Assessing the Impact of myHealth Rewards Enrollment Emails

• ClinicalTrials.gov Identifier: NCT03965754
• Recruitment Status: Completed
• First Posted: May 29, 2019
• Results First Posted: October 5, 2020
• Last Update Posted: December 7, 2020
• Sponsor: Geisinger Clinic
• Information provided by (Responsible Party): Amir Goren, Geisinger Clinic

Study Description

Brief Summary:

The purpose of the study is to evaluate, prospectively, the potential impact of different email message conditions (no email, standard promotional email, social norms, and loss framing) on enrollment in a wellness program (myHealth Rewards) by Geisinger Health Plan (GHP) members.

Condition or disease	Intervention/treatment
Health Promotion; Wellness Programs	Behavioral: Social norms; Behavioral: Loss framing; Behavioral: Email reminder

Detailed Description:

The myHealth Rewards wellness program managed by GHP rewards those GHP members who carry their insurance through employment at Geisinger with reduced health insurance premiums over the course of the following year, if members register for the program and have their health measures on file by the enrollment deadline and are then able to meet their health goals by the respective due date. In spite of the potential savings to health plan members and the wellness program's potential to motivate engagement in healthy activities (with consequent improvement in health outcomes), over 20% of eligible GHP members have not yet enrolled in 2019, even after receiving promotional email communications and reminders. Therefore, the current study was developed to test whether different versions of emails are more effective than a standard reminder email or no-email condition in increasing myHealth Rewards login and enrollment rates. The standard email reminder mentions the average premium savings, the ease of the registration process, and the deadline for registering and having health measures on file, plus it provides links for registering and finding free health screenings where health measures can be collected and registered at one convenient time and location. The social norms email notes that a majority (78%) of GHP members' colleagues had enrolled in 2018, it provides a testimonial from a medical director at Geisinger's Commonwealth School of Medicine, stating the ways in which myHealth Rewards helped that doctor personally, and it emphasizes the simplicity and ease of taking the first step toward enrollment. The loss framing email suggests that GHP members are currently "throwing away" a precise monetary amount in savings by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. It is hypothesized that, on average, each of the emails will increase enrollment compared with no email. Among GHP members who never enrolled in the past, it is hypothesized that the standard email reminder will not be as effective as the social norms and loss framing emails. Therefore, email conditions will be compared separately among those who did and did not register in 2018. Findings will help inform how best to increase enrollment in a wellness program among health plan members who have already received past promotional communications and who may or may not have participated in the past.

Study Design

• Study Type: Observational
• Actual Enrollment: 5697 participants
• Observational Model: Case-Control
• Time Perspective: Prospective
• Official Title: Assessing the Impact of myHealth Rewards Program-related Email Communications on Enrollment
• Actual Study Start Date: May 7, 2019
• Actual Primary Completion Date: May 14, 2019
• Actual Study Completion Date: May 14, 2019

Groups and Cohorts

Group/Cohort	Intervention/treatment
No email; No email will be sent out to this subset of GHP members during the week that the other emails are sent.
Standard email reminder; The standard email reminder mentions the average premium savings, the speed and ease of starting the process, and the deadline for registering and having health measures on file, plus it provides two button links for registering and finding free health screenings where health measures can be collected and registered at one convenient time and location.	Behavioral: Email reminder; This intervention is a standard email reminder that mentions the average premium savings, the speed and ease of starting the process, and the deadline for registering and having health measures on file, plus it provides two button links for registering and finding screenings.
Social norms email; The social norms email notes that a majority (78%) of GHP members' colleagues had enrolled in 2018, it provides a testimonial from a medical director at Geisinger's Commonwealth School of Medicine, stating the ways in which myHealth Rewards helped that doctor personally, and it emphasizes the simplicity and ease of taking the first step toward enrollment.	Behavioral: Social norms; This intervention introduces recipients to descriptive social norms specifying that a majority of their colleagues have signed up for the program, which sets a normative standard against which recipients are expected to compare themselves and to change their behavior accordingly (i.e., when they realize that their behavior is discrepant from that of relevant others). The personal testimonial from a Geisinger medical director serves as a personal exemplar intended to further enhance the effect of the social norms with an implicit indication that the intended behavior is desirable and feasible.; Other Names: Descriptive norms; Social proof; Behavioral: Email reminder; This intervention is a standard email reminder that mentions the average premium savings, the speed and ease of starting the process, and the deadline for registering and having health measures on file, plus it provides two button links for registering and finding screenings.
Loss framing; The loss framing email suggests that GHP members are currently "throwing away" a precise dollar amount (over $2,000) by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action.	Behavioral: Loss framing; This intervention frames the status quo as a state from which recipients, via inaction, are slated to forfeit a sizable and precise monetary amount to which they should otherwise feel entitled (via loss aversion and the endowment effect). People tend to be risk-seeking in the domain of losses; therefore, this intervention is hypothesized to increase enrollment in the hope of achieving zero loss by meeting program goals, as opposed to a sure loss via inaction.; Other Name: Endowment effect; Behavioral: Email reminder; This intervention is a standard email reminder that mentions the average premium savings, the speed and ease of starting the process, and the deadline for registering and having health measures on file, plus it provides two button links for registering and finding screenings.

Outcome Measures

Primary Outcome Measures :

1. Enrollment (7 Days) [ Time Frame: 7 days, from May 7 through 13, 2019 ]
   Enrollment in the myHealth Rewards program (yes/no) within 7 full days of the beginning of the intervention (i.e., when the emails are first sent).
2. Logging in (7 Days) [ Time Frame: 7 days, from May 7 through 13, 2019 ]
   Logging into the myHealth Rewards program (yes/no) within 7 full days of the beginning of the intervention.

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes
• Sampling Method: Probability Sample

Study Population

The population consists of Geisinger Health Plan members who are benefits subscribers.

Criteria

Inclusion Criteria:

• Geisinger employees who are benefits subscribers

Exclusion Criteria:

• Those who had already registered for myHealth Rewards in 2019, up through May 6, 2019
• New Geisinger employees hired between December 1, 2018 and May 6, 2019
• Existing Geisinger employees who transitioned from non-subscribers in 2018 to subscribers in 2019

Contacts and Locations

Locations

United States, Pennsylvania

Geisinger

Danville, Pennsylvania, United States, 17822

Sponsors and Collaborators

Geisinger Clinic

Investigators

• Principal Investigator: Amir Goren, PhD; Geisinger Clinic

  Study Documents (Full-Text)

Documents provided by Amir Goren, Geisinger Clinic:

Study Protocol and Statistical Analysis Plan  [PDF] August 27, 2020

More Information

• Responsible Party: Amir Goren, Program Director, Behavioral Insights Team, Geisinger Clinic
• ClinicalTrials.gov Identifier: NCT03965754
• Other Study ID Numbers: 2019-0404
• First Posted: May 29, 2019
• Results First Posted: October 5, 2020
• Last Update Posted: December 7, 2020
• Last Verified: December 2020

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Plan Description: Data with no personally identifiable information will be made available to other researchers on the Open Science Framework for transparency. This will include the essential data and code needed to replicate the analysis that yielded reported findings. The PI did not examine or analyze any data from this study prior to this registration.
• Supporting Materials: Study Protocol
• Time Frame: The data will become available after publication of study results in a scientific journal and will be available as long as the Open Science Framework hosts the data.
• Access Criteria: The data on the Open Science Framework will be open to anyone requesting that information.
• URL: http://osf.io

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Amir Goren, Geisinger Clinic:

Prospect theory