Focus group results from the national evaluation of the Medicare & you 2000 handbook : beneficiaries

47 Pages·2001·1.5 MB·English

by  Roussel, Amy Elizabeth

/RTI
RESEARCH TRIANGLE INSTITUTE
\oo\ Focus Group Results from the
National Evaluation of
Medicare& You 2000 Handbook:
Beneficiaries
February15,2001
Preparedfor:
SherryTerrell,PhD
ProjectOfficer
HealthCareFinancingAdministration
OfficeofStrategicPlanning
UnderContractNo.HCFA500-96-0010TO04
Preparedby:
AmyElizabethRoussel,Ph.D.
DavidDriscoll,Ph.D.
SarahDaugherty,M.P.H.
LaurenA.McCormack,Ph.D.
CMSLibrary
J7-13
•' 7500So
Consultingassistanceprovidedby: B^>-nore,:'
REPORTS JudithH.Hibbard,Dr.P.H.
RA ShoshannaSofaer,Dr.P.H.
412 UteBayen,Ph.D.
.3
F68
2001
3040ComwallisRoad • PostOfficeBox 12194 . ResearchTrianglePark,NorthCarolina27709-2194USA
.
TABLEOFCONTENTS
Page
ListofTables 11
ExecutiveSummary in
1.0 BackgroundandIntroduction 1
2.0 Methods 3
3.0 DescriptionofGroups 6
3.1 Participation 6
3.2 BeneficiaryCharacteristics 6"
3.3 GroupDynamics •
4.0 Results. 11
4.1 Access 11
4.2 Awareness .14
4.2.1 Purpose 14
4.2.2 "OriginalMedicare" 15
4.2.3 Services/Resources 16
4.3 Understanding 17
4.3.1 Self-RatedKnowledge 18
4.3.2 OtherInformationSources 19
4.3.3 WhatIsDifficulttoUnderstand 21
4.3.4 MedicareHMOs 22
4.3.5 CoverageforLong-TermCare 25
4.3.6 QualityofCareInformation 26
4.4 ImpactandUse 29
5.0 ConclusionsandPolicyImplications 32
AppendixA: FinalMedicareandYouBeneficiaryFocusGroupTopicGuide
AppendixB: ScreeningGuidelines
LISTOFTABLES
Page
1 SummaryofBeneficiaryDemographicsbySite 8
2 SummaryofFindings 33
3 Beneficiaries'SuggestionsfortheHandbook 36
Executive Summary
ThisreportsummarizesthefindingsfromthreefocusgroupswithMedicare
beneficiaries.Theoverallaimofthisworkwastocontributetoeffortstoevaluatethe
NationalMedicareEducationProgram(NMEP)byaugmentinginformationcollectedin
thenationalMedicareandYouevaluationsurveythatRTIconductedbetweenJuly1999
andFebruary2000.
Mostfocusgroupparticipantsrememberedreceivingaversionofthehandbookin
thepast,andtheyweregenerallyproficientatnavigatingthehandbooktofind
information.Beneficiariesgenerallyperceivedthatthepurposeofthehandbookwasto
providegeneralknowledgeandinformationabouttheMedicareprogram. Thehandbook
alsoincreasedparticipants'awarenessofHCFA-sponsoredinformationsources,although
manywerereluctanttousetheinternet.Gainsinparticipants'understandingappearedto
beassociatedwiththeperceivedrelevanceoftheissuesaddressed. Thiswasparticularly
apparentindiscussionsregardingmanagedcare,withHMOmemberspayingmore
attentiontothesematerialsthantheirfee-for-servicecounterparts. Thesefindings
suggestthatitwillbechallengingtodevelopeffectivemethodstoassesstheimpactof
theNMEPonbeneficiaryknowledge,asinterestisanimportantinterveningvariable
betweenexposureandgainsinknowledge. Mostparticipantssawthehandbookasa
referenceguide.
in
.
BACKGROUNDANDINTRODUCTION
1.0
ThisreportpresentsthefindingsfromthreefocusgroupswithMedicare
beneficiariesconductedinAprilandMayof2000. Theoverallaimofthefocusgroup
activitywastocontributetoeffortstoevaluatetheNationalMedicareEducationProgram
(NMEP)byilluminatingsurveyfindingsandsuggestingdirectionsforfutureevaluation
initiatives.
RecentchangestotheMedicareprogramincreasethenumberandrangeof
choicesavailabletobeneficiaries. Theneedforeasilyunderstoodinformationabout
Medicareinaformthatbeneficiariesaremotivatedtouseisgreaterthanever. The
NMEPisHCFA'sprogramaimedatmeetingthatneedthroughacoordinatedprogramof
developingusefulinformationalmaterials,makingthemavailabletobeneficiaries,and
motivatingbeneficiariestodrawontheseresourcesinconsideringtheirMedicare
options.
ThegoalsoftheNMEPare:
1 Increasingbeneficiaryaccesstoinformation;
2. Raisingbeneficiaryawarenessofthenewinformationresources;
3. Helpingbeneficiariesunderstandthechoicesavailabletothem;and
4. Helpingbeneficiariesusetheinformationtomakeaninformedchoice.
.
TheresearchobjectivesforthisfocusgroupeffortparallelthefourNMEPgoals.
Theobjectiveswereasfollows:
1 Discussbeneficiaries'accesstoMedicare&Youandotherinformation
sources.
2. Explorebeneficiaries'awarenessofthepurposeofthehandbook,the
meaningofOriginalMedicare,andtheservicesavailabletoaidin
decision-making.
3. Illuminatebarrierstobeneficiaries'understandingofMedicare,Medicare
HMOs,coverageforlong-termcare,andqualityindicators.
4. Learnhowbeneficiariesusedthehandbook,andwhataspectstheyfound
mostuseful.
Section2ofthisreportoutlinesthemethodsthatwereusedindesigning,
conductingandanalyzingthefocusgroups,whileSection3offersadescriptionofthe
groupsandparticipants. ThefocusgroupfindingsarepresentedinSection4,organized
alongtheconceptualframeworkoftheNMEP: access,awareness,understandingand
use. InSection5weofferasummaryandconclusions.
METHODS
2.0
Focusgroupstookplaceoverafour-weekperiodfromlate-Apriltomid-May
2000. Thepurposeofthefocusgroupswastoaugmenttheinformationcollectedinthe
nationalMedicare&YouevaluationsurveythatRTIconductedbetweenJuly1999and
February2000. Thegeneraltopicareasweredevelopedtomeettheresearchobjectives
outlinedabove. ThetopicguideisincludedinAppendixA.
Onefocusgroupwasconductedineachofthreelocations: Boston,Memphis,and
Denver. Theselocationswerechosentorepresentvaryingdifferentlevelsmarketswith
differentlevelsofmanagedcareexperience;weexpectedparticipantsinthethreeregions
tohavedifferentexperiencesandexpectations. Allthreemetropolitanregionscontainat
least100,000beneficiaries,andaredifferentiatedbyMedicaremanagedcarepenetration
rates. Memphishaslessthana1%MedicareHMOpenetrationrate,Bostonhas26%,
andDenverhas49%ofMedicarebeneficiariesasmembersofHMOs.
ThegroupswereconductedattheofficesoflocalrecruitingfirmshiredbyRTI.
ThenamesandrecruitmentprotocolforeachfirmareshowninAppendixB.
Thefocusgroupsvariedinsizefrom8to11participants. Allparticipantswere
sentacopyoftheMedicare&You2000handbookbyFederalExpresstwotofivedays
priortothesession. Therelativelyshortintervalbetweenreceiptofthehandbookandthe
1"MedicareEnrollmentbyStateandCountyofBeneficiaryResidence"updatedJuly8,1999
(http://www.bcfa.gov/stats/cnty98en.pdf).
3
dateofthefocusgroupwasintendedtominimizethepotentialforparticipantslosingor
forgettingthehandbooks. Thisshortinterval,alongwithanenclosedletterremindingthe
participantstobringthehandbooktothemeeting,hadtheadditionalunintended
consequenceofgivingparticipantstheimpressionthatthehandbookwasthesubjectof
theinterview. Participantsinallthreebeneficiaryfocusgroupsdemonstratedatendency
toreturntothehandbookevenwhenaskedtodiscussoverallperceptionsandconcerns
regardingtheMedicareprogramingeneral.
Usingthelopicguide,atrainedmoderatorguidedparticipantsthrougha
discussiononthepredeterminedsetoftopicsandencouragedthemtoexpresstheir
opinionsandexperiences. Aco-moderatorwasalsopresenttoobserveandrecordnotes
onverbalandnon-verbalexchanges. Thesessionswerevideotaped. Eachgrouplasted
about2hours,andaftertheintervieweachMemphisparticipantreceiveda$40cash
incentive,whileeachBostonandDenverparticipantreceived$50asatokenof
appreciationfortheirparticipation.2 Followingeachfocusgroup,themoderatorandco-
moderatordebriefedpriortocompletingadebriefingformtodocumentmainthemesand
illustrativeparticipantquotes. Thesedebriefingforms,aswellasthenotescollectedby
themoderatorandco-moderatorduringtheinterviews,wereanalyzedforcommon
themesanddifferencesamongthegroups.
Unlikeasamplesurvey,focusgroupscannotbegeneralizedtoalarger
population. Inaddition,groupdynamicsofanyonegroupcanproduceabias,sincesome
peoplemayspeaklessbecauseofothersoragroupmaybeswayedbytheopinionsof
2Paymentamountsvariedduetodifferentcostsoflivingandprevailingnormsinthethreecommunities.
4
oneortwostrongparticipants. Atthesametime,focusgroupsarearichdatasource
throughwhichwecanobtainin-depthfindingsthatmayhelpexplainorenhancethe
findingsfromthequantitativedataanalyses. Whilewecannotgeneralizethefocusgroup
results,ourconfidenceinfocusgroupfindingsincreasestotheextentthatpatterns
emergeregardlessofgroupdynamicsorlocation. Thesamemoderatorpresidedoverall
threegroups,sovariationsbymoderatorarenotanissue.
3.0 DESCRIPTIONOFGROUPS
3.1 Participation
Allelevenrecruitedbeneficiariesattendedthefocusgroupdiscussionin
Memphis,tenofthetwelvebeneficiariesrecruitedinBostonparticipated,andeightofthe
ninerecruitedbeneficiariesinDenverwereinattendance. Thelowno-showrate
suggestedtheenthusiasmforparticipatingin*v-focusgroupdiscussionair-gMedicare
beneficiarieswasstrong. Whilesomeparticipantshadbeenapartofotherfocusgroups,
noonehadbeenpreviouslyinvolvedinahealth-relatedfocusgroup.
3.2 BeneficiaryCharacteristics
Weachievedawellbalanceddistributionofseveraldemographiccharacteristics,
primarilygender,age,andeducationalattainment,inthethreefocusgroups(seeTable1).
Incontrast,racialandethnicdiversityinthefocusgroupswastheprimarydemographic
characteristicthatwaslacking. Thedemographicdistributionsobservedinthevarious
focusgroupsmaybeareflectionofthelimitationsintherecruitingfirms'databasesused
toselecttheparticipants. Thecharacteristicsofthefocusgroupparticipantsarealso
likelytoreflectthegeneraldemographicsinthecitieswherethefocusgroupswere
conducted.