The Agency for Health Care Policy and Research, now the Agency for Healthcare Research and Quality (AHRQ), initiated the Consumer Assessment of Health Plans Study (CAHPS) project in 1995 to develop and test methods to provide consumers with comparative information on performance of health plans as reported by current health plan enrollees. In collaboration with the Florida Agency for Health Care Administration (AHCA), RAND conducted a CAHPS demonstration with the Florida Medicaid program to test applications of plan performance reports in the Medicaid sector. Both paper and computer-based report formats were designed and tested in field applications in Volusia County, Florida. Evidence was found that failures in any of four dimension of a consumer information strategy can impede consumer use of the information. These dimensions are (1) the types, amounts, and display of the plan performance information itself; (2) design of the report medium, including the paper report document and the software and hardware of the Decision Helper; (3) the physical environment in which the information is provided to potential users; and (4) timing of information availability relative to when plan choices are being made. Both appropriate timing and ease of use of plan performance information influenced whether Florida Medicaid consumers used the reports. For the computer-based system, computer literacy was not a barrier for Medicaid recipients, but attention to details in the system design and physical environment were critically important factors. Results of this work have been applied in subsequent demonstrations with the New Jersey and Iowa Medicaid programs.
