31 2018 - December 31 2019
Inpatient visits during study	Number of inpatient visits	6 months, from the date of randomization until end-of-year
Inpatient visits following study	Number of inpatient visits	12 months, from December 31 2018 - December 31 2019
Prescriptions during study	Number of prescriptions	6 months, from the date of randomization until end-of-year
Prescriptions following study	Number of prescriptions	12 months, from December 31 2018 - December 31 2019

Collaborators and Investigators

• Sponsor: Massachusetts Institute of Technology

Study record dates

Study Major Dates

• Study Start (Actual): August 31, 2018
• Primary Completion (Actual): December 31, 2019
• Study Completion (Actual): June 30, 2021

Study Registration Dates

• First Submitted: October 11, 2018
• First Submitted That Met QC Criteria: October 19, 2018
• First Posted (Actual): October 23, 2018

Study Record Updates

• Last Update Posted (Actual): October 6, 2021
• Last Update Submitted That Met QC Criteria: October 4, 2021
• Last Verified: September 1, 2021

More Information

Terms related to this study

• Keywords: Professional Practice Gaps
• Other Study ID Numbers: 1805348624

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No