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Beneficiary Survey-Based Feedback on New Medicare Informational Materials

Health Care Financing Review, Fall, 2001 by Lauren McCormack, A., Steven Garfinkel, A., Judith Hibbard, H., Kerry Kilpatrick, E., William D. Kalsbeek

INTRODUCTION AND BACKGROUND

BBA 1997 requires that comparative information be provided to Medicare beneficiaries on an annual basis to inform them about their health insurance options. In response to the BBA, CMS initiated the National Medicare Education Program (NMEP) to enable beneficiaries to make more informed health plan decisions. The objectives of the program are to ensure that beneficiaries have access to accurate and reliable information, and that they are aware of the different health plan choices available to them, understand the consequences of choosing different plans, and are able to use the information provided to them when making decisions. CMS would also like beneficiaries to view the Medicare program and its private sector partners as trusted and credible sources of information (Goldstein, 1999).

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In addition to several newly created print materials, the education program includes telephone helplines, an Internet information data base called Medicare Compare, training and support for intermediaries, enhanced beneficiary counseling services, and State and community-based outreach and education efforts. The Medicare & You handbook (formerly the Medicare Handbook) is the primary print medium that CMS developed as part of the NMEP. It contains an overview of the Medicare program and basic benefits, a description of the different plan choices, information on how to get assistance and beneficiary fights and protections, a question and answer section, and definitions of important terms used throughout the handbook. It also contains a section comparing the costs and benefits of the five local Medicare health maintenance organizations (HMOs). The handbook was pilot tested in five States (Arizona, Florida, Ohio, Oregon, and Washington State) and the Kansas City metropolitan statistical area (MSA) in fall 1998. The Kansas City handbook was 52 pages long.

That fall, the remainder of the Nation received an abbreviated version of the handbook in the form of an eight-page tri-fold Medicare & You 1999 bulletin which contained most of the key messages contained in the handbook as well as a description of the different plan options and a tear-out telephone list of reference numbers. None of the information in the bulletin was tailored to different geographic regions, and thus it contained no comparative information.

CMS commissioned RTI to evaluate the 1999 pilot version of the Medicare & You materials in the Kansas City MSA. The study included an outcomes survey and focus groups with Medicare beneficiaries. As part of the study, RTI also evaluated the Consumer Assessment of Health Plans Study (CAHPS[R]) survey report that provided Medicare beneficiaries in the Kansas City MSA information comparing the quality of care provided by the five local Medicare HMOs. CMS has adopted the CAHPS[R] survey as its standard for measuring assessments of health plans by Medicare beneficiaries. The CAHPS[R] survey report provides information about beneficiaries' experiences in different health plans that can be used by other consumers who are considering joining a plan. Kansas City was selected because it was one of the CAHPS[R] field test sites in which demonstration evaluations were being conducted at the time CMS initiated the Medicare & You 1999 evaluation. (1)

In this article we present primarily results from the outcomes survey, including descriptive statistics on beneficiaries' assessment of the new Medicare materials and logistic regressions of the perceived usefulness of the materials controlling for other factors. After reporting the most common sources of Medicare information used by beneficiaries, we show how much time they spent with the new materials, how helpful beneficiaries felt these materials were, how easy they were to understand, and how they were used by beneficiaries. We discuss the findings in light of concerns about educational, cognitive, and literacy levels of the older adult population.

DATA AND METHODS

Both new (defined as those just aging into the Medicare program at the time of the interview) and experienced (those age 65 or over) beneficiaries residing in the Kansas City MSA were included in the study. Sampling flames were provided by CMS (n = 1,855 new beneficiaries and n = 170,062 experienced beneficiaries). No explicit stratification was performed on the samples, but we sorted the files by age, sex, race, and Zip Code prior to randomly assigning sample members to a control group or one of three treatment groups, to ensure a proportional draw on these characteristics. We attempted to survey all new beneficiaries, but sampled 3,573 experienced beneficiaries, over-sampling those who said they were interested in getting information about the Medicare program so that we would have a sufficient number of responses about the interventions to analyze. However, the sample did include beneficiaries who said they were not interested in receiving such information so that we could generalize the results to all Medicare beneficiaries in Kansas City.

Health Care Industry

Beneficiary Survey-Based Feedback on New Medicare Informational Materials

Health Care Financing Review, Fall, 2001 by Lauren McCormack, A., Steven Garfinkel, A., Judith Hibbard, H., Kerry Kilpatrick, E., William D. Kalsbeek

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