Incentives for Primary Care Use in a Safety Net Setting
Incentives for Primary Care Use in a Safety Net Setting
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.
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.
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