Although the NMEP’s stated goals do not specify the role of employers, SHIP counselors, or pharmacists as potentially important information intermediaries for beneficiaries, we believe that a comprehensive evaluation of the NMEP should assess the perspectives and potential role of these stakeholders. Employers serve as a trusted source of information for beneficiaries. The proportion of employers offering retiree health benefits for Medicare-eligible retirees has declined over the past decade (McCormack et al., 2002 McCormack et al., 2002; McArdle et al., 2004McArdle et al., 2004), but employer-based retiree health benefits continue to be the leading source of supplemental coverage for Medicare beneficiaries (McCormack et al., 2002McCormack et al., 2002). In a 2004 Kaiser-Hewitt survey of private-sector employers, nearly three-quarters of employers said that they are likely to provide educational materials about the Medicare prescription drug benefit to their retirees (Kaiser-Hewitt, 2004Kaiser-Hewitt, 2004). SHIPs provide personalized counseling and answers to beneficiaries’ questions about Medicare largely through their employees and volunteers who staff toll-free lines and/or meet with beneficiaries in person. Finally, with the implementation of Medicare Part D, pharmacists are a potentially important source of information for beneficiaries regarding Medicare prescription drug coverage.
To assess the perspectives of these stakeholders, we recommend conducting case studies with a small, purposeful sample of employers (n = 9), pharmacists (n = 9), and SHIP agency staff at the state and local levels (n =9). Nine case studies of each category is the maximum allowed without seeking OMB clearance for data collection. We recommend using a case study methodology as opposed to a survey methodology for a number of reasons. First, a major advantage of the case study approach is the ability to meet face to face with the target audience and to hear about and see firsthand their experiences with the Medicare program. Qualitative research methods are particularly well suited to answer more contextual questions because they can be used to discover and explore little-understood phenomena or issues; provide increased context and depth to better understand people’s thoughts and experiences; and can be used to gather information to better interpret how and why events have occurred. Second, we anticipate sampling issues and potentially low response rates for surveys of employers and pharmacists. For example, it is extremely challenging and time consuming to identify and contact the appropriate person within an organization to administer a survey about health benefits. In addition, response rates for employer as well as provider surveys tend to be quite low. Finally, the case study approach is a lower-cost option than three, large-scale quantitative surveys.
In addition to the case studies with employers, pharmacists, and SHIP agency staff, we recommend conducting fewer than nine key informant interviews via telephone with leaders from major coalitions and/or associations representing employers and pharmacists to gain a broader perspective about the issues facing their members. There are several large employer-based health care purchasing coalitions such as the National Business Coalition on Health, National Business Group on Health, Pacific Business Group on Health, Buyers Health Action Group, and the Midwest Business Group on Health. In addition, the Society for Human Resources Management and the National Human Resources Association are professional associations for human resources and employee benefits managers. Similarly, there are several professional associations representing pharmacists, including the American Pharmacists Association, National Association of Chain Drug Stores, National Community Pharmacists Association, and National Pharmaceutical Association. These organizations represent the views of thousands of employers and pharmacists, and it is likely that information gained from interviewing leaders of these groups will complement the case study data collected from individual employers and pharmacists.