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Medicare Beneficiaries' Stage of Readiness to Learn About Medicare Health Maintenance Organizations: 1997
Source publication
The Transtheoretical Model (TTM, the "stage model") can guide development of programs to increase Medicare beneficiaries' readiness to make informed health plan choices. In this study, TTM staging algorithms were developed to assess readiness to engage in three types of informed choice: (1) learning about the Medicare program; (2) learning about Me...
Context in source publication
Context 1
... illustrated in Figure 3, beneficiaries, as a group, were far less ready to learn about the availability and benefits of Medicare HMOs. Based on the second algorithm, 44.7 percent of the 12,480 bene ficiaries who completed the staging ques- tions were classified in the precontempla tion stage. ...
Citations
... Bierze jednocześnie pod uwagę dwa ważne aspekty psychologicznego przygo towania do zmiany: balans decyzyjny, czyli rozkład i postrzeganą wagę argumentów za i przeciw oraz osobistą skuteczność, wyrażającą się w gotowości przechodzenia przez trudne sytuacje oraz unikaniu pokusy powrotu do starych przyzwyczajeń (Levesque i in., 2001). ...
... Drafting the Materials To inform the consumer product development, we applied lessons learned from Phase 1 as well as adult learning principles, guidance on plain language, health education theories, and prior research on Medicare health plan decision making (e.g., Bettman, 1979;Doak, Doak, & Root, 1996;Harris-Kojetin et al., 2001b;Kanouse, Spranca, & Vaiana, 2004;Lieb, 1991;Maibach & Parrott, 1995;Petty & Cacioppo, 1981;Prochaska & DiClemente, 1983;Stephens, 2004). Based on previous research with older adults and their limited knowledge of Medicare (e.g., Hibbard et al., 1998;Levesque, Prochaska, Cummins, Terrell, & Miranda, 2001;Schur, Berk, Wilensky, & Gagnon, 2004), we determined our target audience to be in the precontemplation or contemplation stages within Prochaska and DiClemente's (1983) Stages of Change model. 12 We developed products to help move consumers from 12 Using data from the Medicare Current Beneficiary Survey, Levesque and colleagues (2001) found that 60% of beneficiaries were in the precontemplation stage of readiness to review their Medicare health plan options and 11% were classified in the contemplation stage. ...
... Previous research suggests that specific Medicare audiences should be targeted with education and information specific to their needs (Hibbard et al., 2001;Levesque et al., 2001;Sofaer et al., 2001); that older adults are more likely to use Medicare information when provided at the appropriate time needed to assist with making a decision (Harris-Kojetin et al., 2001a;Siegel & Doner, 1998); that making comparative quality information relevant and easy to use may increase its take-up rate (Shaller et al., 2003); and that having the information come from a source that is trusted by the target audience increases the likelihood that information will be looked at, read, and used (Harris-Kojetin, Jäel, Smith, Kosiak, & Brown, 2002). In creating the Choose with Care materials, we incorporated these suggestions along with guidance from adult learning principles, plain language, health literacy, and health communication and health education theories. ...
People aging into Medicare need to choose a health plan. Several challenges exist for consumers in choosing a Medicare health plan, including limited knowledge of Medicare, limited experience in using comparative health plan quality information, and limited experience and ability to pull together and use plan information from different sources like employers and the Medicare program. The Choose with Care System was developed to help consumers aging into Medicare make informed Medicare health plan choices. Choose with Care is an innovative decision support tool for employers to use to assist people approaching age 65 to learn about their Medicare health plan options and how to incorporate information on the quality of care and services offered by health plans into their choices. Employers are the targeted channel for distributing the Choose with Care materials because they are one of the most recognized and accessible formal intermediaries for information about health insurance. We used multiple methods to test the Choose with Care products. Product testing showed that the Choose with Care materials increase older consumers' knowledge of Medicare and how it relates to retiree health insurance and improves their comprehension and use of comparative quality information when choosing a health plan.
... Stage of change is generally assessed using a staging algorithm, a set of decision rules that place individuals in one of five mutually exclusive stage categories based on their responses to a few questions about their intentions, past behavior, and present behavior. In a preliminary project conducted for CMS's Office of Strategic Planning (Levesque et al. 2001), measures assessing Medicare beneficiaries' readiness to make informed health plan choices were developed and validated. Three staging algorithms, constructed from data collected in CMS's 1996, 1997, and 1998 Medicare Current Beneficiary Survey (MCBS) administered between 1997 and 1999, assessed (1) readiness to learn about the Medicare program, (2) readiness to learn about Medicare health maintenance organizations (HMO)s, and (3) readiness to review health plan options. ...
To assess the applicability of the transtheoretical model of change (TTM) to informed choice in the Medicare population.
Two hundred and thirty-nine new Medicare enrollees randomly selected from the Center for Medicare and Medicaid Services' October 2001 Initial Enrollee File, a repository of data for persons who are going to turn 65 and become entitled to enroll in Medicare in the next 3 months.
Study participants completed TTM measures of stage of change, decisional balance, and self-efficacy for informed choice, as well as measures of Medicare knowledge, perceived knowledge, and information seeking. Model testing was conducted to determine whether well-established relationships between stage of change, decisional balance, and self-efficacy replicate for informed choice in the Medicare population, and whether Medicare knowledge and information-seeking increase across the stages.
Survey data were collected using mail surveys with telephone follow-up for nonresponders.
Predicted relationships were established between stage of change for informed choice and decisional balance, self-efficacy, Medicare knowledge, and information seeking. The amount of variance accounted for by stage of change for informed choice was larger than that found for smoking cessation, where the TTM has had its greatest successes.
The methods and findings lay the groundwork for development of TTM-based interventions for Medicare beneficiaries, and provide a prototype for the application of the TTM to informed decision making among other types of consumers who are being asked to take more responsibility for their health care.
... Some research has suggested that knowledge gained depends on a person's stage of readiness to engage in making an informed insurance choice-those who seek out information are more likely to be more motivated and therefore, more knowl edgeable. In Prochaskas' Transtheoretical Model of behavioral change (Levesque et al., 2001) individuals can be placed into information readiness categories, ranging from precontemplation (generally reflect ing a position of disinterest) to action (reflecting a level of interest and readiness to consider options over a year or less), ending in maintenance (reflecting individu als who have been reviewing options for more than 1 year). ...
As the Medicare Program evolves, adding new insurance options like regional preferred provider organizations (PPOs) and prescription drug benefits, beneficiaries have an even greater need to understand the program. However, past research suggests that many beneficiaries have limited understanding of Medicare and related health insurance options. While improvements in beneficiary understanding of Medicare may be feasible, driven by new and varied efforts to provide the Medicare population with educational opportunities, is there evidence of factors that predict knowledge limitations? This article seeks to address this question by a thorough review of the literature on the measures and factors that influence beneficiary knowledge.
... Many studies examining Medicare utilization barriers have studied beneficiary decisions about their Medicare benefits, including factors influencing benefit program or plan enrollment and disenrollment (Harris-Kojetin et al., 2002;Lied et al., 2003;Riley, Ingber, and Tudor, 1997;Rossiter et al., 1989), effective benefit program information (Edgman-Levitan and Cleary, 1996;Harris-Kojetin et al., 2001;Hibbard et al., 2001;McCormack et al., 2001a;2001b), and information influence on specific health coverage decisions (Bann, Berkman, and Kuo, 2004;Farley et al., 2002;Gazmararian et al., 1999;LaTour, Friedman, and Hughes, 1986;Sofaer et al., 2001). Beneficiary knowledge has been assessed extensively, usually with mail or telephone surveys (Bann, Berkman, and Kuo, 2004;Cafferata, 1984;Fyock et al., 2001;Hibbard et al., 1998;Levesque et al., 2001;McCormack et al., 2001c;McCormack et al., 2002;McCormack and Uhrig, 2003;Sing and Stevens, 2005). These assessments have focused primarily on beneficiary understanding of traditional FFS versus MCA, such as Medicare Advantage and its predecessor Medicare+Choice (M+C), and they will likely be expanded to address the Medicare prescription drug plans that were implemented in January 2006. ...
Medicare beneficiary knowledge about fee-for-service (FFS) Medicare versus managed care alternatives (MCA) has been studied extensively. However, these efforts might be compromised by lack of familiarity with common Medicare terminology. We used qualitative methods to examine beneficiaries' familiarity with Medicare Programs (FFS and MCA) and terminology. Twenty-one indepth, semi-structured beneficiary interview transcripts were analyzed through iterative review. Across sex, race/ethnicity, and benefits programs, participants found interview questions with Medicare terminology difficult to answer, potentially causing missing, incorrect, and inaccurate responses to interview questions. Assessment of beneficiary knowledge may be fundamentally impacted by absence of basic familiarity with Medicare Programs terminology.
... Larger numbers of beneficiaries recalled receiving and reading the materials in 2001 than did in 1999 . Moreover, NMEP efforts keep evolving as Medicare educators identify differences among beneficiaries and design different informational products Levesque at al. 2001). ...
The Medicare Advantage program gives Medicare beneficiaries the opportunity to choose from an array of insurance options instead of receiving prescribed benefits. In 2006, beneficiaries who want prescription drug benefits will need to enroll in a Medicare managed care plan or a private prescription drug plan. To examine awareness and use of Medicare information programs, and the extent to which these programs are associated with beneficiary knowledge about Medicare and managed care, we conducted a national survey of Medicare beneficiaries six to 12 months after the nationwide mailing of the Medicare & You 2000 handbook. Beneficiary information-gathering behavior and experience with Medicare managed care were more highly associated with knowledge about Medicare managed care than formal education, age, income, or membership in a managed care plan before enrolling in Medicare. Practical life experience appears to outweigh traditional factors in beneficiary knowledge of Medicare and managed care.
Our study sought to explore the pre-retirement and post-retirement housing and healthcare plans made by some tutors of colleges of education in Ghana by employing a qualitative descriptive design to delve into the pre-retirement and post-retirement housing and healthcare plans made by tutors. Six (6) out of the 54 college tutors were purposefully recruited for an interview, and 54 college tutors from two (2) institutions of education were chosen for the survey using stratified and simple random sampling procedures. Frequency counts, percentages, and inferential statistics (independent samples test) were used to analyze the data obtained from the self-developed questionnaire (Cronbach’s alpha = 0.78), and themes were identified from the respondents’ responses using thematic analysis. The results from the research revealed that almost half (43%) of the sampled population had some sort of accommodation they were going to retire with, while a majority who did not own any housing property yet said they were making plans to acquire one before they go on retirement or shortly after they go on retirement. The study also found that all participants had some form of healthcare insurance coverage, with the majority subscribing to the public healthcare scheme – the National Health Insurance Scheme (NHIS). The study suggested that to implement financial investment plans for tutors in addition to public pension schemes for a better-secured post-retirement life, teacher unions, employers, and other stakeholders in Ghana should hire the services of professional financial services advisors and investment institutions.
Purpose
The purpose of this research is to identify audience segments of Medicare beneficiaries, for the development of targeted and tailored communication activities to promote informed health care decision making.
Design/methodology/approach
Secondary analysis was conducted on data from the 2001 Medicare Current Beneficiary Survey. The 9,520 Medicare beneficiaries who had complete data on key variables constituted the analytic sample.
Findings
Cluster analysis identified four audience segments that varied separately with regard to health care decision‐making skills and motivation. Those in the active segment are skilled and motivated. Those in the passive segment are unskilled and unmotivated. Those in the high effort segment are motivated, but unskilled. And those in the complacent segment are skilled, but unmotivated. Additional analyses showed that the segments also varied on several additional variables of interest, such as knowledge, income, education, health behavior, health status, and preferred information sources. And finally, the segmentation screening tool was developed and shown to function adequately as a simple method to conduct segmentation in the field.
Research limitations/implications
Future research should further examine the reliability and validity of the segmentation scheme.
Originality/value
This research identified four segments of Medicare beneficiaries that vary with regard to health care decision‐making skills and motivation, and developed a simple tool to conduct segmentation.
Change is the basis for improving and expanding individual, group, and organizational effectiveness, performance, and learning. However, human resource development (HRD) has utilized and developed few empirically validated individual change models or theories. Because HRD is multidisciplinary in nature, it is important for researchers and practitioners to consider what models or theories others have to offer. One influential model from the health and medical field that has promising utility in HRD is the transtheoretical model (TTM) of individual change. The purpose of this article is to introduce this model and explore its application to HRD. This article uses Dubin's criteria for theory building as a general framework for discussing the TTM's background, components, related constructs, and limitations. In addition, it presents the implications of this theoretical model to HRD.
The Internet is a potentially powerful source of low- or no-cost programs through which individuals can be guided in changing their behavior to improve health. Using the Transtheoretical Model and survey methodology, the authors sought to produce reliable and valid instruments for assessing "stage of change" and "informed decision making," and to generate cross-sectional and longitudinal stage-of-change data for a sample of Internet users, as they apply to Internet use for health promotion and disease management. They found that only 24.7% of their sample used the Internet for these purposes and concluded that considerably more research will be needed to determine how to help significant percentages of populations to progress toward enhancing their health through the Internet.
