A prospective cohort study is the most in-depth design option available for evaluating the NMEP, and this design has several advantages over other study options. First, the study will identify how key influences on Medicare decision making change over time. By following beneficiaries through the enrollment and plan decision processes, we can examine not only how factors such as values, NMEP materials, and current health care access influence Medicare plan decisions, but also how reliance on these factors increases or decreases over time. This information is key to understanding how beneficiaries arrive at their plan decisions and to determining the role NMEP components play in the decision process. To date, no evaluation of NMEP has examined beneficiary values or any trends in use of NMEP activities throughout enrollment.
Second, the study will identify whether and how multiple NMEP components work together to impact Medicare plan decision making. Currently, almost all NMEP evaluations have been cross-sectional studies that, at best, can identify associations between NMEP components and increased knowledge or plan satisfaction. Conversely, the prospective cohort design will examine how different NMEP components interact and what role each component plays in a beneficiary’s plan decision. This understanding will be crucial to recognizing when and how NMEP activities actually promote IDM among beneficiaries.
Finally, and most importantly, the design allows us to understand how and under what circumstances beneficiaries make active plan decisions. By following beneficiaries throughout enrollment, we can explore the thought processes used to make plan decisions, identify the most influential factors in those decisions, and determine to what extent IDM takes place. These insights are key to promoting IDM because we gain a better understanding of how NMEP activities can influence such decision-making processes. No evaluation to date has examined the decision-making process within the scope of NMEP activities.