Article Title

“Apple or PC:” Creating a Patient-Centered Tool to Help Medicare Beneficiaries Choose Prescription Drug Plans

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ethnography, observational studies, information technology, evaluation research, qualitative research, Medicare, health care costs/resource use, technology assessment, patient experience/satisfaction


Background: Choosing a Medicare Part D prescription drug plan is complicated; there are many plans from which to choose, and the appropriateness of the coverage varies depending on medication needs and patient preferences. It’s been well documented that Medicare beneficiaries report frustration with choosing a prescription plan due to the large number of options and, in focus group research, we found that many older adults expressed a desire for expert guidance. We designed a patient-centered online Part D plan selection tool (CHOICE) to simplify their choice process and provide personalized, expert recommendations. In this study, we examined patient use of the new tool and the existing decision tool available at Medicare.gov.

Methods: This ethnographic comparative usability study engaged 44 patients during the 2016 open enrollment period (October 15–December 7, 2015). Participants were observed as they chose their drug plan using Medicare.gov and one of three versions of CHOICE. The versions varied in the amount of expert guidance provided on drug plans. The participants completed an exit survey regarding their experience. Descriptive statistics were used to analyze the survey data. The observations were video-recorded and field notes were analyzed thematically.

Results: One usability tester likened CHOICE as an Apple product and Medicare.gov a PC product. User survey results suggest that the time-on-task was much shorter when using CHOICE. Participants were significantly more satisfied with the process of choosing a Part D drug plan using CHOICE (44%) than with using Medicare.gov (14%); 46% of participants strongly agreed that they understood the information in CHOICE and 45% strongly agreed that CHOICE was easy to use compared to 20% and 16%, respectively, when using Medicare.gov (P < 0.05). Participants randomized to two arms of CHOICE with increasing levels of expert guidance were more likely to choose a drug plan other than their current plan than those using Medicare.gov (P < 0.15).

Conclusion: Many user-centered features of CHOICE improved patient experience and enabled them to choose plans more consistent with expert recommendations. We are mounting a large-scale three-arm randomized controlled trial in the 2017 open enrollment period to test CHOICE.




June 27th, 2017


August 10th, 2017