Analyzing the Implementation of the Senior Risk Reduction Demonstration

The Senior Risk Reduction Demonstration (SRRD) is an RCT that tests whether health promotion programs developed in the private sector can be tailored for Medicare beneficiaries. Medicare partnered with health management vendors to develop and implement risk reduction programs for a sample of Medicare beneficiaries. Although some program components were prescribed by the demonstration design, each vendor was allowed considerable flexibility and innovation to construct its own risk reduction program.

The SRRD design requires eligible Medicare beneficiaries completing a Health Risk Assessment (HRA) form to be randomized into one of three treatment arms. ARM 1 and ARM 2 participants receive personalized feedback based on HRA results and are offered standard (ARM 1) or enhanced (ARM 2) health coaching interventions by phone, mail or online. ARM 3 participants do not receive personalized feedback and receive only generic health advice in the form of a brochure. Each vendor tailored their risk reduction program by developing proprietary algorithms that generate risk scores based on HRA results and assign participants to high, moderate or low risk categories within each treatment arm. Each vendor customized its intervention service offerings according to risk category.

Using a series of qualitative research methods, the evaluation team developed detailed descriptions of each vendor's implementation process. Understanding the differences in vendor interventions is important for determining the extent to which outcomes are associated with underlying differences in the interventions used or in the thresholds used for initiating interventions.