Medicare Modernization Act: CMS tries to keep it simple for prescription drug push

The Centers for Medicare & Medicaid Services ups efforts to make sure its new benefit doesn't face the same fate as the drug-discount card

The Centers for Medicare & Medicaid Services ups efforts to make sure its new benefit doesn't face the same fate as the drug-discount card

This month saw the kickoff of one of the largest, most expensive public awareness campaigns that the Centers for Medicare & Medicaid Services (CMS) has ever undertaken: the effort to educate Americans about the new prescription drug benefit under the Medicare Modernization Act (MMA).

Congress passed the act in December 2003, but the drug benefit, easily the most significant and controversial piece of the legislation, won't take effect until January. So for CMS and its partners, this summer will entail intense public affairs work.

The long-planned effort requires reaching out to senior citizens and the disabled, educating them about a complex piece of legislation, helping them decide if they would benefit from its new programs, and guiding them through the enrollment process.

It also requires the close coordination of a number of disparate groups - public and private, payers and providers, advocacy and nonprofit - to offer Medicare beneficiaries a straightforward, unified message.

"We don't want this to smell, look, or feel like big government," says Kathleen Harrington, director of the CMS' office of external affairs. "We want this to smell, look, and feel like a neighborhood."

Bill Pierce, APCO Worldwide VP and former chief spokesman at the Department of Health and Human Services, notes that the biggest challenge continues to be "creating a simple, simple education message. That was a well-learned lesson from the drug card [program]."

When CMS launched the drug-discount-card initiative last year, critics blamed low enrollment (roughly half the number of people expected signed up) on mass confusion and skepticism.

The drug-card program was the temporary measure created to reduce drug costs for seniors ahead of the launch of the 2006 prescription drug benefit.

Now Medicare beneficiaries must again enroll in a particular prescription plan under the MMA. Beneficiaries who do not sign up by May 15, 2006, stand to pay higher drug costs.

In the mad scramble to reach eligible senior citizens and the disabled, CMS and its partners will be explaining the ins and outs of co-pays, deductibles, out-of-pocket caps, and premiums.

Pierce notes that individualized communications will be at the center of the effort. He also predicts that retailers will be an important link to communities.

"Seniors live everywhere," he says. "They fill the entire spectrum in terms of where they are and who they are."

Harrington notes that the education effort will be a mix of strategic communications and field operations. "We're running this like a campaign," she says. "There are many, many eyes on us - policy-maker eyes - to make sure this goes [smoothly]."

At a recent Communicating Pharmaceutical Value conference in DC, Harrington spoke of the outreach in the clipped tone of a general planning an invasion. "Be assured that the full force of the federal government will be applied here," she said, adding that enrollment will be measured county by county, if not street by street. Resources will then be deployed based on need. "We are laser-focused on outcomes. Awareness of this program is not enough."

Enlisting support

It's too early to tally the combined dollar amount being spent on outreach by the public, private, and nonprofit sectors. In addition to using its standing roster of PR agencies, CMS is receiving funds from Congress that are earmarked specifically for the enrollment campaign.

Many firms also have made senior-level hires for Medicare work. Fleishman-Hillard, for instance, recently hired Dr. Sharad Mansukani, who helped draft the MMA, to run its new healthcare public affairs business.

At the PRSA Health Academy meeting, David Chatel, CMS' acting director of patient advocacy, urged PR pros to get involved. "We're reaching out from the national level all the way down to the community level ... [to] target people where they live, work, play, and pray," he said.

CMS is relying on influencers such as doctors, pharmacists, and even financial planners to champion the drug benefit and direct seniors to places where they can find more information. There will be emphasis on minority groups, women's groups, and long-term-care providers.

CMS plans to enlist the help of programs like Meals on Wheels, which delivers food to homebound individuals. Housing- assistance counselors are also being retrained as Medicare counselors.

Harrington says the focus is on creating a "web of support." "I'd like to say it's totally systematic," she says, "but it's not. It's finding another resource and layering it on."

Senior government officials - including President Bush and CMS administrator Dr. Mark McClellan - launched their education efforts on June 16 with a rally to kick off the Medicare Covers America Tour. Newsrooms received b-roll and sound bites of the event through satellite news feeds.

CMS is also learning from the mistakes of the drug-discount-card program. "We face a lot of criticism for driving seniors to faceless operators and to a website," Harrington says. "One-on-one conversation is going to be the key to success here."

But coordination among all groups that want to partner with CMS is nonetheless a delicate challenge - ensuring that the swell of voices doesn't become a marketing cacophony.

Lisa Davis, director of communications at AARP, notes that the influential organization will use the "considerable communications" tools at its disposal (such as its magazine and syndicated radio shows) to educate members about the new benefit.

"There's some skepticism out there because the bill isn't everything to everybody," Davis says.

She notes that the massive education effort "will come with some fits and starts," and criticism is likely. But the goal of media relations, she adds, is not necessarily to stem negative coverage, but to get reporters to play a role in alleviating confusion.

In addition to established groups, a number of coalitions - such as Medicare Today and ABC-RX - are devoting the entirety of their resources to educating beneficiaries and the media about the changes.

Healthcare firms' efforts

In the private sector, health insurers and pharma companies are also joining the charge.

Private health insurers, for instance, are offering the drug plan to beneficiaries. Seniors and the disabled will have the option of choosing between at least two Medicare-approved plans.

Marketing efforts will coincide with the start of the enrollment period on November 15, while the summer push will have an educational tone.

"The thing that is most critical for everyone is the enrollment process," says Warren Levy, chief strategy officer at Vox Medica, which specializes in managed care. "This happens to be one of the most complicated, bewildering sets of changes anyone has had to deal with."

Pharma companies, vilified by politicians because of rising drug costs, are internalizing a new reality in which the government is the largest buyer of prescription products.

PhRMA, the industry's trade organization, plans to be at the forefront of efforts to generate enrollment buzz. Ken Johnson, SVP of communications, similarly notes that most of these efforts will be targeted outreach, with limited advertising.

Some PR pros have speculated that the industry, which has been engaged in a number of image campaigns, is now directing those efforts with an eye toward the federal government.

These subtle maneuvers are in addition to lobbying efforts to make sure their products are included on Medicare formularies.

The trust piece, however, is not about particular drugs, but about companies showing CMS that they can be good business partners. "[The government will] be able to call the shots because they're paying," says Nancy Turett, president and global director of health at Edelman.

Pierce agrees. "Medicare is a trusted program for seniors, [but it's] now expanding its public/ private partnerships," he says. "For Medicare, it's very important that they maintain their trustworthiness. And companies need to make sure they live up to that standard."

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