Show Me My Health Plans: a study protocol of a randomized trial testing a decision support tool for the federal health insurance marketplace in Missouri

Abstract

BackgroundThe implementation of the ACA has improved access to quality health insurance, a necessary first step to improving health outcomes. However, access must be supplemented by education to help individuals make informed choices for plans that meet their individual financial and health needs.Methods/DesignDrawing on a model of information processing and on prior research, we developed a health insurance decision support tool called Show Me My Health Plans. Developed with extensive stakeholder input, the current tool (1) simplifies information through plain language and graphics in an educational component; (2) assesses and reviews knowledge interactively to ensure comprehension of key material; (3) incorporates individual and/or family health status to personalize out-of-pocket cost estimates; (4) assesses preferences for plan features; and (5) helps individuals weigh information appropriate to their interests and needs through a summary page with “good fit” plans generated from a tailored algorithm. The current study will evaluate whether the online decision support tool improves health insurance decisions compared to a usual care condition (the healthcare.gov marketplace website). The trial will include 362 individuals (181 in each group) from rural, suburban, and urban settings within a 90 mile radius around St. Louis. Eligibility criteria includes English-speaking individuals 18–64 years old who are eligible for the ACA marketplace plans. They will be computer randomized to view the intervention or usual care condition.DiscussionPresenting individuals with options that they can understand tailored to their needs and preferences could help improve decision quality. By helping individuals narrow down the complexity of health insurance plan options, decision support tools such as this one could prepare individuals to better navigate enrollment in a plan that meets their individual needs. The randomized trial was registered in clinicaltrials.gov (NCT02522624) on August 6, 2015.

Show Me My Health Plans

“…Drawing on a model of information processing and empirical decision-making research, 21 we developed a health insurance decision aid called Show Me My Health Plans (SMHP) to assist individuals enrolling in the health insurance marketplace in Missouri. 22 A modified version of SMHP can be accessed at showmehealthplans.org , and screen shots are shown in Online Appendix A. Specifically, SMHP 1) simplifies information with plain language and graphics; 2) assesses knowledge through an interactive quiz that provides feedback about correct or incorrect responses to ensure comprehension of key material; 3) incorporates individual and dependent health status to personalize annual out-of-pocket cost estimates; 4) assesses preferences for plan features through a rating system (from 1 = not at all important to 5 = very important) and a ranking system (asking users to order features from most to least important); and 5) helps individuals weigh information appropriate to their needs with a summary plan-sorting page, highlighting “good fit” plans generated from a tailoring algorithm.…”

“…SMHP’s development is detailed in a previously published article. 22 Briefly, it was based on formative work with uninsured participants, health providers, community advisors, and health policy experts with attention to health literacy, numeracy, and graphic literacy. The algorithm used to estimate individual or family expected annual out-of-pocket costs included estimates from the Medical Expenditure Panel Survey (MEPS) with an additional risk-adjustment factor based on age, gender, and medical conditions.…”

Dissemination of a Web-Based Tool for Supporting Health Insurance Plan Decisions (Show Me Health Plans): Cross-Sectional Observational Study (Preprint)

“…In brief, the RCT recruited English-speaking participants who were 18 to 64 years of age, not Medicaid-eligible, and living within 90 miles of St. Louis, Missouri. 328 enrolled participants were randomly allocated to the SMHP intervention group or to the HealthCare.gov control group [15,16]. Dissemination phase users were told for whom the tool was most relevant (users eligible for the ACA marketplace), but anyone could access the information with no login or access criteria required.…”

“…Match with preferences was calculated by comparing participant's intended plan choice with features that users selected as important. Matches were categorized as good, moderate, or poor, using methodology described in prior papers [15,16]. Match with algorithmic predictions was calculated by comparing how many tool users selected one of the plans that was displayed as a "good fit" plan based on their demographics and healthcare needs.…”

“…SMHP was designed for those with limited health insurance literacy. The effectiveness of the SMHP tool was examined in a randomized trial, and described in previous publications [15,16]. Study participants who used SMHP had higher health insurance knowledge, decision self-efficacy, confidence in their choice of a health plan, and improved health insurance literacy compared to participants using HealthCare.gov [15,16].…”