Financial Incentives for Care Gaps

NCT ID: NCT03715907

Last Updated: 2021-10-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

8042 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-08-31

Study Completion Date

2021-06-30

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Delivery of Health Care

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Control: W34

Members receiving the Control intervention for the W34 (3- to 6-year-old well visit) gap will not receive a mailer.

Group Type NO_INTERVENTION

No interventions assigned to this group

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.

Group Type EXPERIMENTAL

Information

Intervention Type BEHAVIORAL

Information on care gap and closure process.

Incentives: W34

Informational W34 mailer and incentive to close gap

Group Type EXPERIMENTAL

Financial Incentives

Intervention Type BEHAVIORAL

Incentives for gap closure.

Information

Intervention Type BEHAVIORAL

Information on care gap and closure process.

Control: LSC

Members receiving the Control intervention for the LSC (lead screening in children) gap will not receive a mailer.

Group Type NO_INTERVENTION

No interventions assigned to this group

Information only: LSC

Informational LSC mailer and incentive to close gap

Group Type EXPERIMENTAL

Information

Intervention Type BEHAVIORAL

Information on care gap and closure process.

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.

Group Type EXPERIMENTAL

Financial Incentives

Intervention Type BEHAVIORAL

Incentives for gap closure.

Information

Intervention Type BEHAVIORAL

Information on care gap and closure process.

Control: IMA

No mailer for IMA (immunizations) gap

Group Type NO_INTERVENTION

No interventions assigned to this group

Information only: IMA

Informational IMA mailer

Group Type EXPERIMENTAL

Information

Intervention Type BEHAVIORAL

Information on care gap and closure process.

Incentives: IMA

Informational IMA mailer and incentive

Group Type EXPERIMENTAL

Financial Incentives

Intervention Type BEHAVIORAL

Incentives for gap closure.

Information

Intervention Type BEHAVIORAL

Information on care gap and closure process.

Control: CDC

No mailer for CDC (clinical diabetes care) gap

Group Type NO_INTERVENTION

No interventions assigned to this group

Information only: CDC

Informational CDC mailer

Group Type EXPERIMENTAL

Information

Intervention Type BEHAVIORAL

Information on care gap and closure process.

Incentives: CDC

Informational CDC mailer and incentive

Group Type EXPERIMENTAL

Financial Incentives

Intervention Type BEHAVIORAL

Incentives for gap closure.

Information

Intervention Type BEHAVIORAL

Information on care gap and closure process.

Control: CCS

No mailer for CCS (cervical cancer screening)

Group Type NO_INTERVENTION

No interventions assigned to this group

Information only: CCS

Informational CCS mailer

Group Type EXPERIMENTAL

Information

Intervention Type BEHAVIORAL

Information on care gap and closure process.

Incentives: CCS

Informational CCS mailer and incentive

Group Type EXPERIMENTAL

Financial Incentives

Intervention Type BEHAVIORAL

Incentives for gap closure.

Information

Intervention Type BEHAVIORAL

Information on care gap and closure process.

Control: AWC

No mailer for AWC (adolescent well-care visit) gap

Group Type NO_INTERVENTION

No interventions assigned to this group

Information only: AWC

Informational AWC mailer

Group Type EXPERIMENTAL

Information

Intervention Type BEHAVIORAL

Information on care gap and closure process.

Incentives: AWC

Informational AWC mailer and incentive

Group Type EXPERIMENTAL

Financial Incentives

Intervention Type BEHAVIORAL

Incentives for gap closure.

Information

Intervention Type BEHAVIORAL

Information on care gap and closure process.

Interventions

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Financial Incentives

Incentives for gap closure.

Intervention Type BEHAVIORAL

Information

Information on care gap and closure process.

Intervention Type BEHAVIORAL

Eligibility Criteria

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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
Minimum Eligible Age

21 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Massachusetts Institute of Technology

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Massachusetts Institute of Technology

Cambridge, Massachusetts, United States

Site Status

Countries

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United States

Other Identifiers

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1805348624

Identifier Type: -

Identifier Source: org_study_id

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