Direct-to-Member Household or Targeted Mailings: Incentivizing Medicaid Calls for Quitline Services

Hood-Medland E, Dove M, Stewart S, Cummings S, Kirby C, Cela C, Kohatsu N, Tong E
Source: Am. J. Prev. Med.
Publication Year: 2018
Population Focus: Medicaid beneficiaries
Study Design: Pre-post without Comparison Group
Type of Literature: White
link: https://www.ajpmonline.org/article/S0749-3797(18)32102-0/abstract
Abstract

Innovative methods are needed to promote tobacco cessation services. The Medi-Cal Incentives to Quit Smoking project (2012–2015) promoted modest financial and medication incentives to encourage Medi-Cal smokers to utilize the California Smokers’ Helpline (Helpline). This article describes the implementation and impact of two different direct-to-member mailing approaches. Medi-Cal Incentives to Quit Smoking promotional materials were mailed directly to members using two approaches: (1) household mailings: households identified through centralized membership divisions and (2) individually targeted mailings: smokers identified by medical codes from Medi-Cal managed care plans. Mailings included messaging on incentives, such as gift cards or nicotine patches. Number of calls per month, calls per unit mailed, and associated printing costs per call were compared during and 1 month after mailings. Activated caller response was based on reporting a household mailing promotional code or based on requesting financial incentives for individually targeted mailings. Analyses were conducted in 2018. Direct-to-member mailings, particularly with incentive messaging, demonstrated an increase in call volumes during and 1 month after mailing, and increased Medi-Cal calls to the Helpline per unit mailed. Mailings with only counseling messages had the lowest %age of activated calls per unit mailed, whereas the incentive messaging mailings were consistently higher. Although household mailings demonstrated lower printing costs per call, individually targeted mailings had a higher %age of activated calls per unit mailed. Household and individually targeted mailings are feasible approaches to increase Medi-Cal calls to the Helpline, particularly with incentive messaging. Choosing an approach and messaging depends on available resources, timing, and purpose.

Insights Results

Overview of article

  • This article describes the implementation and impact of two different direct-to-member mailing approaches within the Medi-Cal Incentives to Quit project, which promotes modest financial and medication incentives to encourage Medi-Cal smokers to utilize the California Smokers’ Helpline

Methods of article

  • For this intervention, Medi-Cal Incentives to Quit Smoking promotional materials were mailed directly to members using 2 approaches: 1) Household mailings: households identified through centralized membership divisions; and (2) Individually targeted mailings: smokers identified by medical codes from Medi-Cal managed care plans. Mailings included messaging on incentives, such as gift cards or nicotine patches
  • Number of calls per month, calls per unit mailed, and associated printing costs per call were compared during and 1 month after mailings for evaluation of the intervention

Results

  • Both direct to member mailings (e.g., household and individually targeted), especially when couples with incentives (e.g., gift cards) showed improved connection to calls to quit lines. However, given competing priorities and concerns for sustainability, household mailings may not be sufficient
  • Direct-to-member mailings, particularly with incentive messaging, demonstrated an increase in call volumes during and 1 month after mailing, and increased Medi-Cal member calls to the Helpline per unit mailed

Key takeaways/implications

  • Both household and individually targeted mailings increased calls to the Helpline. Individually targeted mailing has higher total costs, but it is better able to target specific populations (e.g., families with children who may be exposed to second hand smoke). It may also be difficult to identify specific populations using billing or diagnostic codes. For household mailings, there may be limited ability for tailoring, but they are associated with lower total costs
  • Other lessons learned include value of promotional tracking codes and the burden of printing costs
  • Limitations for the study include potential over- or under-estimated caller response and potential inappropriate self-reporting by participants
  • Future research efforts should focus on cost effectiveness of direct-to-member mailings. Other population-based tobacco cessation interventions, such as those under the Medicaid Incentives for the Prevention of Chronic Diseases state programs, should be monitored
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