Immediately plagued by confusion and administrative glitches, the CMS is simplifying its message and talking directly to seniors about its new drug plan.
The Centers for Medicare and Medicaid Services (CMS) debuted its new prescription drug benefit this month to a storm of skepticism and confusion that critics and media have been forecasting for more than a year.
Administrative glitches have stymied the program since its January 1 kickoff, and the government last week put into place emergency measures to overcome the initial problems. About 20 states have also stepped in to cover medications for beneficiaries who were denied prescriptions.
But officials on the front lines of the enrollment effort disputed arguments that the scope of the problem was as dire as it seemed.
The outreach and marketing efforts - which kicked off in June and November, respectively - were some of the most expensive and far-reaching efforts around any government program to date. Most of the communications plans were direct marketing efforts targeting seniors; and groups from Meals on Wheels to AARP devoted their resources to helping beneficiaries cope with the changes.
Health insurance companies also created their own campaigns to educate beneficiaries about the program as well as position themselves as leaders on the issue.
In the days following the program's launch, however, headlines described pharmacists who were "overwhelmed" and seniors who faced "numerous headaches" as the drug plan "descends into chaos."
The articles describe seniors who could not get their prescriptions filled, faced higher co-pays than they expected, or didn't receive their drug cards in time.
Yet groups that had worked feverishly on education and enrollment campaigns around Part D of the 2003 Medicare Modernization Act defended the efforts and noted that beneficiaries just need time to acclimate to it.
To be sure, CMS had prepared for this moment; the program's complexity has been criticized since the government unveiled its 2004 drug-discount-card program, which provided seniors with temporary drug coverage ahead of the implementation of Part D.
"We face a lot of criticism for driving seniors to faceless telephone operators and to a website," said Kathleen Harrington, CMS's director of external affairs, at a May conference for pharma PR pros. "We really have so many points of contact with beneficiaries where if [one interaction is] negative, it can undermine the campaign."
Indeed, many seniors reported long waits to speak with health insurance reps when they were confronted with problems.
Neither Harrington nor America's Health Insurance Plans, a trade group representing health insurers, returned calls by press time.
Peter Ashkenaz, deputy director for media affairs at CMS, maintains that these articles do not reflect the stories of people who are already saving money on their prescription drugs. "What you see is a random sampling of one beneficiary," he says, adding that advocacy groups critical of the benefit drove many of the stories in the media.
Peter Pitts, who was once the senior communications officer at the Food & Drug Administration, notes that some administrative difficulties were expected.
"No government program runs smoothly," says Pitts, who is now SVP of global health affairs at MS&L. "I think ultimately it's going to be a huge success. What the communications goal should be now - and should have been all along - is a momentum builder rather than an apology."
Pitts adds that the public health message was lost in economic and business stories about the benefit. "The media absolutely added to the problem," he says. "There was a lot of political banter that added to the fear. There were hardly any stories that I can recall that talked about [the details of] the benefit."
An October Wall Street Journal/Harris Interactive survey found a high level of awareness of the new drug plan even before official marketing began. Yet most seniors were unsure of what to make of it.
Sixty-two percent of the survey's 2,160 respondents had seen or heard an ad for the program, and more than half (53%) had searched for information about it. Health insurers themselves were the most common source of information.
Yet nearly three-quarters (71%) of respondents found the information somewhat or very hard to understand, and only 8% thought it was somewhat or very easy to understand.
"You're dealing with a personal issue that scares a lot of people," Pitts says. "It was always going to be difficult."
"You have to be realistic and straightforward with seniors," says Bill Pierce, APCO Worldwide VP and a former Department of Health and Human Ser- vices spokesman. "This was an immensely complicated law to implement and to create all the necessary infrastructure in a short period of time. Given that ... I think history will show this has been a fairly impressive accomplishment."
Pierce notes that where most of the media coverage is lacking is in providing resources to seniors, such as telling them what to do if they confront a problem.
Michael Freeman, EVP of the Healthcare Leadership Council, a coalition of healthcare industry CEOs, and national spokesman for Medicare Today, believes the coverage has been overblown.
"I don't think things are going wrong," he says. "It's not something people will jump in on the first day."
As for the negative headlines, he adds, "There was a preconception before enrollment began that it was confusing; there was a written script. There are a lot of politics involved, too."
Freeman adds that Medicare Today, one of the largest coalitions speeding enrollment efforts, has worked with agency GYMR to hold many events. The group, a drug-company funded organization, which is also supported by health insurance companies, pharma groups, and other medical businesses, has also continued to court the media.
It has promoted studies about the drug plan, produced PSAs with actress Rita Moreno, sent letters to the editor, identified more than 300 spokespeople, and collected more than 400 anecdotes from seniors.
"We're continuing to make sure people understand the concept and how it works," Freeman says. "It's now a matter of answering questions about it."
Medicare Today is currently commissioning a poll on how the media coverage has impacted enrollment. "Negative coverage does not help," Freeman says.
But he also notes that most of the negative coverage has been concentrated in what he describes as the New York-Washington corridor. "Outside the Beltway, the news has been more pragmatic and helpful," he says.
Pierce notes that CMS now faces the task of communicating both with beneficiaries and the health insurers offering the benefit. "Those challenges are being met," he says. Individual companies are also continuing out-reach efforts. Humana, one of the largest Medicare contractors, is working with FischerHealth and Wal-Mart on an education-based road tour.
Its eight RVs are scouring the country and answering questions about the program. "The strategy we put together for Humana is to have face-to-face conversations with seniors," says Bob Berra, FischerHealth's chief account officer. "I think [the initial administrative glitches] just reassured our strategy. Companies must stay focused on continuing that dialogue with seniors because this will take time."
Berra notes that the outreach effort was built with the expectation that the program would get off to a bumpy start. "Most people in this business expected glitches along the way," he says.
As many states warn about a public-health emergency, Pitts notes that the focus for PR pros should be on educating reporters, and pushing for coverage that focuses on the nuts and bolts of how to enroll in the program.
"It's hard to communicate a complicated message simply, but you don't have to explain everything from A to Z," he says. "You need to entice [Medicare beneficiaries] into the program rather than teach them quantum physics."