Recruitment Strategies and Participation in 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. As part of the SRRD evaluation, we conducted a participation analysis.

CMS provided each SRRD vendor with a pool of 20,000 Medicare beneficiaries from which to recruit. With limited exceptions, participation rates, participant characteristics, and retention were similar across the two vendors, despite their taking unique approaches to recruitment. For example, Vendor A recruited beneficiaries using a wave approach, focused on Year 1 participants during Year 2 recruiting to enhance re-enrollment, and made interpreters available during phone calls if necessary. Vendor B sent recruitment materials to all potential participants in a single mailing and used automated phone calls for a portion of recruiting calls.

Analyses indicate that participation rates were highest among non-Hispanic Whites, non-dual eligibles, individuals with certain chronic conditions, and beneficiaries with Medicare expenditures in the middle two quartiles. Highest re-enrollment occurred among beneficiaries participating in the placebo arm, and vendor A's participants were more likely to be minorities and had higher Medicare expenditures than Vendor B's participants.

Participation patterns observed in SRRD provide lessons for other initiatives having voluntary participation such as the Medicare Annual Wellness Visit and Medicaid Incentives for Prevention of Chronic Disease. For example, despite active recruiting efforts, participation among dual eligibles was lower than that of non-duals, but this difference was much higher for Vendor B (13 percentage points) than for Vendor A (6 percentage points).