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Completed

NCT Number: NCT03715907

Financial Incentives for Care Gaps

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.

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Key information

Conditions

Delivery of Health Care

Age range

21 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Massachusetts Institute of Technology

Cambridge, Massachusetts, 02139, United States

About this study

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.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

Financial Incentives

Behavioral

Incentives for gap closure.

Information

Behavioral

Information on care gap and closure process.

Primary outcomes

  1. Proportion of care gaps closed

    Time frame: 6 months, from the date of randomization until end-of-year (i.e., December 31, 2018)

    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.

  2. Proportion of care gaps closed

    Time frame: 18 months, from the date of randomization until December 31, 2019

    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.

Secondary outcomes

  1. Health care expenditure during study - Total claims

    Time frame: 6 months, from the date of randomization until end-of-year

    (dollars)

  2. Health care expenditure following study - Total claims

    Time frame: 12 months, from December 31 2018 - December 31 2019

    Total claims (dollars)

  3. Outpatient visits during study

    Time frame: 6 months, from the date of randomization until end-of-year

    Number of outpatient visits

  4. Outpatient visits following study

    Time frame: 12 months, from December 31 2018 - December 31 2019

    Number of outpatient visits

  5. Inpatient visits during study

    Time frame: 6 months, from the date of randomization until end-of-year

    Number of inpatient visits

  6. Inpatient visits following study

    Time frame: 12 months, from December 31 2018 - December 31 2019

    Number of inpatient visits

  7. Prescriptions during study

    Time frame: 6 months, from the date of randomization until end-of-year

    Number of prescriptions

  8. Prescriptions following study

    Time frame: 12 months, from December 31 2018 - December 31 2019

    Number of prescriptions

Sponsors and collaborators

Lead sponsor

Massachusetts Institute of Technology

Other

Registry information

Official study title

Financial Incentives for Care Gaps: A Randomized Controlled Trial

Important dates

Study start
2018
Primary completion
2019
Study completion
2021
First posted
Oct 23, 2018
Registry last updated
Oct 6, 2021

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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