Health BehaviorNCT05891418
Effect of Email Nudges on Plan Switching and Healthcare Utilization Among Unemployment Insurance Recipients
A study testing Two informational emails with plan information and Standard notice of eligibility determination in people with Health Behavior, run by Office of Evaluation Sciences at 1 site in United States.
Trial summary
In March 2021, President Biden signed into law the American Rescue Plan Act of 2021 (ARP), a landmark federal economic relief and stimulus package designed to provide support to Americans hit by the economic recession brought about by the COVID-19 global pandemic. Read more about this study
- Who is it for?
- Ages 0 to 74 yearsHealthy volunteers can take part
- Conditions the study is for
- Health Behavior
- What is being tested?
- Two informational emails with plan information and Standard notice of eligibility determination
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 42,470 participants
- Where
- 1 siteUnited States
- Study dates
- 25 Jun 2021to 31 Dec 2021
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 0 to 74 years
- All sexes
- Healthy volunteers accepted
- Child, Adult, Older adult
Who may be able to join
- Has email address, in a non-silver plan and reported unemployment insurance in 2021
Who cannot join
- In a silver plan, no email address
Trial locations and contacts
1 site in 1 country.
About this study
In March 2021, President Biden signed into law the American Rescue Plan Act of 2021 (ARP), a landmark federal economic relief and stimulus package designed to provide support to Americans hit by the economic recession brought about by the COVID-19 global pandemic. The law provides increased federal premium tax credits (PTC), and ensures that consumers will pay no more than 8.5 percent of household income on health insurance premiums in 2021 and 2022, if enrolled through an Affordable Care Act marketplace like Covered California.
The ARP also provides additional PTC and cost-sharing reduction (CSR) benefits to eligible marketplace enrollees who report receiving unemployment insurance benefits (UIB) for at least one week in 2021. Under the law, for 2021 only, Covered California consumers will have their household income level treated as if it were at 138.1 percent of the federal poverty level (FPL), regardless of their projected annual income, which will make them eligible for a Silver 94 plan, and which offers the greatest value on cost-sharing benefits.
Read more
But in order to access those cost-sharing benefits, households must be in silver tier plans, but over 40,000 were not. This project's goal is to assess the effects of an informational email on plan switching into Cost Sharing Reduction Silver plans and downstream healthcare utilization.
The project's research design is a randomized intervention among approximately 42,500 enrolled households with an email address in non-silver tier plans. The investigators randomly assigned to either two informational emails or to a no email control group. The investigators then collected administrative data to examine plan switching behavior and healthcare utilization among households in the study.
- Conditions
- Health Behavior
- Being tested
- Two informational emails with plan information, Standard notice of eligibility determination
- Keywords
- Affordable Care Act, randomized controlled trial, nudge, American Rescue Plan, unemployment insurance
- Medical subject headings
- Health Behavior
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Two informational emails with plan informationBehavioural
Informational emails about the benefits of Cost-Sharing Reduction Silver plans.
Standard notice of eligibility determinationBehavioural
No extra outreach during intervention period.
| Study group | Role | What they receive |
|---|---|---|
| Control Group with a standard eligibility notice | Experimental | Control group was assigned to receive no email outreach in June and July beyond an eligibility redetermination notice. Receives: Behavioral: Standard notice of eligibility determination |
| Treatment group with a standard eligibility notice and assigned two email nudges | Experimental | Assigned to receive an eligibility redetermination notice along with two informational emails about the benefits of Cost-Sharing Reduction Silver plans. Receives: Behavioral: Two informational emails with plan information |
What is being measured
The primary outcome is the main question the study is designed to answer.
Cost-Sharing Reduction Silver Enrollment
Percent of households enrolled in a Cost-Sharing Reduction Silver Plan
Measured: 1 month
Office Visit
Percent of households with an office visit
Measured: 6 months
Prescription drug use
Percent of households with a prescription drug fill
Measured: 6 months
Emergency room visit
Percent of households with an emergency room visit
Measured: 6 months
Hospitalization
Percent of households with a hospitalization
Measured: 6 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted6 Jun 2023
- Study start25 Jun 2021
- Primary completion31 Dec 2021
- Study completion31 Dec 2021
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Health BehaviorStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 42,470 participants (actual)
Sponsor and investigators
- Lead sponsor
- Office of Evaluation Sciences
- Sponsor type
- US federal agency
- Responsible party
- Principal investigator, Andrew Feher, Office of Evaluation Sciences
- Investigators
- Andrew Feher, PhD, Principal investigator, Covered California
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05891418
- Sponsor's protocol ID
- 022023
- Status last verified
- Jun 2023
- First submitted
- 14 Feb 2023
- Last updated
- 6 Jun 2023
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: The researchers are committed to sharing as much data as possible for replication, consistent with the privacy and security requirements of the state agency that govern the re-disclosure of the data.
Publications
Lovchikova M, Feher A, Lian L. Health Plan Switching and Health Care Utilization: A Randomized Clinical Trial. JAMA Health Forum. 2024 Mar 1;5(3):e240324. doi: 10.1001/jamahealthforum.2024.0324.
PubMed 38551588
Study at a glance
From the registry record, last updated by the sponsor on 6 Jun 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Email Nudges on Plan Switching and Healthcare Utilization Among Unemployment Insurance Recipients
- ClinicalTrials.gov ID
- NCT05891418
- Acronym / sponsor ID
- 022023
- Conditions
- Health Behavior
- Keywords
- Affordable Care Act, randomized controlled trial, nudge, American Rescue Plan, unemployment insurance
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 42,470 participants (actual)
- Lead sponsor
- Office of Evaluation SciencesUS federal agency
- Study start
- 25 Jun 2021 (actual)
- Primary completion
- 31 Dec 2021 (actual)
- Study completion
- 31 Dec 2021 (actual)
- First posted
- 6 Jun 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
In March 2021, President Biden signed into law the American Rescue Plan Act of 2021 (ARP), a landmark federal economic relief and stimulus package designed to provide support to Americans hit by the economic recession brought about by the COVID-19 global pandemic. The law provides increased federal premium tax credits (PTC), and ensures that consumers will pay no more than 8.5 percent of household income on health insurance premiums in 2021 and 2022, if enrolled through an Affordable Care Act marketplace like Covered California.
The ARP also provides additional PTC and cost-sharing reduction (CSR) benefits to eligible marketplace enrollees who report receiving unemployment insurance benefits (UIB) for at least one week in 2021. Under the law, for 2021 only, Covered California consumers will have their household income level treated as if it were at 138.1 percent of the federal poverty level (FPL), regardless of their projected annual income, which will make them eligible for a Silver 94 plan, and which offers the greatest value on cost-sharing benefits.
But in order to access those cost-sharing benefits, households must be in silver tier plans, but over 40,000 were not. This project's goal is to assess the effects of an informational email on plan switching into Cost Sharing Reduction Silver plans and downstream healthcare utilization.
The project's research design is a randomized intervention among approximately 42,500 enrolled households with an email address in non-silver tier plans. The investigators randomly assigned to either two informational emails or to a no email control group. The investigators then collected administrative data to examine plan switching behavior and healthcare utilization among households in the study.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Control Group with a standard eligibility notice | Experimental | Behavioral: Standard notice of eligibility determinationControl group was assigned to receive no email outreach in June and July beyond an eligibility redetermination notice. |
| Treatment group with a standard eligibility notice and assigned two email nudges | Experimental | Behavioral: Two informational emails with plan informationAssigned to receive an eligibility redetermination notice along with two informational emails about the benefits of Cost-Sharing Reduction Silver plans. |
Who may qualify
- Ages
- 0 to 74 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (1 listed)
- Has email address, in a non-silver plan and reported unemployment insurance in 2021
Key exclusion criteria (1 listed)
- In a silver plan, no email address
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Two informational emails with plan informationInformational emails about the benefits of Cost-Sharing Reduction Silver plans. | Behavioural | Treatment group with a standard eligibility notice and assigned two email nudges |
| Standard notice of eligibility determinationNo extra outreach during intervention period. | Behavioural | Control Group with a standard eligibility notice |
Primary outcome
Cost-Sharing Reduction Silver Enrollment
Time frame: 1 month
Percent of households enrolled in a Cost-Sharing Reduction Silver Plan
Office Visit
Time frame: 6 months
Percent of households with an office visit
Prescription drug use
Time frame: 6 months
Percent of households with a prescription drug fill
Emergency room visit
Time frame: 6 months
Percent of households with an emergency room visit
Hospitalization
Time frame: 6 months
Percent of households with a hospitalization
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 6 Jun 2023.
- Derived from this study: PubMed 38551588Lovchikova M, Feher A, Lian L. Health Plan Switching and Health Care Utilization: A Randomized Clinical Trial. JAMA Health Forum. 2024 Mar 1;5(3):e240324. doi: 10.1001/jamahealthforum.2024.0324.
- Individual participant dataSharing planned: Yes. The researchers are committed to sharing as much data as possible for replication, consistent with the privacy and security requirements of the state agency that govern the re-disclosure of the data.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Andrew Feher, PhD principal investigator
Covered California
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Two informational emails with plan information and Standard notice of eligibility determination in people with Health Behavior, run by Office of Evaluation Sciences at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 6 Jun 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Cost-Sharing Reduction Silver Enrollment (time frame: 1 month). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05891418, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Jun 2023.