Communicating with Consumers about Health Insurance Options At Healthcare.Gov

Background:  This case study describes work providing Americans with comprehensive health insurance information that they can use to make more informed choices about their options under the new health care legislation.  

Program background:  Section 1103 of the Affordable Care Act (ACA) called for CMS to establish a web portal to provide health insurance information to consumers, especially as related to the provisions under the new legislation.  However, we knew that providing information, by itself, was not enough.   In order to be of most value to consumers, we needed to design the portal with attention to the form and context of the information that was to be provided as well as to the needs and cognitive styles of the intended audiences. We applied basic social marketing principles to better understand the various target audiences for this information including their expectations, knowledge, needs, attitudes, behaviors, and motivations related to healthcare coverage opportunities. We applied this understanding to the development of the insurance web portal that was rolled out as part of HealthCare.gov.  This initial work took place quite rapidly – over a period of less than 2 months – in order to meet the legislative mandate of establishing the portal by July 1, 2010. 

Evaluation Methods and Results:  Initial formative research included eighteen small group discussions held at five geographically diverse locations with a total of 73 participants drawn to be broadly representative of the target audience for the insurance web portal – 45 interested uninsured, 10 insecure insured, and 18 small business owners.  This work built on findings from our environmental scan and helped to establish a framework for addressing the key concerns and barriers that consumers were expected to experience as they began to familiarize themselves with the healthcare coverage options that became available to them under the new healthcare legislation.  A second phase of the research examined web site usability and assessment of understanding of coverage options that helped to inform the initial rollout of HealthCare.gov.   We found that interest in affordable coverage was high.  Consumers were hopeful, but skeptical.  The perceived value of coverage was peace of mind and security.  Government sites can be trustworthy, but are rarely easy to use or clear.  Consumers will not tolerate jargon or a “sales pitch” but will appreciate tailoring of information to make it easier to use.  The concept of a clearinghouse of public and private health plans was well received, but possibility of information overload was noted.  Consumers were receptive to self-paced learning opportunities that would improve their ability to make better decisions.  Live beta test sites were well received and allowed refinement of user experience prior to rollout.

Conclusions:  This initial formative research helped to identify solutions to some of the key concerns and barriers and supported the successful rollout the insurance web portal as part of HealthCare.gov.  Ongoing research integrated with a program of continuous quality improvement is in place to help realize the full potential of this resource.

Implications for research and/or practice:  This case study illustrates the value of social marketing approaches to developing and targeting healthcare communications to consumers.