Helping Consumers Choose Health Plans

Sandra Robinson, M.S.P.H., Acting Director, Center for Quality Measurement and 
Improvement, HHS Agency for Health Care Policy and Research 

We provide content and want to build the knowledge base -- but what
you may not know is that we have an Internet project.  Today we also
have a small business innovation project that both develops tools to
help consumers and focuses on Medicaid and low income users.  We
will talk about how to reach low income people, and ways to serve
mixed populations.

The purpose of this discussion is to give you a background on our
work on the Kiosk project, detail some of the development issues,
then run through a prototype demonstration on the Kiosk project.

Our purpose is to help people make informed choices on heath plans.
We are an information and enrollment health broker which offers
choice counseling; we give people the information they need to help
them through the choice process, but the purpose is not to tell them
which plan to use, of course.
We have call centers, and this is the way the majority of people
reach us --they use the phone.  We do seminars and one-on-one
counseling.  Some states do one of these options of information
dissemination or they do a mixture of them.

Now we are developing new methods, including cable access which link
videos to the consumer.  We are looking at using a Web site on the
Internet.  Most groups encourage the use of the Internet.

Now let's look at the Kiosk.

On the Kiosk project, the purpose is to provide information through
an integration of our other selections of media.  We are integrating
quality data into traditional data (names of health care providers,
the price of premiums and the co-payments, etc.).  We are doing this
in Oregon with a satisfaction survey.  We well have an enrollment
module, where we can offer enrollment online.  We have limited the
access to those on Medicare, and we appeal to young families.

We are going to integrate consumer preferences to them -- the
computer will ask them, "What are your values ?" to subscribe a
patient to a custom plan.

This system provides another way to get information out.  Also
people don't like reading, and it is entertainment.  It increase
information available to health care consumers.  With the Kiosk
system the people can chose the information to read.  It can
eliminate inaccessibility to hard to reach areas.  You can have
Kiosks in malls and they are not limited to 9 to 5 working hours.

We have multiple plans, varied audiences, the quality of information
is integrated -- a tricky issue -- and we allow access to data.

Regarding the target audience -- we have made information available
to those with minimal reading levels.  We even have audio options.
We have multiple language audiences, but it is often too expensive
to implement.  But we have a Spanish line.  The phone service allows
access for those who speak other languages as well.  Each person has
a different set of issues to study.

We have gone through process of hiring a multimedia developer.
Microsoft has such parallels to our own process -- the users are
women, vegetarian, emotional, etc., and the developers are male,
analytical, etc.  The coding for multimedia is very complex.  The
color is very difficult to change.  Be aware!

Kiosk development is a new animal.  You spend 6 months developing
the steps.  We are still designing the steps.  We have walk throughs
and give feedback and critical analysis.  We expect to be completed
by next winter.  It is a time consuming development process.

When developing the Kiosk, you have to think in terms of sitcoms for
the audiovisuals.  People can only sit for 8 to 10 minutes.

Plans are fighting among themselves because of the plan comparisons
on line.  The advocates project is providing decision making tools
for minorities and their families.  A company whose employees we
worked with offers a small health plan, and the workers are 40%
minor and majority are illiterate.  There is a lot of anxiety and
frustration among these people.  We have not found confidences among
people on Medicaid and low income workers.  Plans are unreadable.
We've been monitoring a help line.  When they are told to contact
their primary care physician first, we are told that is crazy.  It
will be hard to explain health plans to them.

We have seen what the quality is of the information.  The media
frightens them -- or it consoles them.  Don't worry, you're covered.
We have gotten a lot of feed back.  The state workers are not giving
people health information frequently.  Doctors cannot keep up with
the plans or the providers.  More reliance is seen on social
services.

When we looked at the plans and what people needed to know about the
plans we found very little recognition of the plan, no recognition
of health history, and no ability to use the brochures.  People also
don't want to wait for voice mail.  If we are going to address the
issue of equity, we will have to be educators as well as information
users.  In our new literature we actually teach people about the
plan.

Our material is empirically tested over and over and over again.  In
the early stages of phase one I reported that the material is not
teaching about managed care and that the choices people make can
backfire.

[shows video]

We are working on a survey that will be shared with the consumers.
The consumers will participate fully in the survey.  We will be the
first to share the data publicly.  We will be showing some of that
data, and it is very positive data.

The beauty of the Kiosk is that it will make the process of
selecting a provider so easy.  Also we can track where people get
hung up in the selection process -- wherever people spend most of
their time -- and we will have an exit survey asking the user to
rate the program.

[shows video]

[testing the computer and audiovisuals]

Data is difficult to get.  We did not receive complete addresses and
other data information from any providers in Connecticut or in
Oregon.  We had to do a lot of "fill in the blanks."

We can download information on any frequency.  This will increase
the avail of data.  It is a very complex process.  The technology is
there, but the information is not.  Data is updated on a monthly
basis, but PPP availability is constant.

We want to know about we can't get in a valid way.  If anything on
the screen is contested, we need a valid reference.  We use the
state approved health plan handbook.  We do not want to get into the
gray areas and battles with health plans about the benefits that are
not empirical.

One final comment about working cross culturally: You have to take
into consideration the modes of communication and the language
barriers.  In communicating with members of some Southeast Asian
communities, talking about an emergency and taking someone to the
hospital is a problem based on language use -- the word "hospital"
is commonly translated as "house of death."  This is a problem --
our problem to deal with -- not theirs.