Maximizing Social Marketing Campaign Impact Among Low-Income Medicare Beneficiaries

Background:  Communicating benefits and motivating enrollment in the Medicare Low Income Subsidy (LIS) program that assists low-income Medicare beneficiaries by covering their prescription drug costs and Part D premiums has proven to be challenging.  Recent estimates suggest that 2 million beneficiaries may be eligible for this benefit but have yet to enroll in the program. 

Program background:  The Centers for Medicare and Medicaid Services (CMS) conducted a field experiment to evaluate the impact of two targeting approaches and several direct marketing strategies in enhancing standard community-based efforts to garner applications for LIS among the target population.    The study explored the use of a mass commercial database to hone target audience definition and provide audience insight to tailor messages to these individuals and the use of commercially-available predicted income levels to better target the outreach effort.

Evaluation Methods and Results:  Study participants were randomly selected from an internal CMS list of beneficiaries in targeted geographic areas with low incomes who did not have Part D coverage and so were likely to be eligible for the LIS.  Additional inclusion criteria included residence in a state without a comprehensive State Prescription Assistance Program and in counties with active State Health Insurance Programs (SHIPs).  This list was cross-referenced against Experian’s consumer database to both identify individuals most likely to be eligible for the program (“refined list”) and to provide a psychographic segmentation of the target audience to understand potential motivations for participation. Participants were randomly assigned to receive one of 5 treatments differing in outreach intensity:  Control, CMS letter, a Custom designed self-mailer with BRC (business reply card) pre-populated with address of local SHIP, an Invitation-style mailer + BRC + prerecorded calls, and an Invitation-style mailer + BRC + personal enrollment assistance calls. A telephone survey (n = 4,208) was used to assess immediate impact of the interventions on self-reported activity related to LIS.  In addition, objectively verified application for the benefit based on SSA administrative data (within 4 months of intervention) was also obtained.   Logistic regression analysis was used to evaluate the impact of the interventions. Using income estimates provided by the consumer database to target outreach was useful, The odds of finding a beneficiary who was income-eligible was 31% higher using the Refined list rather than the Standard list (Odds Ratio = 1.31, p< .001).   Highly significant differences were also found for intervention type. Overall, application rates among those in the target audience control group ranged from 0.08% (self-report) and 0.51% (administrative), while rates among those in the lowest cost direct marketing strategy (CMS letter) ranged from 2.84 (self-report) and 2.51% (administrative; Odds Ratios > 11.0).  Higher rates of application were obtained by the most intense interventions (3.72% self-report, 4.76% administrative, OR > 13.0), but associated costs were much higher. 

Conclusions:  Relatively low-cost direct marketing and targeting strategies can significantly enhance community-based outreach for the LIS and help to increase participation in the program.

Implications for research and/or practice:  Although often overlooked, communication and outreach to hard-to-reach audiences can be informed and augmented by employing consumer databases.