Incentives for Primary Care Use in a Safety Net Setting

Virginia Commonwealth University (VCU)

Status: Completed

Conditions: Primary Care Physician; Uninsured; Health Care Utilization

Treatments: Behavioral: 0 dollars group; Behavioral: 50 dollars group; Behavioral: 25 dollars group

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT02922855

HM20000002

1R01HS022534 (U.S. AHRQ Grant/Contract)

Details and patient eligibility

About

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. The investigators will offer financial incentives to encourage an initial primary care visit within 6 months of enrollment and evaluate whether the primary care visit altered subsequent health seeking behavior and influenced patient satisfaction and other outcomes such as self-reported health status.

Full description

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. The investigators will offer financial incentives to encourage an initial primary care visit within 6 months of enrollment and evaluate whether the primary care visit altered subsequent health seeking behavior and influenced patient satisfaction and other outcomes such as self-reported health status.

Incentives should steer patients in their decision to seek primary care, reduce barriers to care, and ultimately improve patient health and reduce utilization and costs through their relationship with a PCP. This study is the first of its kind to incentivize low-income patients. This population has the greatest need for health care and exerts the greatest pressure on the United States' safety net system. Furthermore, the safety net population is the target of policies such as Medicaid eligibility expansions, yet urban safety net patients are largely understudied. These patients are rarely given the opportunity to participate in research, and when they are the subjects of measures to reduce health care utilization, they are the subject of policies using negative incentives such as those that introduce cost sharing for using ED services.1 Alternatively, safety net providers invest in case management systems to reduce utilization. The proposed study is a departure from prior measures to reduce utilization among low-income patients by focusing on patients and using positive incentives. The study borrows from the principles of behavioral economics to motivate patients towards primary care utilization. Once in the primary care system, The investigators will test whether primary care contact reduces more expensive forms (e.g., inpatient, ED) of health care.

The investigators will compare outcomes of patients assigned in the highest incentive group ($50) to patients assigned to the modest incentive group ($25) and to patients assigned to usual care (no incentive, but assignment to a PCP). The investigators will also compare incentive patients ($50, $25) to a contemporaneous group of patients that enroll in the safety net clinic at the same time.

Enrollment: 1,228 patients

Sex: All

Ages: 21 to 64 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adults between ages 21-64 years
• No prior enrollment in VCC for the past 12 months
• English or Spanish speaking, and
• Can be contacted by mail and telephone (preferably) or willing to be interviewed in person.

Exclusion criteria

• Unable to be contacted by phone/mail
• Cannot provide consent
• No longer located in catchment area

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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1,228 participants in 4 patient groups

Contemporaneous Control

No Intervention group

Description:

This group is our 'usual care' control group. They were not contacted for an interview and were not offered an incentive to visit their primary care physician.

$0 group

Active Comparator group

Description:

This group completed a baseline interview but was not offered any incentive if they visited their primary care physician.

Treatment:

Behavioral: 0 dollars group

$25 group

Experimental group

Description:

This group completed a baseline interview and was offered $25 they visited their primary care physician within 6 months.

Treatment:

Behavioral: 25 dollars group

$50 group

Experimental group

Description:

This group completed a baseline interview and was offered $50 they visited their primary care physician within 6 months.

Treatment:

Behavioral: 50 dollars group