Increasing Medication Adherence Through Physician Incentives and Messaging

Traditional economics would suggest that the best way to maximize adherence would be to give physicians financial incentives to improve adherence to all relevant drugs, and that communications to physicians should emphasize all of the relevant drugs. Behavioral economics suggests theory suggests that if you emphasize everything, then you are effectively emphasizing nothing. Behavioral econonmics would suggest to maximize adherence one should give physicians financial incentives for improving adherence for a small number of relevant drugs, and communications to physicians should emphasize a small number of the relevant drugs. This allows physicians to focus their energy and reduces the probability that they will give up because they're overwhelmed, or in other words, avoid the phenomenon called metric fatigue.

Humana has already implemented an incentives program for physicians, and the investigators will work with them to design a program that just focuses on medication adherence. Physicians targeted for this pilot could also be enrolled in another Humana incentives program, but this incentives program will act independently of the other.

There are two treatment dimensions the investigators will test via random assignment at the practice level:

• Physicians given financial incentives for improving patient medication adherence for all of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and cholesterol (statins) medication vs. one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, or cholesterol (statins) medication.
• Physicians given communication emphasizing the importance of improving adherence to all of the previous medication classes vs. one one of the previous medication classes.

In a previous study to increase uptake of colonoscopies among employees at a partner firm, the investigators found that using a post it note to catch the attention of the employee statistically significantly increased colonoscopy uptake over a control group. The investigators will also employ an eye catching method in the proposed pilot. When physicians are sent a communication regarding the opportunity to receive an incentive as part of our pilot, they will also receive a single patient sheet for each patient who has less than 80% adherence. They will be encouraged to include the patient sheet in their chart as a reminder to discuss medication adherence with their patient the next time they see them. For half of our arms, the investigators will make the patient sheets a bright, non-white, color, in order to futher draw the physicians' attention to that specific paper in their chart.

Our experimental arms will be:

• Comprehensive incentives + comprehensive communication
• Comprehensive incentives + comprehensive communication + printed on bright non-white paper
• Focused incentives + focused communication (one for all three drug classes)
• Focused incentives + focused communication + printed on bright non-white paper (one for all three drug classes)
• Comprehensive communiation
• Comprehensive communication + printed on bright non-white paper
• Control arm: no communication + no incentives

The investigators hypothesize that physicians who receive focused incentives and focused communications will have more patients with increased medication adherence than physicians who receive comprehensive incentives and comprehensive communications. The investigators also hypothsize that physicians who receive patient sheets using bright, non-white paper will have more patients with increased medication adherence than physicians who receive plain white patient sheets.

Inclusion criteria

• Physician in the Humana network
• Treats Humana Medicare Advantage Members
• Has Humana Medicare Advantage members who are taking at least one of the following medications: oral diabetes medication, hypertension (ACEI or ARB) medication, and/or cholesterol (statins) medication, and who are less than 80% adherent.

Exclusion criteria

• Practices with more than 10 physicians