Audience Segmentation to Support Consumer Engagement in Using Healthcare Benefits

Audience Segmentation to Support Consumer Engagement in Using Healthcare Benefits

Frank Funderburk, Diane Field, & Clarese Astrin

Division of ResearchOffice of Communications

Centers for Medicare & Medicaid Services

May 17, 2015

Note: The statements expressed here are those of the authors and do not necessarily reflect the views or policies of CMS.

BackgroundBackground

• Health reform brings changes for health insurance options of consumers and small businesses.

• Providing clear information that people can use to make the best of their options is critical to success.

• Information alone will not be enough. Education to build skills and support health insurance literacy must be coupled with communications that motivate engagement.

2

Segmentation for New AudiencesSegmentation for New Audiences

• Medicare population is changing as Baby Boomers and Gen Xers age in

• ACA gives CMS responsibility for new populations

• Generational segmentation alone is inadequate

• Attitudinal and perceptual issues related to healthcare and health insurance must be considered

Audience Segmentation ResearchAudience Segmentation Research

• Support long-term strategic planning• Focus education, outreach, and communication

campaigns• Build on prior work (e.g., Williams & Heller, 2007)

– Geographic– Demographic– Psychographic

• Includes Seniors, Boomers, Gen X, and [more recently] Millennials

• Improved targeting and tailoring of communication to maximize scarce resources

• Research initiated in 2008 and is ongoing• Futures modeling • Qualitative studies• Quantitative studies • Message and channel development • Field test (Prevention)• Application to developing issues – Uninsured,

Healthcare Quality

Mixed Methods StrategyMixed Methods Strategy

• Factor Analysis of Attitude Scales– Raw scores and normalized within respondent.

• Oblimin rotation – 13 factors accounting for 60% of variance.

• Specific factors were also developed for information interest, health status, information utility, cost salience, internet use.

• Imputation of missing income values

Segmentation Methodology: Data Exploration

Segmentation Methodology: Data Exploration

• Latent class segmentation• Variables used to create final segmentation model

– Attitude factor – I think a lot about health– Attitude factor – I worry about the future– Attitude factor – Self Confidence– Attitude factor – Conventional vs. alternative treatment tendency– Health status factor– Active health information user factor– Income– Gender– Age

• Optimal number of segments based on Bayesian Information Criterion (BIC) and statistical stability of segments

Segmentation MethodologySegmentation Methodology

CMS Six Segments Overview(General Audience; National Sample 18 - 80)

CMS Six Segments Overview(General Audience; National Sample 18 - 80)

Segment AgeHealth Status

Importance of Healthcare Information

Prevention Worry

Internet &

Seek Health

Info

Informed, Healthy & Educated [17.2%]

Better Important Uses 100%96%

Sick, Active & Worried [23.2%] Worse Important Worried 77%43%

Mature & Secure [11.7%] Older A little Better

Important Uses Not 51%22%

Healthy & Young [19.6%] Younger Better Not imp Not 88%42%

Passive & Skeptical [20.4%] A little Better

Not imp Does Not Not 54%16%

Vulnerable & Unengaged [7.9%] Worse Not imp Worried 17%0%

Tailoring Communications ApproachTailoring Communications Approach

• Message (motivators, barriers, meaning of terms)

• Appeal (rational vs. emotional)• Tone (encouragement vs. warning)• Call to Action (incentives to prompt action)• Messenger (expert authority, prominent

personality, peer)• Images (visual impact, attention-

generating)

Field Test of Segmentation Prevention Ad

Field Test of Segmentation Prevention Ad

• Can segmentation improve communication effectiveness?

• Optimized ads developed for each segment• Respondents recruited to help “evaluate

potential health marketing materials” and pre-screened to determine segment

• Each respondent was asked to evaluate 2 print ads – 1 crafted for segment and 1 randomly drawn from others

• Segment assignment was based on a 10-item predictive algorithm

Predictive Model for Segment Assignment

Predictive Model for Segment Assignment

Item Domain(s)Year of birth Age

Current chronic health condition? Health Status

Looked for information on health topics? Health Engagement

Someone else takes care if healthcare issues, so I really don’t need to Health Engagement

It is very important for me to be informed about health issues Health Engagement

I have other people I can always turn to if I need help Worry

I’m concerned about not being able to pay for healthcare Worry/ Income

I’m usually one of the first to try new technologies Self-Confidence/ Engagement/Age

I have a financial plan that includes funding for future healthcare costs Worry/ Self-Confidence

Household income Income

Optimized Ads for Segments 1 & 2Optimized Ads for Segments 1 & 2

Informed, Healthy & Educated Sick, Active & Worried

Optimized Ads for Segments 3 & 4Optimized Ads for Segments 3 & 4

Mature & Secure Healthy & Young

Optimized Ads for Segments 5 & 6Optimized Ads for Segments 5 & 6

Passive & Skeptical Vulnerable & Unengaged

Communications Can be Customized to Leverage Outcomes

Communications Can be Customized to Leverage Outcomes

Ad EffectivenessOptimized Ad vs. Randomized Ad

Q69. Which of the two ads would you say speaks to you more personally?

Informed, Healthy & Educated

(N=412)%

Sick, Active & Worried

(N=409)%

Mature & Secure

(M=405)%

Healthy & Young

(N=413)%

Passive & Skeptical

(N=410)%

Vulnerable & Unengaged

(N=404)%

Optimized

50 51 60 67 65 58

Randomized

50 49 40 33 35 42

A Few Summary PointsA Few Summary Points

• Field test supported value of this segmentation approach for developing communications strategy

• A focus on making outreach and communications compelling to the hardest to reach and motivate audiences can often work – and these ads can have broader appeal and reach other segments as well.– Some messages and themes can well resonate across all

segments

Extending the Segmentation Approach to Health Insurance

Extending the Segmentation Approach to Health Insurance

• Data combined from several nationally-representative samples (N≈3,000) aged < 65.

• Segmentation assignment based on 10-item predictive algorithm.

• Standard demographics.• Self-reported health insurance status (insured

vs. uninsured) was dependent variable.• Logistic Regression was analytic method.

B S.E. Wald df Sig. Exp(B)

Male -.188 .116 2.642 1 .104 .829

HH Income GT $50K 1.177 .145 65.894 1 .000 3.246

More than High School .088 .123 .512 1 .474 1.092

Married .340 .119 8.139 1 .004 1.405

Caucasian (vs. others) .071 .140 .261 1 .610 1.074

Age Group .214 .127 2.843 1 .092 1.239

Hispanic (vs. non-Hispanic) .417 .219 3.629 1 .057 1.517

Works Full Time .685 .124 30.657 1 .000 1.985

Confidence .346 .088 15.448 1 .000 1.414

Uses Internet .414 .143 8.383 1 .004 1.513

Takes Prescription Drugs 1.111 .134 68.803 1 .000 3.037

Very Good or Better Health .325 .131 6.160 1 .013 1.384

CMS_SEG [Overall] –

Comparison Group (1) =

Informed, Healthy & Educated

   

26.020 5 .000

 

Sick, Active & Worried (2 v 1) -1.050 .253 17.209 1 .000 .350

Mature & Secure (3 v 1) .024 .391 .004 1 .952 1.024

Healthy & Young (4 v 1) -.738 .240 9.434 1 .002 .478

Passive & Skeptical (5 v 1) -.859 .249 11.931 1 .001 .424

Vulnerable & Unengaged (6

v 1)-.588 .307 3.667 1 .056 .556

Constant -2.228 .604 13.610 1 .000 .108

Segmentation Assignment is Strongly Predictive

Segmentation Assignment is Strongly Predictive

Characteristics of Emerging Health Insurance Marketplace

Characteristics of Emerging Health Insurance Marketplace

• Broad scope.– Diverse “target audiences.”

• Complex and changing information needs.• Design with attention to form and context of

information provision. • Tailored to needs and cognitive styles of

audience(s).• Audience segmentation can help target and

tailor communications more effectively

19

Environmental Scan:Who are the Uninsured?

Environmental Scan:Who are the Uninsured?

• Most of the uninsured are in low income working families and do not have access to employer-sponsored care.

• Little is known about factors that contribute to the decision to remain uninsured, apart from those attributed to economic barriers.

• Other perceptual and attitudinal barriers are likely present and will need to be addressed to improve outreach success rates and optimize program benefits.

20

Geographic Diversity of the UninsuredGeographic Diversity of the Uninsured

Number Uninsured Percent Uninsured

Sick, Active & Worried Healthy & Young Passive & Skeptical59% female 43% female 46% female58% High School or less 56% High School or less 63% High School or less67% w chronic condition 4% w chronic condition 23% w chronic condition53% married 41% married 56% married42% employed 57% employed 56% employed77% Caucasian16% African American15% Hispanic

62% Caucasian16% African American22% Hispanic

62% Caucasian29% African American15% Hispanic

90% likely to qualify for subsidy.

84% likely to qualify for subsidy.

82% likely to qualify for subsidy.

Comparing the Uninsured Segments: Demographics

Comparing the Uninsured Segments: Demographics

Psychographic Diversity of the Uninsured

Psychographic Diversity of the Uninsured

Informed Healthy & Educated

Sick Active & Worried

Mature & SecureHealthy & Young

Passive & Skeptical

Vulnerable & Unengaged

Percentage of the Uninsured (aged 18-64)

Healthy & YoungHealthy & Young

• 47.8% of nonelderly uninsured adults.

• Take health for granted.• Internet savvy, but don’t search

for health-related topics.• Low motivation to enroll.• Potential for sub-segmentation.• 54% say cost is a main reason

they are uninsured.• 62% say they would be

interested in shopping for insurance in the new marketplace.

Sick Active & WorriedSick Active & Worried

• 28.9% of uninsured.• Mostly Gen X and Baby

Boomers.• Most likely to be in poor health,

many are also caregivers.• Actively seek information for

health issues, but may need help interpreting it.

• 79% say cost is a major reason they are uninsured.

• 72% say they would be interested in shopping for insurance in the new marketplace.

Passive & SkepticalPassive & Skeptical

• 15.3% of the uninsured• Spans the generations, but

mostly 49 or older.• Strong status quo bias.• Skeptical of communication from

“authority figures.”• Lives for today. • Lower health insurance literacy

skills, low motivation to enroll. • 73% say cost is a main reason

they are uninsured.• 50% say they would be interested

in shopping for insurance in the new marketplace.

Sick, Active & Worried

Healthy & Young Passive & Skeptical

Common Themes Across Segments

Cost-conscious and sensitive to motivational propositions emphasize high perceived value, getting a good deal, best deal for the dollar. Family centered lifestyles and obligations.

Cost-conscious and sensitive to motivational propositions emphasize high perceived value, getting a good deal, best deal for the dollar. Family centered lifestyles and obligations.

Cost-conscious and sensitive to motivational propositions emphasize high perceived value, getting a good deal, best deal for the dollar. Family centered lifestyles and obligations.

Distinct Themes Among Segments

Willingness to take a chance and do things their own way. Preferences for simple and straightforward with “no frills.”

Image-conscious, interested in self-improvement. Open minded, interest in having the “latest and greatest.”

Live for today.Preference for known brands [“the real thing”].

Themes and SegmentsThemes and Segments

Sick, Active & Worried Healthy & Young Passive & UnengagedMosaic® Segment, Town Elders: Stable, minimalist seniors living in older residences and leading sedentary lifestyles. Home-centered, stable, comfort over style, traditionalists, patriotic, cautious money managers, family pride, community roots, spiritual.

Mosaic® Segment, Hope for Tomorrow: Young, lower income African American single parents in second-city apartments. Transient, trend conscious, striving for more, utilitarian consumerism, diligent, optimistic.

Mosaic® Segment, Hispanic Harmony: Middle-class Hispanic families living lively lifestyles in city-centric neighborhoods. Gen X Hispanics, aspirational consumers, bargain hunters, sports junkies, family-centered lifestyles, mid-sized cities, young families, investment-averse, middle class, healthy living.

Mosaic® Segment, Small Town Shallow Pockets: Older, downscale singles and empty nesters living in modest exurban small towns. Conservative, modest lifestyles, convenience, community active, bargain shoppers, unpretentious, domestic travels, traditional media tastes.

Mosaic® Segment, Dare to Dream: Young singles, couples and single parents with lower incomes starting out in city apartments. Mobile singles, active life style, optimistic, crowded households, internet savvy, online gaming.

Mosaic® Segment, Gospel & Grits: Lower middle-income African-American multigenerational families living in small towns. Active social lives, modest educations, aspirational, philanthropic streak, socially conservative, discriminating consumers, limited budgets, moderate digital use, fashionable, multigenerational households.

Mosaic® Segment, Rolling the Dice: Middle-aged, mid-scale income singles and divorced individuals in secondary cities. Un pretentious, individualists, opportunity seekers, TV addicts, meager means, open minded, credit cards, athletic activities, limited educations, online for entertainment.

Mosaic® Segment, Digital Dependents: Mix of Gen Y and Gen X singles who live digital-driven, urban lifestyles. Eco-minded, outdoor activities, gamers & bloggers, digital trendsetters, risk takers, ubiquitous internet use, active social lives, appearances are important, artistic.

Mosaic® Segment, Work Hard Pray Hard: Working-class, middle-aged couples and singles living in rural homes. Remote settings, church-based activities, unpretentious, limited digital use, socially conservative, bargain shoppers, outdoor sports, community involvement, frugal, self-reliant.

Linking to Commercial Lifestyle Databases: Experian Mosaic Example

Linking to Commercial Lifestyle Databases: Experian Mosaic Example

Comparing the Uninsured SegmentsComparing the Uninsured Segments

Sick, Active , & Worried Healthy & Young Passive & Skeptical

Cost is cited as main reason for being uninsured by 79%; 60% have been noncompliant with medications due to cost.

Cost is cited as main reason for being uninsured by 54%; 33% have been noncompliant with medications due to cost.

Cost is cited as a main reason for being uninsured by 73%; 33% have been noncompliant with medications due to cost.

Health is fair to very poor; 67% have a chronic condition, 34% report a disability.

Health is excellent to very good; 4% have a chronic condition, 5% report a disability.

Health is fair to excellent; 23% have chronic condition; 12% report a disability.

79% use internet 91% use internet 62% use internet

Key ImplicationsKey Implications

• Sick Active & Worried - Awareness of new options will be critical, fewer motivational barriers, but may need help sharpening skills to make best use of information.

• Healthy & Young – Motivational messages with a focus on making a smart decision.

• Passive & Skeptical -- Motivational messages with a focus on independence, control, testimonials.– In addition, skill building and support will be especially

needed in community-based settings for those in the Passive & Skeptical Segment.

• Motivating consumers and businesses to use Marketplace.

• Supporting informed consumer decision-making:– Simplifying buying insurance with decision tools.– Standardization of insurance plan information.

• Improving outreach to diverse, low literacy consumers.• Improving consumer-“navigator” communication.• Explaining eligibility for coverage and tax

credits/subsidies operation of subsidized coverage.

Relevance of Health Insurance Literacy for Communications Tasks

Relevance of Health Insurance Literacy for Communications Tasks

Audience Segmentation Supports Effective Social Marketing

Audience Segmentation Supports Effective Social Marketing

• Understand target audience(s) – health literacy, culture, language, values, attitudes, perceptions, “consumer reality.”

• For each audience:• Identify barriers and facilitators.• Use plain language and consumer-centered design. • Test materials and messages.• Develop campaigns and outreach.• Evaluate behavioral impact.• Refine and repeat process.

Communications GoalsCommunications Goals

• Most consumers are not looking to compare the quality of providers

• Some consumers don’t believe they have a choice• Most consumers haven’t heard about quality

compare tools• Most consumers first learn about tools when it is

most difficult to use them• Communicators need to use a variety of tactics to

engage consumers – multi-faceted and long term

Application to Quality ToolsApplication to Quality Tools

Perceptions of ChoicePerceptions of ChoiceConsumer Choice

 Total

%

1: Informed, Healthy & Educated

%

2: Sick, Active & Worried

%

3: Mature & Secure

%

4: Healthy & Young

%

5: Passive & Skeptical

%

6: Vulnerable & Unengaged

%

Which doctors you or your family goes to for care

71 87 55 83 69 73 75

Which hospital you or your family goes to for care

70 79 59 85 69 70 69

Which home health agency you or your family goes to for care

44 55 39 46 41 48 39

Which health insurance plan you or your family has (Insured)

47 50 36 68 45 46 58

Being without health insurance coverage now (Uninsured)

35 42 28 23 36 40 45

Perceptions of Quality Differences Among Providers

Perceptions of Quality Differences Among Providers

Healthcare Quality Ratings

 Total

%

1: Informed, Healthy

& Educated

%

2: Sick, Active

& Worried

%

3: Mature

& Secure

%

4: Healthy

& Young

%

5: Passive

& Skeptical

%

6: Vulnerable

& Unengaged

%

Doctors – Any difference 85 96 89 84 86 75 70Big difference 60 74 74 61 54 48 50Small difference 25 22 15 23 32 27 20

Hospitals – Any difference 84 93 85 78 87 75 71Big difference 57 71 63 46 56 48 48Small difference 27 22 22 32 30 27 23

Health insurance plans – Any difference

81 93 80 79 84 71 67

Big difference 61 82 65 55 60 50 52Small difference 20 11 15 24 25 21 15

Nursing homes – Any difference

68 79 68 66 72 56 57

Big difference 52 72 55 54 48 44 43Small difference 16 7 13 12 24 11 14

Home health agencies – Any difference

56 66 56 44 61 47 43

Big difference 34 50 37 29 31 30 26Small difference 22 16 18 15 31 17 17

Awareness of Quality Tools has been flat for over a decade, but differ by SegmentAwareness of Quality Tools has been flat for over a decade, but differ by Segment

38

Continued consumer research will be essential to guide programs that improve the ability of consumers to navigate the evolving healthcare system, make better decisions, and find appropriate and affordable health care coverage. We are interested in hearing from you and look forward to continuing to share our findings.

A Look Ahead We can get there with your help!

A Look Ahead We can get there with your help!

Author Contact InformationAuthor Contact Information

Division of ResearchOffice of Communications

Frank Funderburk frank.funderburk@cms.hhs.gov

Clarese Astrin clarese.astrin@cms.hhs.gov

Diane Field diane.field@cms.hhs.gov