We propose to implement a randomized controlled trial (RCT) of incentives for an initial primary care visitwithin 6 months of enrollment in a health care coverage program. Study subjects are drawn from a low-incomeadult population that gains coverage and access to community-based primary care services under a programadministered by an academic safety-net hospital. We will offer financial incentives to encourage an initialprimary care visit within 6 months of enrollment and evaluate whether the primary care visit altered subsequenthealth seeking behavior and influenced patient satisfaction and other outcomes such as self-reported healthstatus. Using a mixed methods approach, we will compare outcomes among patients who receive one of twolevels of incentives ($25, $50) versus those who receive usual care. Patients will be interviewed at enrollmentand at the end of the study (12 months following their enrollment) for their feedback on the incentives, theirhealth status, and their experience with the health care system. We will also objectively assess their utilizationthrough the analysis of medical claims. All hypotheses test the $50 and $25 experimental groups against eachother and the control group.
Our specific aims are to:
Aim 1. Enroll low-income, uninsured adults in an RCT to test the impact of incentives on visiting a primary careprovider (PCP) within 6 months of enrollment and to measure health care utilization 12 months following studyenrollment.H1: The likelihood of a PCP visit is highest in the experimental groups.H1a: Time delay to a PCP visit is shortest in the experimental groups.H1b: The average number of PCP visits is higher in the experimental groups.H2: The use of preventive care (drawing from HEDIS measures) is higher in the experimental groups.H3: The number of total ED, non-emergent ED, inpatient and outpatient visits is lower in the experimentalgroups.H4: The number of pharmaceuticals used is lower in the experimental groups.H5: Total cost of health care utilization will be lower in the experimental groups.H6: The experimental groups will be more likely to re-enroll in the Virginia Coordinated Care program.
Aim 2. Administer semi-structured interviews at pre-randomization and study completion to qualitatively explorethe effects of incentives.H1: Satisfaction with health care services will be higher in the experimental groups.H2: Self-reported health status will be higher in the experimental groups.H3: Incentives will be the primary motivator for patients in the experimental groups to seek primary care.
We propose to implement a randomized controlled trial (RCT) of incentives for an initial primary care visit within 6 months of enrollment in a health care coverage program. Study subjects are drawn from a low-income adult population that gains coverage and access to community-based primary care services under a program administered by an academic safety-net hospital.
| Bradley, Cathy J; Neumark, David (2017) Small Cash Incentives Can Encourage Primary Care Visits By Low-Income People With New Health Care Coverage. Health Aff (Millwood) 36:1376-1384 |
