are beginning to organize information in terms of groups of information, for example, including all data on women's health indicators (e.g., mammography rates) together. Eventually, organizations will be presenting qualitative data using an evaluative approach in which algorithms and weighting systems will be applied to the data. These systems will allow some plans to be favored over others. This final way of presenting information is being developed by the Foundation for Accountability and other similar organizations.

  1. The issue of using standardized information versus customized information. Throughout the workshop the notion of "mass customization" was mentioned. With mass customization, information is tailored to appeal to the interests and concerns of different groups of Medicare beneficiaries. Information experts argued that this type of information dissemination is easier to do over the Internet than in print. The senior population at present, however, favors print materials over the Internet's resources. The committee was advised to tell HCFA to establish prototypes for displaying and disseminating information that would encourage private-sector creativity but that would still enable plans to let beneficiaries know that "we are standard in these ways, but not in these."
  2. Targeting of the correct audience is important. The Medicare population is very heterogeneous. When disseminating information it is critical to avoid stereotyping, particularly by age, dependency status, and health status. Research indicates that those with technically poor health status sometimes perceive their own health to be better than it really is.
  3. Developing information for the short term versus the longer term. Creating information for the immediate deadline of November 1998 is a first step. The real issues will be played out over the next 5 years. It is critical not to do anything in the short term that must be undone in order to do it right in the long-term. Some information experts encouraged the committee to look at the development of information in generational terms. The expectations of the generation currently in or just entering Medicare will be vastly different from those of the baby boomers and younger generations when they enter the Medicare program.*


Contract management is a critical issue for HCFA. Under Medicare+Choice, many new plans (and types of plans) will be entering the Medicare marketplace. Several of these plans will be small and largely untested. The potential for error is great. Presenters examining the implementation issues for Medicare+Choice encouraged HCFA to tighten its contract management procedures so that it could quickly step into a bad situation. HCFA was also encouraged to follow the example of the Office of Personnel Management and the Federal Employees' Health Benefits Plan and put more of the burden for good performance and conduct on the health plans themselves.

The plans need to be accountable for providing good and complete information to beneficiaries. If people are not getting the medical care they need, the language translation services promised to them, or the disease management program advertised to them, it should be the plan's responsibility to correct these errors before HCFA steps in with severe punitive measures. The committee heard that it is unreasonable to expect a government agency to manage with a slim


Carol Cronin.

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