Encouraging Annual Wellness Visits Among ACO Beneficiaries

Annual Wellness Visits (AWVs) are a type of detailed healthcare checkup to which Medicare beneficiaries are entitled, free of charge, once per year. The Keystone Affordable Care Organization (KACO), of which Geisinger is a part, is working to increase the number of eligible patients who take advantage of AWVs via mail and telephone outreach.

The purpose of the current study is to assess what content and communication modality results in the most effective messaging campaign. Patients will either receive a phone call or a mailed postcard, or they will be part of a no-contact control condition. Furthermore, the content of the postcard will vary in terms of humor and salience, as well as whether telehealth is mentioned as an AWV option.* Although telehealth is a great option for patients who are unable to attend an in-person visit, the latter is preferable in terms of quality of care. Furthermore, insurance coverage for telehealth visits may not extend indefinitely beyond the COVID-19 pandemic. Highlighting the telehealth option may help attract patients who would not otherwise get an AWV, increasing the effectiveness of the intervention. On the other hand, it may unintentionally nudge patients who would otherwise have scheduled an in-person visit to opt for telehealth instead.

The following research questions will assess effectiveness in increasing patient scheduling of an AWV:

• Are postcards effective compared with a no-contact control condition?
• How effective are postcards when compared with phone calls, a presumably more intrusive type of intervention?
• Is a humorous cartoon, accompanied by language using examples to make salient the future health risks that could be prevented, more effective than stock photography of similar patient-doctor situations (typically used in outreach), accompanied by prevention language that is less specific?
• Is it more effective to highlight the availability of telehealth video visits than not to mention that option?
• Are in-person AWVs are scheduled at least as frequently when the telehealth option is highlighted as when it is not?

Included in the study will be patients from 7 KACO partner sites: Caring Community Health Center, Evangelical Community Hospital, Geisinger, Geisinger-Hm Joint Venture, Holy Spirit, Wayne Memorial Hospital, and Wright Center. Generalized linear mixed models (GLMMs) will examine the primary study outcomes as a function of the study arms (between-subjects), with partner site included as a random effect, assuming high intraclass correlation coefficients.

• Wayne Memorial Hospital patients will not receive postcards with tele-health content. In addition, only patients from the following partner sites will be randomized to receive a phone call: Evangelical Community Hospital, Wayne Memorial Hospital, and the Wright Center. Geisinger patients will not be randomized to receive phone calls, but Geisinger patients who are randomized to other conditions may receive phone calls as part of regular operations. This will be accounted for during analysis as a model regressor.

Inclusion criteria

• KACO Medicare beneficiary
• Haven't had an AWV or due for their next one
• For phone call condition only: patients of Evangelical Community Hospital, Wayne Memorial Hospital, and the Wright Center

Exclusion criteria

• Patient has already been called about AWV or had a visit scheduled
• For "patient initiated contact" outcome only: patients of Wayne Memorial Hospital or who have not been assigned to a partner site. This is because postcards received by these patients will not include a specific phone number to call.
• For telehealth conditions only: patients of Wayne Memorial Hospital