• Promoting health care system innovation, which is the charge of the new Center for Medicare and Medicaid Innovation.

Funderburk’s team at CMS focuses on using social marketing techniques supported by rigorous consumer testing, an approach that is applicable to both health literacy and to the ACA implementation goals.

Social Marketing

Vulnerable populations within Medicare, Medicaid, and CHIP include patients who are disabled (dual eligible) or have chronic diseases, seniors, low-income individuals and families, and people with low English proficiency. By taking a social marketing perspective in trying to reach these diverse audiences, CMS takes into account health literacy, culture, language, attitudes, perceptions, and “consumer reality,” that is, consumer needs, values, beliefs, motivations, and behaviors. The goal is to identify barriers to individuals taking a more active role in their personal health care. CMS is using plain language and consumer-centered design in its products and materials, and conducting extensive testing of materials and messages. Funderburk referred participants to a recently developed and disseminated CMS toolkit for making written materials more user friendly (http://www.cms.gov/WrittenMaterialsToolkit). A campaign team then helps to develop outreach activities for both general audiences and targeted audiences. An important part of the process is evaluating the behavioral impact of the marketing campaigns, and then refining and repeating the process.

CMS is using social marketing to improve communication activities that are particularly relevant to implementation of the ACA, including communications related to discharge planning, CHIP enrollment, and understanding Medicare choices. One of the specific audiences CMS has been trying to reach is the 2-3 million people who are eligible for, but have not enrolled in, low-income subsidy. This provides them with Medicare Part D prescription drug coverage at no, or very low cost, depending on their income level. CMS has conducted extensive focus groups and individual interviews with a variety of audiences, as well as an experimental field test of direct marketing techniques, to see if the agency could achieve a measurable impact in the number of people in this target audience applying for the subsidy benefit. The data suggest that a carefully constructed CMS letter can increase the application rate for the low-income subsidy if it is written in plain language, provides very simple steps to follow, and includes the phone number of a local contact person. More labor intensive approaches, including one-on-one assistance, were not substantially more effective than the letter, and are much more expensive.

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