Assessing the Impact of myHealth Rewards Program-related Communications on Enrollment: Replication

Study Overview
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Brief Summary
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The purpose of the study is to evaluate, prospectively, the potential impact on myHealth Rewards wellness program enrollment (prior to the 2020 deadline) of sending different messages via email to Geisinger Health Plan (GHP) members who have not yet enrolled. In particular, this study aims to replicate and extend (with greater sample size and statistical power) the findings from a previous study in which email communication using loss framing language achieved significantly higher click-through rates than a more standard communication, whereas actual enrollment rates were not significantly higher.

Detailed Description
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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), about 23% of eligible existing GHP members did not enroll during the primary 2019 enrollment period, even after receiving promotional email communications and reminders. Previous work examining myHealth Rewards found that email communication using loss framing language achieved significantly higher click-through rates than a more standard communication, whereas actual enrollment rates were not statistically significantly higher. The current study aims to analyze de-identified Geisinger Health Plan (GHP) member data, comparing enrollment status (and secondarily, click-through rates) within the 2020 enrollment period across email conditions to which GHP members will be randomly assigned. The main part of this study will compare the effects of a standard, generic communication vs. communication with loss framing, using a larger sample size for adequate statistical power to detect the original difference in enrollment rates as significant, should that difference be real and reliable. Additional conditions are added after this main comparison in order to compare more precisely other pairs of communications conceived in the original study. The generic email condition will consist of a standard email of the kind that would typically be sent by GHP to encourage enrollment, which includes the average amount saved, the ease of registration, and a reward incentive. The loss framing condition will highlight that respondents are forfeiting savings unless they take action and register. The two testimonial conditions will have a testimonial from a doctor (medical expert condition) or a customer care specialist (rank-and-file condition) about how the program helped them. The two social norms conditions will show the percentage (percentage condition) or number (number condition) of fellow Geisinger members who already signed up. Emails will go out in three waves. For each wave, Geisinger employees who have not already registered at that time will be randomized into one of two groups: Wave 1: generic email vs. loss framing email Wave 2: testimonial (expert) vs. testimonial (rank-and-file) Wave 3: social norms (percentage) vs. social norms (number) It is hypothesized that, on average, the loss frame email will increase enrollment compared with the standard email. The other comparisons are exploratory and do not have a priori hypotheses. Findings will help inform how best to increase enrollment in a wellness program through email communication.

Official Title
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Assessing the Impact of myHealth Rewards Program-related Communications on Enrollment: Replication

Conditions
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Health Promotion, Wellness Program

Intervention / Treatment
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* Behavioral: Email
* Behavioral: Loss frame
* Behavioral: Testimonial (medical expert)
* Behavioral: Testimonial (rank-and-file)
* Behavioral: Social norms (percentage)
* Behavioral: Social norms (number)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Geisinger Health Plan members Geisinger Health System employees who have not yet enrolled in myHealth Rewards Exclusion Criteria: Enrollment in myHealth Rewards before the email launch date for each wave Do not have an email address on file

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Standard email<br>This email mentions the cost-saving benefits of enrollment by participants who met their 2018 goals. It also includes the message that registration can be completed quickly (in less than five minutes). Finally, it also includes reward incentive information, wherein registering by a March deadline provides qualified recipients with the potential to win prizes. This information is contained in all other emails. | Behavioral: Email<br>* Email<br>|
| Loss frame email<br>In addition to the content of the generic email, the subject line and content of the loss frame email recommends that GHP members not throw away a precise dollar amount in savings (over $2,000) by not participating and that they can therefore avoid missing out on substantial gains (i.e., savings) by taking action. This email further frames the reward as something recipients will miss out on if they do not sign up. 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. | Behavioral: Email<br>* Email<br>Behavioral: Loss frame<br>* Email<br>* Other names: Endowment effect;|
| Testimonial (medical expert) email<br>In addition to the content of the generic email, the testimonial (medical expert) email includes a testimonial from a doctor, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress. This intervention shows proof of other people successfully enrolling and benefitting from the program. Specifically, it is an endorsement from a presumed authority figure. Recipients may be more likely to enroll for this program if they see a physician - who would be seen as an authority on health and wellness - talking about the medical benefits of the program. It is unclear in the current context and population if a message from an expert or rank-and-file employee would be more effective. | Behavioral: Email<br>* Email<br>Behavioral: Testimonial (medical expert)<br>* Email<br>* Other names: Authority;|
| Testimonial (rank-and-file) email<br>In addition to the content of the generic email, the testimonial (rank-and-file) email includes a testimonial from a customer care specialist, which notes the personal benefits of myHealth Rewards in terms of managing blood pressure, blood sugar, cholesterol, weight, and stress. This intervention shows proof of other people successfully enrolling and benefitting from the program. Specifically, it is an endorsement from a peer (relative to most Geisinger employees). Recipients may be more likely to enroll for this program if they see a rank-and-file employee talking about the program as this person would be more relatable (relative to a doctor). It is unclear in the current context and population if a message from an expert or rank-and-file employee would be more effective. | Behavioral: Email<br>* Email<br>Behavioral: Testimonial (rank-and-file)<br>* Email<br>* Other names: Social proof;|
| Social norms (percentage) email<br>In addition to the content of the generic email, the social norms (percentage) email will include communication about the percentage of benefit-eligible employees who had already registered for myHealth Rewards. This message sets up a descriptive norm, showing that a majority of people are doing a certain behavior. When people see a behavior as the norm, they are more likely to follow it. The use of percentages makes it clear that this behavior is indeed being done by most people in the group. It is unclear in the current context and population if a message using percentages or numbers would be more effective. | Behavioral: Email<br>* Email<br>Behavioral: Social norms (percentage)<br>* Email<br>* Other names: Social proof;|
| Social norms (number) email<br>In addition to the content of the generic email, the social norms (number) email will include communication about the number of benefit-eligible employees who had already registered for myHealth Rewards. This message sets up a descriptive norm, showing that a large number of people are doing a certain behavior. When people see a behavior as the norm, they are more likely to follow it. While the use of numbers does not indicate that this behavior is being done by a majority, using a large number can be more convincing just in showing sheer quantity. | Behavioral: Email<br>* Email<br>Behavioral: Social norms (number)<br>* Email<br>* Other names: Social proof;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of Enrollment (14 Days) | Enrollment in the myHealth Rewards program (yes/no) within 14 full days of the beginning of the intervention for each of the three waves. | 14 days | 
| Rate of Logging in (14 Days) | Logging into the myHealth Rewards program (yes/no) within 14 full days of the beginning of the intervention for each of the three waves. | 14 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Prospect theory, Social norms, Social proof, Authority