Health Care Financing Review

Consumer Information
Fall 2001, Volume 23, Number 1

CMS’s Consumer Information Efforts
Elizabeth Goldstein, Ph.D.
(Page 1, .pdf, 171 KB)

In this issue of the Health Care Financing Review, we focus on consumer information for the Medicare population. Over the last several years the Centers for Medicare & Medicaid Services (CMS) has increased its efforts to provide clear and useful information to Medicare beneficiaries to help them make more informed health care decisions. The emphasis on consumer information increased dramatically in fall 1998 with the implementation of the National Medicare Education Program (NMEP) called Medicare & You. The goals of the NMEP are to educate Medicare beneficiaries to help them make more informed decisions about Medicare program benefits; health plan choices; Supplemental health insurance; beneficiary rights, responsibilities, and protections; and health behaviors. CMS phased-in the initial implementation of the NMEP in five States—Arizona, Florida, Ohio, Oregon, and Washington State—in order to obtain feedback from beneficiaries and make improvements prior to the national implementation.

Lessons Learned from the National Medicare & You Education Program
Elizabeth Goldstein, Ph.D., Lori Teichman, Ph.D., Barbara Crawley, M.S., Gary Gaumer, Ph.D., Catherine Joseph, and Leo Reardon
(Page 5, .pdf, 530 KB)

In fall 1998 CMS implemented the National Medicare Education Program (NMEP) to educate beneficiaries about their Medicare program benefits; health plan choices; supplemental health insurance; beneficiary rights, responsibilities, and protections; and health behaviors. CMS has been monitoring the implementation of the NMEP in six case study sites as well as monitoring each of the information channels for communicating with beneficiaries. This article describes select findings from the case studies, and highlights from assessment activities related to the Medicare & You handbook, the toll-free 1-800-MEDICARE Helpline, Internet, and Regional Education About Choices in Health (REACH).

Beneficiaries’ Perceptions of New Medicare Health Plan Choice Print Materials
Lauren D. Harris-Kojetin, Ph.D., Lauren A. McCormack, Ph.D., Elizabeth M.F. Jaël, M.P.H., and Karen S. Lissy, M.P.H.
(Page 21, .pdf, 193 KB)

This article presents findings from a study involving seven focus groups with aged and disabled Medicare beneficiaries in the Kansas City area regarding their impressions of a pilot version of the Medicare & You 1999 handbook and the Medicare Consumer Assessment of Health Plans Study (CAHPS) survey report. Beneficiaries generally had positive reactions to both booklets and viewed the hand-book as an important reference tool. Based on the findings, we present policy recommendations for the development and dissemination of Medicare health plan information to beneficiaries.

Beneficiary Survey-Based Feedback on New Medicare Informational Materials
Lauren A. McCormack, Ph.D., Steven A. Garfinkel, Ph.D., Judith H. Hibbard, Dr.P.H., Kerry E. Kilpatrick, Ph.D., M.B.A., and William D. Kalsbeek, Ph.D.
(Page 37, .pdf, 176 KB)

In response to the Balanced Budget Act (BBA) of 1997, the Center for Medicare & Medicaid Services (CMS) initiated a massive information and education campaign to promote effective health plan decision-making. Early results suggest that the pilot version of the Medicare & You handbook and other new Medicare informational materials were viewed favorably overall. Despite their limitations, most beneficiaries found the information useful. The longer, more comprehensive materials were not perceived to be more useful than the shorter, less complicated version. Additional research is needed to determine which sub-groups of beneficiaries may need more and, possibly less, information.

Measuring Beneficiary Knowledge in Two Randomized Experiments
Lauren A. McCormack, Ph.D., Wayne Anderson, Ph.D., May Kuo, Ph.D., Sarah Daugherty, M.P.H., Carla Bann, Ph.D., and Judith H. Hibbard, Dr.P.H.
(Page 47, .pdf, 206 KB)

This article reports results of two studies that measured beneficiaries’ knowledge of the Medicare program and related health insurance options using pre- and post-experimental designs. Knowledge was measured using multiple item indexes before and after receiving new informational materials developed by the Centers for Medicare & Medicaid Services (CMS) as part of the National Medicare Education Program (NMEP). Beneficiaries in both studies showed statistically significant gains in knowledge after receiving the new materials. Policy implications for the measurement of knowledge and creation of future versions of the materials are discussed.

Beneficiary Decisionmaking: The Impact of Labeling Health Plan Choices
Jack Fyock, Ph.D., Christopher P. Koepke, Ph.D., John Meitl, M.A., Sharyn Sutton, Ph.D., Elizabeth Thompson, M.A., and Moshe Engelberg, Ph.D.
(Page 63, .pdf, 245 KB)

One critical health plan decision concerns choosing an original Medicare plan or a Medicare managed care plan. Evidence suggests that people are confused by the phrase "Original Medicare plan." Using focus group and Q-sort methodology, the authors sought to identify a name for the Medicare fee-for-service (FFS) product. Two key insights were gained. First, participants used the word "Medicare" to name the FFS product. Second, participants did not choose between two plans. Rather, they decided between supplemental insurance and a managed care product. These factors should influence how CMS "brands" not only the FFS product but also the overall Medicare program.

Preventing Medical Errors: Communicating a Role for Medicare Beneficiaries
Elaine K. Swift, Ph.D., Christopher P. Koepke, Ph.D., Jorge A. Ferrer, M.D., and David Miranda, Ph.D.
(Page 77, .pdf, 451 KB)

This study used a focus group methodology to examine how Medicare beneficiaries reacted to messages on specific kinds of preventive action, including those adopted by public and private section health organizations. Beneficiaries were asked to rank the messages on their own, and then to discuss their rankings in focus groups. The best-received messages advocated a collaborative patient-provider relationship. They also specified which actions to take, and how to implement them. The authors conclude that public health campaigns to reduce errors need not undermine trust in providers.

Assessing Medicare Beneficiaries’ Readiness to Make Informed Health Plan Choices
Deborah A. Levesque, Ph.D., James O. Prochaska, Ph.D., Carol O. Cummins, M.Ed., M.L.I.S., Sherry Terrell, Ph.D., and David Miranda, Ph.D.
(Page 87, .pdf, 399 KB)

The Transtheoretical Model (TTM, the "stage model") can guide development of pro-grams to increase Medicare beneficiaries’ readiness to make informed health plan choices. In this study, TTM staging algorithms were developed to assess readiness to engage in three types of informed choice: (1) learning about the Medicare program; (2) learning about Medicare health maintenance organizations (HMOs); and (3) reviewing different plan options. Stage of change based on all three algorithms is related to knowledge about the Medicare program and information-seeking. Findings provide evidence for the construct validity of the stage measures and for the applicability of the TTM to informed choice among beneficiaries.

Family Members and Friends Who Help Beneficiaries Make Health Decisions
Shoshanna Sofaer, Dr.P.H., Barbara Kreling, Erin Kenney, Ph.D., Elaine K. Swift, Ph.D., and Tracey Dewart, Ph.D.
(Page 105, .pdf, 184 KB)

People enrolled in Medicare often turn to family members and friends for help in making health decisions, including Medicare health plan choices. To learn how family members and friends participate in decisionmaking, what information they currently use, and what information they would like, we held eight focus groups in San Diego and Baltimore. Although responses were different in the two markets, participants in both cities reported receiving inadequate information and indicated they were largely unaware of available CMS-supported information. Beneficiaries want easy-to-use print materials targeted to their needs and opportunities to participate in seminars and receive personal counseling.

Medicare Beneficiary Satisfaction with Durable Medical Equipment Suppliers
Thomas J. Hoerger, Ph.D., Eric A. Finkelstein, Ph.D., and Shulamit L. Bernard, Ph.D.
(Page 123, .pdf, 204 KB)

CMS has recently launched a series of initiatives to control Medicare spending on durable medical equipment (DME) and prosthetics, orthotics, and supplies (DMEPOS). An important question is how these initiatives will affect beneficiary satisfaction. Using survey data, we analyze Medicare beneficiary satisfaction with DMEPOS suppliers in two Florida counties. Our results show that beneficiaries are currently highly satisfied with their DMEPOS suppliers. Beneficiary satisfaction is positively related to rapid delivery, training, dependability, and frequency of service. Results of our analysis can be used as baseline estimates in evaluating CMS initiatives to reduce Medicare payments for DMEPOS.

Including Hospice in Medicare Capitation Payments: Would it Save Money?
Gerald Riley M.S.P.H., and Charles Herboldsheimer
(Page 137, .pdf, 154 KB)

Hospice services received by Medicare risk-based health maintenance organization (HMO) enrollees are paid on a non-capitated basis, creating financial incentives for HMOs to encourage their terminally ill patients to elect hospice. Using Medicare administrative records for 1998, we found that hospice enrollment in the last month of life was significantly higher among HMO enrollees than among beneficiaries in fee-for-service (FFS). However, low mortality rates among HMO enrollees produced similar population-based rates of hospice use in the HMO and FFS sectors. Simulations showed that including hospice care under capitation payments in July 1998 would have produced very small savings for Medicare.

HEDIS® Performance Trends in Medicare Managed Care
Terry R. Lied, Ph.D., and Steven Sheingold, Ph.D.
(Page 149, .pdf, 237 KB)

The authors analyzed performance trends between 1996 and 1998 for health plans in the Medicare managed care program. Four measures from the Health Employer Data and Information Set (HEDIS®) were used to track performance changes: adult access to preventive/ambulatory health services, beta blocker treatment following heart attacks, breast cancer screening, and eye exams for people with diabetes. Using a cohort analysis at the health plan level, statistically significant improvements in performance rates were observed for all measures. Health plans exhibiting relatively poor performance in 1996 accounted for the largest share of overall improvement in these measures across years.

Reconciling Medical Expenditure Estimates from the MEPS and the NHA, 1996
Thomas M. Selden, Ph.D., Katharine R. Levit, Joel W. Cohen, Ph.D., Samuel H. Zuvekas, Ph.D., John F. Moeller, Ph.D., David McKusick, Ph.D., and Ross H. Arnett, III
(Page 161, .pdf, 313 KB)

This article compares 1996 estimates of national medical care expenditures from the Medical Expenditure Panel Survey (MEPS) and the National Health Accounts (NHA). The MEPS estimate for total expenditures in 1996 was $548 billion; whereas, the NHA estimate for personal health care (PHC) in 1996 was $912 billion. Much of this apparent difference, however, arises from differences in scope between MEPS and NHA—rather than from differences in estimates for comparably- defined expenditures. We adjusted the NHA for differences in included populations and types of services covered, finding a much smaller difference between MEPS and a comparably-defined NHA.