Addressing complexity: The development and pilot testing of a user-friendly Medicare Part D patient decision aid tool.

Abstract

Background: Selecting a Medicare Part D prescription drug plan can be challenging because of limited health insurance literacy and complex plan features. Existing online tools, such as the Medicare Plan Finder (MPF), often lack personalization.

Objective: To describe the conceptualization and development of a personalized Medicare Part D decision aid (DA) to supplement the MPF.

Methods: A user-centered, iterative design process informed by the Ottawa Decision Support Framework and International Patient Decision Aid Standards was used to develop a DA that helps older adults with Part D plan selection. First, a literature review and 1-hour interviews with Medicare-eligible individuals informed the development of a prototype. These individuals formed a stakeholder advisory board (SAB). The first prototype was then alpha tested with 2 SAB focus groups. Using focus group feedback, the final prototype was developed. Beta testing participants, including Medicare-eligible individuals and Medicare counselors, were recruited and completed an online version of the DA, alongside pre-DA and post-DA questionnaires to examine DA effectiveness using a modified Health Insurance Literacy Measure, a modified System Usability Scale, and a user satisfaction survey.

Results: Before the development of the prototype, SAB interviewees (n = 9) suggested that simplified explanations of insurance terminology and side-by-side comparisons of options would be important to the DA. Alpha testing (n = 7) feedback was used to modify the first prototype to improve usability and clarity. Among 25 beta testing participants, Health Insurance Literacy Measure scores increased from 19.76 (SD = 7.15) before using the aid to 24.13 (SD = 4.02) afterward (P = 0.0009). Approximately one-quarter of participants indicated that they would change to a new plan after the tool, whereas half affirmed that the DA validated their existing plan choice.

Conclusions: This pilot study shows that a user-centered, interactive DA can improve health insurance literacy and support Medicare Part D plan decisions.