Communicating with Consumers about Health Insurance Options at Healthcare.gov  Frank Funderburk, Diane Field Office of Com...
Background <ul><li>Health reform brings changes for health insurance options of consumers </li></ul><ul><li>Providing clea...
Requirements of Portal <ul><li>Broad scope </li></ul><ul><ul><li>Diverse “target audiences”  </li></ul></ul><ul><li>Comple...
Environmental Scan
Environmental Scan: Who are the Uninsured? <ul><li>Most of the uninsured are in low income working families and do not hav...
Relevance of Health Literacy <ul><li>Supporting informed consumer decision-making </li></ul><ul><li>Encouraging use of dec...
Social Marketing Research Helped Achieve Health Insurance Portal Goals <ul><li>Understand target audience – health literac...
Some Guiding Principles Applied to Portal Development Activities <ul><li>Consumer Centric vs. Information Centric </li></u...
Taking the Journey Part 1
Taking the Journey Part 2
Insurance Web Portal Formative Research
Feelings About Being Uninsured  <ul><li>We Heard: </li></ul><ul><li>Fear and worry </li></ul><ul><li>Uninsured - unanticip...
Expectations & Questions <ul><li>We Heard: </li></ul><ul><li>Hopeful, but skeptical.  </li></ul><ul><li>Who determines aff...
Credible Information Sources <ul><li>We Heard: </li></ul><ul><li>Government sites are trustworthy, but not easy to underst...
Generating Interest and Motivating Consumers <ul><li>We Heard: </li></ul><ul><li>Need for personally-relevant, timely info...
What Makes a Good Web Experience? <ul><li>We Heard: </li></ul><ul><li>It meets my needs, it’s intuitive, easy to navigate,...
Words & Tone <ul><li>We Heard: </li></ul><ul><li>Coverage has more appeal than insurance.  </li></ul><ul><li>Words to repe...
Initial Usability Testing
Welcome!
Find Your Options
Learn More About Your Options
Learn About Available Insurance Plans
Compare Plans and Options
Improving Consumer Understanding
Next Steps: Improving Consumer Understanding
Ongoing Metrics and Monitoring
Additional  Metrics and Monitoring
A Model for Website Assessment
A Look Ahead  <ul><li>Our work will continue to improve the ability of consumers to navigate the evolving healthcare syste...
Author Contact Information <ul><li>Frank Funderburk </li></ul><ul><li>Director, Division of Research </li></ul><ul><li>Off...
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Funderburk field et al communicating with consumers nchcmm 8 11-11

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This deck discusses how consumer-focused research can be used to help consumers make better health insurance choices

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  • Paper presented at National Conference on Health Communication, Marketing and Media. Atlanta, GA August 11, 2011. Note: The statements expressed here are those of the authors and do not necessarily reflect the views or policies of CMS
  • Bullet 2 – Source: Consumer Decisionmaking in the Insurance Market, RAND Health Research Highlights, 2006. Helping people find appropriate health insurance information and simplifying application process can increase enrollment as much as modest premium subsidies (e.g., Marquis et al., 2006)
  • Audiences include: chronically uninsured, recently unemployed who lost employer coverage, parents/guardians of young children, people previously denied coverage because of pre-existing conditions, high-risk pool participants, individual market, small business market (employers and employees of small businesses). What are key initial target audiences? Our suggestion is adults 26 – 64 who are currently uninsured (or have been uninsured for at least 2 months during the past year?), internet users, some use of web tools (e.g., consumer reports, feature comparisons) would be ok, less than completed college, mix of gender, race, ethnicity. According to Congressional Budget Office estimates nearly all of the individual exchange customers in 2014 are expected to be previously uninsured – These people need a mental model for starting to think about what health insurance is, how it works, why it is important to them, and what to expect. The map is useful, but it is not the terrain. The portal must accommodate to changes due to new benefits that are to be phased in, state programs with differing eligibility requirements, etc. More information is not always better. People can be overloaded with information that is irrelevant to their decision-making, or incompatible with their cognitive abilities. The portal should assist consumers in sorting the information to present the right information at the right time in a manner that the consumer can understand it and use it to improve decisions. Audience segmentation is a key to getting this right, and it will be an ongoing effort throughout the process of implementation.
  • According to Congressional Budget Office estimates nearly all of the individual exchange customers in 2014 are expected to be previously uninsured – These people need a mental model for starting to think about what health insurance is, how it works, why it is important to them, and what to expect. The map is useful, but it is not the terrain. A variety of decisional biases can also result in poor choices – e.g., availability heuristic [ease of recall, retrievability, presumed associations], representativeness heuristic [ignoring base rates, sample size &amp; reliability, misconceptions of chance/probability], anchoring and adjustment biases [insufficient anchor adjustment, overestimating probability of conjunctive events and underestimating the probability of disjunctive events, overconfidence], confirmation bias, hindsight, status quo bias. These should also be considered and addressed as part of a health communications strategy.
  • Data for bullet 1 come from analysis of census data Bullet 2 is based on literature scan Bullet 3 is based on DR experiences with LIS, Medicaid/CHIP, and Part D campaigns and is supported by a variety of peer-reviewed articles and commentaries. According to Congressional Budget Office estimates nearly all of the individual exchange customers in 2014 are expected to be previously uninsured – These people need a mental model for starting to think about what health insurance is, how it works, why it is important to them, and what to expect. The map is useful, but it is not the terrain.
  • Health literacy – broadly defined – is another factor leading to poor decisions. Understanding which segments of the audience will need training in skills to effectively use health insurance information will be a key issue in segmentation studies.
  • Social marketing is centered on understanding the target audience -- Understand “consumer reality” Values Beliefs Needs Behavior Barriers Motivations Reactions to key concepts Literature review/Environmental scan (What is already out there? How can we learn from it?)
  • Consumer centric includes consideration of health literacy, but this must be defined broadly to encompass more than text-based materials. Web literacy, e-literacy, financial literacy, media literacy, insurance literacy, etc. – all are relevant. Portal is seen as flexible and continuously evolving Recently developed and disseminated a toolkit for helping to make written materials useful and understandable – a plain language and consumer-focused design orientation ( http://cms.hhs.gov/WrittenMaterialsToolkit ) Social marketing supported by rigorous consumer testing plays a key role in achieving both health literacy and Affordable Care Act goals
  • Experience and information is designed to engage consumers as they move through the portal, matching their information needs with concrete information that they can use (as opposed to general abstract concepts that they need to translate).
  • Show how the information and tools can provide tangible benefits that are valued by the consumer. Can we engage consumers as co-creators, not just “end users?” How can we maximize the value of their feedback?
  • Our goal was to ensure that the web portal development remained consumer-centric so that it would be useful to the intended audience. Health literacy concepts were an essential component of our strategy. Improved user experience and ability to engage people “where they were” with context-sensitive options to drill down for more details was also part of the process. Next sections will review what we learned from initial consumer testing. Approaches to formative research waves: Focus groups with audience segments (What to call it? What will motivate you to go there? What will be most [least] helpful?) In-depth interviews (How can we improve navigation? Why did you go there?) Cognitive testing (Was that understood?) Review of partner portals (What is already out there? How can we learn from it?)
  • Eighteen small group discussion with 73 participants 45 interested uninsured, 10 insecure insured, 18 small business owners
  • Show progression from wireframes illustrating concepts to functioning web site based on rapid turn around research, prototyping, and testing
  • The welcome screen is inviting, includes personas that lead to informational resources or an option to explore coverage options
  • Options screen asks non-threating questions in a simple format to help tailor content to the individual.
  • Options are presented in plain language terms and are narrowed based on information previously provided
  • Plans can be browed, sorted, and explored in a standardized format
  • On October 1 consumers were be able to make side-by-side comparisons of private insurance plans that could be of interest to them. Consumer testing and feedback helped to improve the interface, testing ways to convey limitations in information that could be provided, helping to focus choice option on a smaller set of plans most likely to be appropriate for the individual.
  • Some of our work has focused on improving consumer understanding of information available to them. This slide shows a mock-up of a tutorial that is being evaluated and refined.
  • The goal of the tutorial is to provide more detail on how to use the available information to improve decisions. The focus remains on how to keep the consumer as the central focus of the product from inception through evaluation. We tested understanding of language and descriptions, especially those that helped consumers to understand that the premium estimates were subject to variability, that not all who applied were accepted at the quoted rate, and that some were denied this plan all together.
  • We are monitoring a variety of common web use metrics for both the Healthcare.gov entry point and the more detailed insurance portal. In August 2010 the site had recorded about 1.3 M visits, and over 4 M views.
  • We are also able to visualize the areas of the portal that are of most interest, as illustrated in this “heat map.” We can track the paths that people take during the course of their journey through the portal.
  • This slide depicts a model for evaluating and improving a website. The model examines the effects of various aspects of the web site on selected outcomes related to consumer perception of the site. In particular, the model is predictive and shows how much outcome factors like site success, overall impression, and likelihood of recommending site to others will advance if improvements are made to various drivers (noted as level 1, level 2, or level 3). Level 1 drivers are based on background features such as appearance (e.g., colors used, good mix of text and graphics) and performance (e.g., pages load quickly, links take me to the appropriate place, availability when needed). Level 2 drivers involve participant interaction with the site features such as content, interactivity, navigability, and search functions (e.g., content was useful, entering information was easy, information was easy to find, search results were relevant). Level 3 drivers summarize the joint effects of the prior levels with a focus on site success (e.g., able to accomplish what was needed, able to understand information). Outcomes are generally one additional step removed and reflect consumer satisfaction and the likelihood of returning to the site in the future or recommending it to others. Typically scores for each component are developed based on responses to a small number of questions administered via questionnaire. The model allows one to assess the extent to which the site is effective as well as the specific features of the site that are most important to a specific group of users. The model further allows one to predict the amount of improvement in effectiveness that could be achieved by through enhancement of various site features. This can help guide cost-effective quality improvement for the site over time.
  • Continued research to develop and refine a consumer-based communication strategy Understand “consumer reality” Values, beliefs, needs, behavior, barriers, motivations, reactions to key concepts Quantitative research to model factors related to satisfaction, optimal decision-making, audience segmentation, and web site quality improvement.
  • Funderburk field et al communicating with consumers nchcmm 8 11-11

    1. 1. Communicating with Consumers about Health Insurance Options at Healthcare.gov Frank Funderburk, Diane Field Office of Communications Centers for Medicare & Medicaid Services Mark Richards, Nanci Banks & Tanya Feinstein KRC Research, Inc. National Conference on Health Communication, Marketing & Media, August 11, 2011 Note: The statements expressed here are those of the authors and do not necessarily reflect the views or policies of CMS
    2. 2. Background <ul><li>Health reform brings changes for health insurance options of consumers </li></ul><ul><li>Providing clear information that people can use to make the best of their options is critical to success </li></ul><ul><li>PCCA, Section 1103 called for CMS to establish a web portal to provide insurance information to individuals and small businesses by July 1, 2010 </li></ul>
    3. 3. Requirements of Portal <ul><li>Broad scope </li></ul><ul><ul><li>Diverse “target audiences” </li></ul></ul><ul><li>Complex and changing information needs </li></ul><ul><li>Information alone is not enough </li></ul><ul><li>Design with attention to form and context of information provision </li></ul><ul><li>Tailored to needs and cognitive styles of audience(s) </li></ul>
    4. 4. Environmental Scan
    5. 5. Environmental Scan: Who are the Uninsured? <ul><li>Most of the uninsured are in low income working families and do not have access to employer-sponsored care. </li></ul><ul><li>Little is known about factors that contribute to the decision to remain uninsured, apart from those attributed to economic barriers. </li></ul><ul><li>Other perceptual and attitudinal barriers are likely present and will need to be addressed to improve outreach success rates and optimize program benefits. </li></ul>
    6. 6. Relevance of Health Literacy <ul><li>Supporting informed consumer decision-making </li></ul><ul><li>Encouraging use of decision tools </li></ul><ul><li>Standardization of insurance plan information </li></ul><ul><li>Improving outreach to diverse, low literacy consumers </li></ul><ul><li>Improving consumer-“navigator” communication </li></ul><ul><li>Understanding eligibility for and operation of subsidized coverage </li></ul>
    7. 7. Social Marketing Research Helped Achieve Health Insurance Portal Goals <ul><li>Understand target audience – health literacy, culture, language, values, attitudes, perceptions, “consumer reality” </li></ul><ul><li>Identify barriers and facilitators </li></ul><ul><li>Use plain language and consumer-centered design </li></ul><ul><li>Test materials and messages </li></ul><ul><li>Develop campaigns and outreach </li></ul><ul><li>Evaluate behavioral impact </li></ul><ul><li>Refine and repeat process </li></ul>
    8. 8. Some Guiding Principles Applied to Portal Development Activities <ul><li>Consumer Centric vs. Information Centric </li></ul><ul><li>Design considers consumers’ health literacy, attitudes, needs and values and cognitive information processing limitations </li></ul><ul><li>Focus on engaging consumers by matching information with needs </li></ul><ul><li>Ongoing consumer testing and consumer engagement is viewed as central to success </li></ul>
    9. 9. Taking the Journey Part 1
    10. 10. Taking the Journey Part 2
    11. 11. Insurance Web Portal Formative Research
    12. 12. Feelings About Being Uninsured <ul><li>We Heard: </li></ul><ul><li>Fear and worry </li></ul><ul><li>Uninsured - unanticipated illness or accident </li></ul><ul><li>Insured - losing coverage </li></ul><ul><li>Employers - not being able to attract/retain employees or afford coverage </li></ul><ul><li>Implications: </li></ul><ul><li>Value of coverage is peace of mind, security. </li></ul><ul><li>Interest in affordable coverage is high. </li></ul>
    13. 13. Expectations & Questions <ul><li>We Heard: </li></ul><ul><li>Hopeful, but skeptical. </li></ul><ul><li>Who determines affordability? </li></ul><ul><li>How will this affect me? What will it cover? </li></ul><ul><li>Will I understand what I’m getting? </li></ul><ul><li>Implications: </li></ul><ul><li>Must set reasonable expectations </li></ul><ul><li>Provide basic information to consumers with little or no experience with health insurance. </li></ul><ul><li>Use clear plain language not jargon </li></ul>
    14. 14. Credible Information Sources <ul><li>We Heard: </li></ul><ul><li>Government sites are trustworthy, but not easy to understand or use. </li></ul><ul><li>Social networks and community sources provide support to allay fears about biased or inaccurate information </li></ul><ul><li>Implications: </li></ul><ul><li>Opportunity exists to exceed expectations – </li></ul><ul><li>This site can help consumers make more confident decisions, but must avoid traps of jargon, overly detailed content, and perceived bias </li></ul>
    15. 15. Generating Interest and Motivating Consumers <ul><li>We Heard: </li></ul><ul><li>Need for personally-relevant, timely information </li></ul><ul><li>Potential source of confusion – that site will just push government-run insurance </li></ul><ul><li>How can I afford insurance? </li></ul><ul><li>Implications: </li></ul><ul><li>Stress tailoring of factual and authoritative information to the individual </li></ul><ul><li>Site as a “clearinghouse” for both public and private plans. </li></ul><ul><li>Emphasize what can be done now to improve affordability </li></ul>
    16. 16. What Makes a Good Web Experience? <ul><li>We Heard: </li></ul><ul><li>It meets my needs, it’s intuitive, easy to navigate, simple, easy to search, flexible, credible, up-to-date, accurate. </li></ul><ul><li>Implications: </li></ul><ul><li>Consumers have clear expectations for web experiences and will leave a site that does not measure up. </li></ul><ul><li>Do it right or they won’t come back! </li></ul>
    17. 17. Words & Tone <ul><li>We Heard: </li></ul><ul><li>Coverage has more appeal than insurance. </li></ul><ul><li>Words to repeat – affordable, peace of mind, security, options, choices, “your needs,” insurance marketplace. </li></ul><ul><li>Words to avoid – jargon (e.g., high risk pools, federal poverty level, exchanges) and slick, “feel good” marketing hype. </li></ul><ul><li>Implications: </li></ul><ul><li>Be positive and factual, transparent, anticipate and explain negatives. </li></ul>
    18. 18. Initial Usability Testing
    19. 19. Welcome!
    20. 20. Find Your Options
    21. 21. Learn More About Your Options
    22. 22. Learn About Available Insurance Plans
    23. 23. Compare Plans and Options
    24. 24. Improving Consumer Understanding
    25. 25. Next Steps: Improving Consumer Understanding
    26. 26. Ongoing Metrics and Monitoring
    27. 27. Additional Metrics and Monitoring
    28. 28. A Model for Website Assessment
    29. 29. A Look Ahead <ul><li>Our work will continue to improve the ability of consumers to navigate the evolving healthcare system, make better decisions, and find appropriate and affordable health care coverage. This work contributes to both Agency and Department goals and supports the concept of “patient-centered care” for the 21 st century. </li></ul>
    30. 30. Author Contact Information <ul><li>Frank Funderburk </li></ul><ul><li>Director, Division of Research </li></ul><ul><li>Office of Communications </li></ul><ul><li>410-786-1820 </li></ul><ul><li>[email_address] </li></ul>

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