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

Mary C Politi, Abigail R Barker, Kimberly A Kaphingst, Timothy McBride, Enbal Shacham, Carey S Kebodeaux, Mary C Politi, Abigail R Barker, Kimberly A Kaphingst, Timothy McBride, Enbal Shacham, Carey S Kebodeaux

Abstract

Background: The 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/design: Drawing 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.

Discussion: Presenting 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.

Figures

Fig. 1
Fig. 1
Screenshots from Show Me My Health Plans. Our final card sorting feature uses an algorithm to predict annual expenditures based on MEPS data and the plan details in the ACA marketplace plans available in their county. It also shows them features of the top plans that are personalized to their annual expenditures plus preferences. They can save plans to favorites and see all plans available to them if they want to trade off more coverage at a higher cost, for example, but our algorithm sorts them by annual plan cost to them/their families (also factoring in potential financial risks based on number of health conditions and the probability that they might incur very high costs associated with them in any given calendar year)
Fig. 2
Fig. 2
Planned study flow diagram

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Source: PubMed

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