Using an online decision aid to help medicare beneficiaries choose a prescription drug plan / M. Kate Bundorf [and six others].

Format:

Book

Author/Creator:

Bundorf, M. Kate, author.

Series:

Final research report (Patient-Centered Outcomes Research Institute (U.S.))

Language:

English

Subjects (All):

Decision making.

Physical Description:

1 online resource (105 pages) : illustrations.

Place of Publication:

Washington, D.C. : Patient-Centered Outcomes Research Institute (PCORI), 2019.

Summary:

BACKGROUND: The introduction of the Medicare Part D prescription drug benefits dramatically increased coverage for prescription drugs among Medicare beneficiaries. Part D's design, however, requires beneficiaries to choose among private plans, creating new challenges for consumers. Beneficiaries often report that choosing a plan is difficult, and research has raised concerns over decision quality in plan choice. Little evidence exists, however, on how to facilitate decision-making and improve decision quality in this context. OBJECTIVE: To develop and evaluate tools to help Medicare beneficiaries choose among Part D prescription drug plans. The project had the following specific aims:1. To develop a method to automate the presentation of individually customized information on the financial consequences for Medicare beneficiaries who enroll in different Medicare Part D stand-alone prescription drug plans2. To develop a patient-centered decision tool in partnership with patient and provider stakeholders to communicate information to Medicare beneficiaries about Part D prescription drug plans (CHOICE)3. To determine whether providing Medicare beneficiaries with a patient-centered decision tool improves patient outcomes METHODS: The study population included people aged 66 to 85 years enrolled in a Part D plan who received their care from the Palo Alto Medical Foundation (PAMF), a large multispecialty practice in northern California. Using data on drug prescribing from PAMF's electronic health record (EHR), we developed, in collaboration with patient and provider stakeholders, a patient-centered tool to provide personalized information on patients' coverage alternatives (CHOICE). We conducted 4 studies from 2014 to 2018. To inform tool development, we conducted a focus group study of Part D decision-making, an ethnographic study of how beneficiaries used the existing, publicly available tool developed by the Centers for Medicare & Medicaid Services (CMS), and a comparative usability study of the CMS tool (Medicare.gov's Plan Finder) relative to 3 prototypes of CHOICE. We evaluated the effectiveness of the CHOICE tool in a randomized controlled trial conducted during the fall 2016 open enrollment period. We compared 2 final versions of the CHOICE tool, one with expert recommendations and the other without, against the control that directed beneficiaries to publicly available resources. The primary study outcomes were (1) plan switching, (2) change in expected spending on prescription drugs, (3) satisfaction with the choice process, and (4) decisional conflict. RESULTS: Access to the CHOICE tool increased rates of plan switching, particularly for people who used the version of the tool with expert recommendations. Of people randomized to the CHOICE tool with expert recommendations, 36% switched plans during open enrollment, compared with 31% randomized to the CHOICE tool without expert recommendations and 28% in the control arm. The difference in switching rates of the CHOICE tool with expert recommendations relative to control arm was statistically significant at p = 0.04. Similarly, the proportion of study participants who reported that they were very satisfied with the choice process was greater in the expert recommendation arm (0.47) than the control arm (0.39) (p = 0.05). While estimated reductions in spending on prescription drugs, including premiums, were larger in both treatment arms than in the control arm, the differences were not statistically significant. We found no evidence of differences in decisional conflict across arms. CONCLUSIONS: A patient-centered, online tool with personalized information and expert recommendations may increase satisfaction with the choice process and rates of plan switching among people enrolled in Medicare Part D stand-alone plans. Additional research is necessary to determine whether and how to engage more people in evaluating their coverage options and to determine the best approaches for more diverse groups. STUDY LIMITATIONS: The study population comprised people with relatively high levels of income and education who also were relatively computer savvy, based on their prior use of an electronic patient portal.

Contents:

Background

Participation of Patients and Other Stakeholders

Methods

Results

Discussion

Conclusions

References

Related Publications

Acknowledgments

Appendices.

Notes:

Description based on publisher supplied metadata and other sources.