From Coverage to Care Connects Newly Insured to the Healthcare System

March 2015
Topics: Healthcare Economics and Organizations, Social Behavior, Public Health (General)
Millions of Americans now have health insurance because of the Affordable Care Act, but will they know how to use it? MITRE worked with CMS to uncover the barriers to using their coverage—and crafted materials to ensure they can.

As millions of uninsured and underinsured Americans were about to enroll in health insurance under the Patient Protection and Affordable Care Act (ACA) in 2013, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) raised some important questions. Among them: Would consumers understand their coverage and know how to use it to navigate the complex healthcare system successfully? And could these improvements in knowledge lead to more appropriate use of the ER?

Without adequate education and support, newly insured consumers might not fully engage in the system and may not maintain their coverage. Without changing consumer behavior, health outcomes would remain bleak and healthcare costs nationwide would continue to soar.

To address the problem, MITRE and The RAND Corporation partnered under the CMS Alliance to Modernize Healthcare (CAMH), a federally funded research and development center (FFRDC), to research and design educational materials for the From Coverage to Care (C2C) initiative. The goal: arm newly insured consumers with practical information about connecting to care. Some of the topics include the importance of preventive health; health insurance terminology; and what to expect when you visit a health provider.

The materials include the Roadmap to Better Care and a Healthier You for consumers, which details key parts of using health care coverage, such as how to find a provider, where to go for care, and what to do after an appointment. Supporting materials were also developed for community partners who play a pivotal role in educating consumers. Because MITRE has no commercial conflicts of interest, we provide guidance that doesn't favor or endorse any specific provider, hospital, or insurance company. We have supported CMS for many years in its efforts to improve our nation's healthcare system and have in-depth understanding of the challenges involved.

CMS Anticipates Consumer Needs

"While many organizations focused on enrollment, the CMS Office of Minority Health was thinking ahead and trying to anticipate what consumers would do with their new coverage," explains MITRE's Corinne Berry, one of the lead researchers on the project. "They recognized that the success of ACA hinges on the uninsured not only obtaining coverage, but also on understanding it, valuing it, and using it to become well. Our team worked with CMS to develop the C2C materials to address the information needs and questions of the newly insured while promoting the importance of prevention and primary care."

In phase one of the project in 2013, the team conducted field research in four states: California, Arizona, Michigan, and Mississippi. The researchers gathered data through listening sessions with consumers and by interviewing community stakeholders, providers, and policy makers. The findings revealed a need to educate consumers about topics related to using their new coverage and connecting to care. Phase two involved developing and piloting materials in the same four states to answer the questions and concerns heard from the field.

The data gathered over the course of this multi-phase project, have informed both the refinement of the pilot materials and the broader C2C initiative, which CMS launched nationwide in June 2014.

Initial Feedback from the Pilot Study

Early testing of the pilot materials indicated that newly insured consumers felt better informed and community stakeholders were actively leveraging the materials. Some comments from the field include:

  • "I just loved this information….I really love the part about not having to stay with a doctor if I didn’t have a good experience."
  • "I think the book is the 'how' answer to everything…. I think the book is written really well."

Facilitators and leaders at community-based organizations are echoing consumer opinion about the educational materials and sharing their observations:

  • "People liked that it [the booklet] told them how to prepare for their first appointment."
  • "We do come across a lot [of situations] where a person goes to a doctor and doesn't like them, so they stop going—this [material] was helpful in telling them they can change [providers]."

From Coverage to Care's Impact Already Being Felt

With the support of the CAMH team, CMS launched From Coverage to Care nationwide, only two months after the close of open enrollment. The C2C resources are currently available in English and Spanish with additional translations in progress. To date, stakeholders across the U.S. have ordered more than 1 million products, and as the next season of open enrollment approaches, the orders continue to come in.

Marnie Bloom, MITRE project lead, sums up the end goal: "Now that people are enrolled, this is really about people being healthy and learning how to take care of themselves. It's about being empowered as patients and individuals in our healthcare system."

—by Kathleen K. Smith


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