Medicare:

Communications to Beneficiaries on the Prescription Drug Benefit Could Be Improved

GAO-06-654: Published: May 3, 2006. Publicly Released: May 3, 2006.

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On January 1, 2006, Medicare began providing coverage for outpatient prescription drugs through its new Part D benefit. Beneficiaries who enroll in Part D may choose a drug plan from those offered by private plan sponsors under contract to the Centers for Medicare & Medicaid Services (CMS), which administers the Part D benefit. Beneficiaries have until May 15, 2006, to enroll in the Part D benefit and select a plan without the risk of penalties. GAO was asked to review the quality of CMS's communications on the Part D benefit. GAO examined 70 CMS publications to select 6 documents for review and contracted with the American Institutes for Research to evaluate the clarity of these texts; made 500 calls to the 1-800-MEDICARE help line; and contracted with the Nielsen Norman Group to evaluate the usability of the Medicare Web site.

The information given in the six sample documents that GAO reviewed describing the Part D benefit was largely complete and accurate, although this information lacked clarity. The documents were unclear in two ways. First, although about 40 percent of seniors read at or below the fifth-grade level, the reading levels of these documents ranged from seventh grade to postcollege. Second, on average, the six documents did not comply with about half of 60 common guidelines for good communication. For example, the documents used too much technical jargon and often did not define difficult terms, such as formulary. Moreover, 16 beneficiaries and advisers that GAO tested reported frustration with the documents' lack of clarity and had difficulty completing the tasks assigned to them. Although the documents lacked clarity, they informed readers of enrollment steps and factors affecting coverage decisions and were consistent with laws, regulations, and agency guidance. Customer service representatives (CSR) responded to the 500 calls GAO placed to CMS's 1-800-MEDICARE help line accurately and completely about two-thirds of the time. Of the remainder, 18 percent of the calls received inaccurate responses, 8 percent of the responses were inappropriate given the question asked, and about 3 percent received incomplete responses. In addition, about 5 percent of GAO's calls were not answered, primarily because of disconnections. Accuracy and completeness rates of CSRs' responses varied significantly across the five questions GAO asked. For example, while CSRs provided accurate and complete responses to calls about beneficiaries' eligibility for extra help 90 percent of the time, the accuracy rate for calls concerning the drug plan that would cost the least for a specified beneficiary was 41 percent. For this question, the CSRs responded inappropriately for 35 percent of the calls by explaining that they could not identify the least costly plan without the beneficiary's personal information--even though CSRs had the information needed to answer the question. The time GAO callers waited to speak with CSRs also varied, ranging from no wait time to over 55 minutes. For 75 percent of the calls--374 of the 500--the wait was less than 5 minutes. The Part D benefit portion of the Medicare Web site can be difficult to use. GAO's test of the site's overall usability--the ease of finding needed information and performing various tasks--resulted in scores of 47 percent for seniors and 53 percent for younger adults, out of a possible 100 percent. While there is no widely accepted benchmark for usability, these scores indicate that using the site can be difficult. For example, the prescription drug plan finder was complicated to use and some of its key functions, such as "continue" and "choose a drug plan," were often not visible on the page without scrolling down.

Status Legend:

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  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: In order to improve the Part D benefit education and outreach materials that CMS provides to Medicare beneficiaries, the CMS Administrator should monitor the accuracy and completeness of CSRs' responses to callers' inquiries and identify tools targeted to improve their performance in responding to questions concerning the Part D benefit, such as additional scripts and training.

    Agency Affected: Department of Health and Human Services: Centers for Medicare and Medicaid Services

    Status: Closed - Implemented

    Comments: In 2007, CMS reported that it now tracks the accuracy and completeness of customer service representatives' (CSR) responses through additional call monitoring. It has also made an effort to identify individual CSRs that are in need of further training by recording additional calls. In addition, CMS has developed new CSR training sessions, with an emphasis on the Part D benefit, as well as reference materials to assist them with calls.

    Recommendation: In order to improve the Part D benefit education and outreach materials that CMS provides to Medicare beneficiaries, the CMS Administrator should determine why CSRs frequently do not search for available drug plans if the caller does not provide personal identifying information.

    Agency Affected: Department of Health and Human Services: Centers for Medicare and Medicaid Services

    Status: Closed - Implemented

    Comments: In 2007, CMS reported that it has taken steps to enhance processes and training at its 1-800 MEDICARE call centers. These steps include working to ensure that customer service representatives (CSR) understand what information can be shared with callers regarding the prescription drug plans when callers do not provide personal, identifying information. For example, CMS has developed scripts used by the CSRs are clear about providing information to callers under these circumstances, has issued a related training update, and has focused on this issue in supervisory staff meetings with CSRs.

    Recommendation: In order to improve the Part D benefit education and outreach materials that CMS provides to Medicare beneficiaries, the CMS Administrator should ensure that CMS's written documents describe the Part D benefit in a manner that is consistent with commonly recognized communications guidelines and that is responsive to the intended audience's needs.

    Agency Affected: Department of Health and Human Services: Centers for Medicare and Medicaid Services

    Status: Closed - Implemented

    Comments: In 2010 CMS reported that, since our 2006 report on Part D communications was issued, it has continually improved its educational and outreach materials explaining the Part D prescription drug benefit. In addition, it noted that it has tested these materials with its target audience. CMS has also expressed a continuing commitment to providing technical information in an understandable, beneficiary-friendly manner to help beneficiaries make decisions about their prescription drug coverage. CMS said that its products follow commonly recognized communications guidelines by providing simple sentences and messages, defining terms, repeating important messages with consistent wording, using bullets, and remaining stylistically consistent. It also stated it has conducted an extensive "environmental scan" to identify its audience's communication needs, and that it consolidated and revised its publications in response. CMS also described steps it follows to develop each year's new edition of the Medicare and You Handbook, which summarizes all Medicare benefits, including Part D. For example, it cited holding meetings with advocates and stakeholders, scanning 1-800-MEDICARE, www.medicare.gov, and the Medicare Ombudsman's tracking systems to identify issues important to beneficiaries, using experts in consumer communications to get feedback from almost 100 beneficiaries, caregivers, and others, instituting quality assurance and proofing processes, including adherence to an extensive style guide based on materials from professional trainings, consumer testing, and plain language guidelines.

    Recommendation: In order to improve the Part D benefit education and outreach materials that CMS provides to Medicare beneficiaries, the CMS Administrator should improve the usability of the Part D portion of the Medicare Web site by refining Web-based tools, providing workable site navigation features and links, and making Web-based forms easier to use and correct.

    Agency Affected: Department of Health and Human Services: Centers for Medicare and Medicaid Services

    Status: Closed - Implemented

    Comments: In 2007, CMS reported that it has enhanced the usability of the Part D portion of the Medicare web site. For example, it has improved the Medicare Prescription Drug Plan Finder (MPDPF) by providing clearer displays of the drug pricing data, drug utilization management requirements, and other important features that make the site easier to navigate and use. CMS also modified the website's default settings so that the generic drug option is more accessible during use of the application. It has also made it easier for beneficiaries to save information during their initial session and retrieve it during future visits. CMS is also utilizing the services of a web design firm to improve the MPDPF and tightly integrate it with other tools on www.medicare.gov.

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