Messaging Intervention to Increase Medicare Annual Wellness Visits -- The NUDGE AWV Clinical Trial

Messaging Intervention to Increase Medicare Annual Wellness Visits: The MIMA Randomized Clinical Trial

Medicare Annual Wellness Visits (AWVs) are critical for addressing preventive care needs among older adults, yet the most recent estimates from the Center for Medicare Services suggest less than 50% of eligible patients take advantage of this free healthcare benefit. Behavioral science-informed messaging interventions offer a promising strategy to increase AWV participation by guiding patient behavior. In this study, investigators will evaluate a health system initiative that utilizes personalized email and text messages to encourage Medicare beneficiaries to schedule and attend their AWVs. This approach aims to boost patient engagement in preventive health services, ultimately improving care outcomes for older adult populations

Study Overview

• Status: Completed
• Conditions: Breast Cancer Screening; Colon Cancer Screening; Annual Wellness Visit
• Intervention / Treatment: Behavioral: Two Messaging Nudges; Behavioral: Five messaging nudges

Detailed Description

The Centers for Medicare & Medicaid Services (CMS) recommends Annual Wellness Visits (AWVs) to encourage preventive care and improve long-term health outcomes for Medicare beneficiaries. These visits are designed to provide a proactive approach to healthcare by focusing on identifying risk factors, updating medical histories, and developing personalized prevention plans that promote early detection of diseases. By prioritizing prevention over treatment, AWVs help reduce the overall cost burden on the healthcare system while enhancing patient engagement and empowering individuals to take a more active role in managing their health. Yet despite these benefits, most Medicare members who are eligible for an AWV - at no cost to them - do not complete one.

Behavioral science research suggests that personalized messages, designed to facilitate action, can have significant impacts on health behavior. Studies have found these messaging interventions can increase vaccination rates, cancer screening rates, and other care gap closure.

• Study Type: Interventional
• Enrollment (Actual): 29842
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Missouri
    • St. Louis, Missouri, United States, 63134
      • Ascension Health

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age 65 or older
• Have either a mobile phone number or an email address on file with the health system
• Included in and non-compliant on the Ascension AWV Clinical Priority Goal measure
• Have consented to receive electronic communications from the health system

Exclusion Criteria:

• Patients whose primary care providers are exempted from the campaign by the health system
• Completed MAWV appointment in previous 30 days
• Has an upcoming AWV appointment scheduled
• Have received a nudge campaign from the Clinical Transformation team in the past 90 days
• Patients who have previously opted out of receiving electronic communications from the health system in our message delivery platform (Salesforce)

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Usual Care; This is a group will serve as usual care and have no intervention during the study period
Experimental: Two Messages; This group will receive two messages as part of the study -- one email and one text message.	Behavioral: Two Messaging Nudges; This intervention involves receiving one personalized email and one personalized text message, which include the provider's name, the patient's name, and a phone number to schedule an Annual Wellness Visit
Experimental: Up To Five Messages; This group will receive up to five messages as part o the study -- two emails and three text messages.	Behavioral: Five messaging nudges; This intervention involves patients receiving up to five personalized email and text messages, which include the provider's name, the patient's name, and a phone number to schedule an Annual Wellness Visit

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Annual Wellness Visit scheduling	Percentage of patients who schedule an AWV	14 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Completed Annual Wellness Visit	Percentage of patients who have completed an AWV	90 Days
Days to Annual Wellness Visit Completion	Number of days to AWV appointment completion	90 days

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Breast cancer screening	Completion of breast cancer screening post intervention	180 days
Colon Cancer Screening	Completion colon cancer screening post intervention	180 days
Ordering of tests for breast cancer screening	Ordering of tests for breast cancer screening	90 days
Ordering of tests for colon cancer screening	Ordering of tests for colon cancer screening	90 days

Collaborators and Investigators

• Sponsor: Emily Rosenzweig

Study record dates

Study Major Dates

• Study Start (Actual): October 22, 2024
• Primary Completion (Actual): November 12, 2024
• Study Completion (Actual): April 27, 2025

Study Registration Dates

• First Submitted: October 10, 2024
• First Submitted That Met QC Criteria: October 10, 2024
• First Posted (Actual): October 15, 2024

Study Record Updates

• Last Update Posted (Actual): August 5, 2025
• Last Update Submitted That Met QC Criteria: July 31, 2025
• Last Verified: July 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Intestinal Diseases; Gastrointestinal Neoplasms; Digestive System Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Colorectal Neoplasms; Intestinal Neoplasms; Colonic Diseases; Colonic Neoplasms
• Other Study ID Numbers: RAS20240013

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Has patient information that we are not approved to share

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No