Direct Mail Best Practices for Reaching Low-Income Populations

Background:   The Centers for Medicare & Medicaid Services (CMS) is tasked with delivering quality health care to millions of beneficiaries across the country.  One of our challenges is making sure our poorest and most vulnerable citizens understand their health care options and are able to take advantage of all the programs and services available through our agency.  This includes helping millions of low-income seniors navigate a maze of policy information, assistance programs and health plan choices to make sure they have health and drug coverage that meets their needs. The low-income population is historically vulnerable to health disparities; disproportionally minority, many are also dealing with information barriers posed by education, geography, disability, culture, or language that make health care utilization difficult. This is also a population that’s notoriously passive about their health care decisions and often mistrustful of the government.

Program background:  CMS has approximately 12 regular direct mailings specific to the low-income beneficiary population, including “dual-eligibles” (people who qualify for both Medicare and Medicaid). These mailings explain special prescription drug benefits and policy changes; many of the mailings also encourage beneficiaries to take direct action in their self-interest. Over the past four years, we’ve used evidence-based industry research and feedback to iteratively refine these mailings for optimum effectiveness.  We’ve developed a set of best practices for ensuring that direct mail notifications to underserved low-income beneficiaries are clear, effective and actionable,

Evaluation Methods and Results: Refinements to the beneficiary mailings have increased effectiveness considerably. While no quantitative data exists yet, feedback from partners, advocates and consumer testing has been highly positive.

Conclusions: In short, we’re using numerous research-based industry best practices to ensure that low-income beneficiaries have coverage that meets their needs and are equipped to take advantage of all the programs and services available to them.

Implications for research and/or practice:  CMS best practices for mailings to low-income beneficiaries include the following:

• Printing the notices on different colored paper to make them easy for beneficiaries to remember and reference, and to help counselors and 1-800 CSRs better target assistance to people who get the notices. (For example, we immediately know that a beneficiary who reports they “got a blue letter” was affected by Medicare prescription drug plan reassignment.)
• Using the latest information architecture research to redesign the notices with clear, action-oriented headings and information signposts to facilitate scanning for low-literacy users.
• Using formatting, logos and envelopes that differentiate official Medicare mailings from plan materials and other marketing collateral and encourage reader trust.
• Applying plain language principles to keep sentences as short, clear and active as possible, while still retaining accuracy and meeting Subject Matter Expert clearance requirements.
• Using consumer testing to iteratively refine messages for maximum impact and help identify places in the notices where readers were becoming confused.
• Printing notices with English on the front and Spanish on the back whenever possible