Social Norms, Messengers, and Processing Fluency to Increase Hypertension Medication Adherence

Summary

Medicare Advantage beneficiaries ages 65-79 and insured by Humana with at least two unique fills of hypertension medication within the 2023 calendar year and adherence level between 60 and 85% will be identified using Humana Medicare Advantage claims data. Individuals meeting these inclusion criteria will be included and, with an institutional review board approved waiver of informed consent, will be randomized to one of 6 mailed messages or control (no message). The messages will be sent by Humana and use different behavioral techniques (social norms, messenger effects, and/or processing fluency) providing their medication refill score. Humana will send a second message within 60 days of the first message noting any changes in the refill score.

The primary outcome will be the average end-of-year adherence in each arm. A secondary outcome will be the proportion of study participants with end-of-year adherence greater than or equal to 80%. The study team's hypothesis is that messages using dynamic social norms, messenger effects, and processing fluency in combination will more effectively increase average end-of-year adherence level compared to usual care.

Humana will conduct all study participant outreach and data analyses, which will be performed using routinely collected insurance claims data. Regulatory oversight is conducted using Humana's centralized institutional review board (IRB) of record. The work completed by Humana study staff is funded by Humana, Inc.

Dr. Choudhry and his colleagues (including subaward recipients ideas42 and Tuck School of Business at Dartmouth) will provide technical and subject matter expertise related to study research design and implementation, protocol design, statistical analysis, publication (abstract, poster, manuscript) preparation and/or review, and assistance throughout the peer review process including revisions and additional analyses if necessary for this project. The work completed by study staff at Brigham and Women's Hospital, ideas42, and Tuck School of Business at Dartmouth is funded by NIA.

Conditions

• Medication Adherence
• Hypertension

Interventions

BEHAVIORAL

Scorecard

Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score."

BEHAVIORAL

Social norms

Participants will be mailed a dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores).

BEHAVIORAL

Messenger effects

Participants will be mailed a scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication.

BEHAVIORAL

Processing fluency

Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."

Sponsors & Collaborators

• Humana Inc.

  collaborator INDUSTRY

• National Institute on Aging (NIA)

  collaborator NIH

• Brigham and Women's Hospital

  lead OTHER

Principal Investigators

• Ted Robertson, MPA · Ideas42

• Punam Keller, PhD, MBA · Tuck School of Business at Dartmouth

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

65 Years

Max Age

79 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2023-08-18

Primary Completion

2023-12-31

Completion

2023-12-31

Countries

• United States

Study Locations