GIS and Social Marketing at The Centers for Medicare & Medicaid Services

1. GIS and Social Marketing at The Centers for Medicare & Medicaid Services Joan N.Gardner (Applied Geographics) Jodi Duckhorn (CMS) This project is funded by The Centers for Medicare & Medicaid Services (CMS)

2. Interactive Web Site for The Center for Medicare & Medicaid Services • Joan N. Gardner, President, Applied Geographics, Inc. • Jodi M. Duckhorn, Social Science Research Analyst, U.S. Department of Health and Human Services • Centers for Medicare & Medicaid Services (formerly HCFA) • Center for Beneficiary Choices • Beneficiary Education and Analysis Group • Division of Beneficiary Analysis • ESRI Health Conference, Washington DC • November 2001

3. Application for Census Data • Phase I • Social Marketing • Phase 2 • Map atlas • Interactive web site

4. Context for Social Marketing at The Centers for Medicare & Medicaid Services (CMS) • Balanced Budget Act mandated that CMS become more beneficiary friendly • CMS has refocused to become more consumer-oriented • Discover and respond to beneficiary wants and needs • Help beneficiaries understand their benefits and CMS programs • Social marketing applies commercial marketing concepts to health and human services programs designed to influence behavior of target audiences in order to improve personal and societal welfare • CMS has adopted a social marketing strategy to better understand and communicate with their beneficiaries

5. Integrating GIS and Social Marketing at CMS • CMS’s Center for Beneficiary Choices (CBC) is integrating GIS into an already well developed social marketing initiative to better understand beneficiaries • The Project’s Objectives: To better identify, segment and target HCFA beneficiaries so that CMS’s messages will be more relevant, focused and more well received by our beneficiaries • Roles: • Identify relevant data sources for specific mapping requests • Develop map templates • Map data, by county, to segment beneficiary population

6. Programs Administered by CMS • CMS administers Medicare, Medicaid and the State Children’s Health Insurance Program (SCHIP) • Medicare provides health insurance for people age 65 and over, those with permanent kidney failure and certain people with disabilities • Approximately 39 million individuals (HCFA, 1998) • Medicaid is a jointly funded, Federal-State health insurance program for certain low-income and needy people • Approximately 36 million individuals (HCFA, 1998) • SCHIP provides low cost or free health insurance for low income children who do not qualify for Medicaid

7. Mapping CMS Beneficiary Populations, beginning with Medicare • CBC plans to use GIS to look at all 3 beneficiary populations (Medicare, Medicaid, and SCHIP) • This project began with the Medicare beneficiary population • According to 1996 CMS data: • 83% of beneficiaries are white, 9% are African American, 6% are Hispanic, 2% are Asian and Pacific Islanders, 0.4% are American Indian or Alaskan Natives • But how are these people distributed geographically? • CMS can use GIS to answer this question • This information allows CMS to target certain areas of the US with culturally appropriate consumer information

8. GIS Supports a Closer Look • A major premise of social marketing is to tailor the message to different audience segments • GIS specifically supports these analyses for CMS by: • integrating data from disparate sources • analyzing and displaying data at local levels of geography • defining and targeting segments of Medicare eligibles and beneficiaries

9. Sample Social Marketing and GIS #1: Medicare Beneficiary Population • CMS used this map to show the Advisory Panel on Medicare Education a baseline picture depicting where the Medicare beneficiaries reside by county and state.

11. Sample Social Marketing and GIS #2: African American Population • Medicare covers annual screening mammograms for eligible women. • Since it is less likely that African American and Hispanic women will seek screening, CMS has targeted the over 65 age group of African American and Hispanic communities for outreach and education about this benefit. The outreach focused on one or both minority groups.

13. Sample Social Marketing and GIS #3: American Indian Population • CMS is working with American Indian and Alaskan Native populations to explain what Medicare services are available. • CMS can use maps to locate areas with high concentrations of American Indians and Alaskan Natives in order to reach beneficiaries and their providers who offer services and Medicare information to this population.

15. Sample Social Marketing and GIS #4: Asian and Pacific Islander Population • In many Asian cultures it is perceived that older individuals live with their children or other relatives when they can no longer live on their own. In addition, Asians are less likely to travel outside of their communities for health care as their communities are important and tightly knit (Spector, 1996). • CMS can target elderly Asians to help them better understand the Program of All-Inclusive Care for the Elderly (PACE) program, an optional Medicare benefit that allows elderly people to stay in their homes and communities and still receive intensive medical, social and rehabilitative services.

17. Sample Social Marketing and GIS #5: Hispanic Population • Diabetes is a serious health concern for some minority populations due to an increased prevalence of this disease in several minority populations. • CMS can target specific minority communities with brochures explaining Medicare coverage for diabetes printed in not only English by in other languages such as Spanish as well.

19. Sample Social Marketing and GIS #6: Beneficiaries Living in Rural America • Approximately 1 in 4 Medicare beneficiaries live in rural America. These rural beneficiaries have lower in come levels and much less access to technology compared to other Medicare beneficiaries. • CMS can target rural communities with easy to read information specifically written to help rural beneficiaries understand their Medicare benefits.

21. Sample Social Marketing and GIS #7: Beneficiaries Enrolled HMOs • CMS can use maps to locate enrollment trends and areas where disenrollment from Medicare managed care plans is most prevalent.

23. Current Uses of GIS for CMS Social Marketing • Share maps and supporting data and documentation with CMS projects and regions and internal central office staff • Use maps to prioritize and determine specific segments of CMS beneficiaries to target • Integrate data used to produce maps with other information, such as utilization of services, for analysis and decision making

24. Data Challenges • Data Access • CMS requires signed data and computer use agreements to protect data confidentiality and individual beneficiary privacy. The requirements are strict and must be met. • CMS’s data query system is on a mainframe and requires training and time to extract data • Data Quality • Public CMS data are not always available at low levels of geography

25. Data Challenges (Con’t) • Data Management • CMS collects billions of claim records, with varying file formats • CMS manages vast quantities of health utilization data which require aggregation to support social marketing • Data Analysis • Audience will determine the importance of data currency • Beneficiary characteristics database should be developed more extensively

26. Second Phase of the Project • Jodi Duckhorn, CMS, Project Leader • Peter Girard, AGI Director of Software Architecture • Vicky Tam, AGI Senior GIS Analyst • Web atlas • Interactive web site, compliant with ADA

27. Census 2000 Data • The following maps were created at AGI for this presentation • Show what can be done using the 2000 data • new data • comparison with 1990 data

34. Interactive Web Site • Uses SVG(scalable vector graphics) viewer which is a plug-in • Free download from Adobe • Uses 2.5 mg bytes • Pan and zoom capability • Save as a file

35. SVG Viewer • Created a script which loops through all the states • Creates a projection for each state • Creates SVG coordinates for all counties • Pulled into a database

36. SVG Viewer • Advantages • Needs no map server • Less to maintain • One Access database • More possibilities for ADA requirements

38. SVG information • http:/www.adobe.com/svg/viewer/install/main.html • Version 3.0 should be ready soon and will have a smaller download

39. Other Health Projects • Silent Spring Institute-Breast Cancer Research • Bureau of Transportation Statistics-Welfare to Work • www/bts.gov/state/visit.html • MA DPH-Geocoding Cancer Registry 1987-present • Geocoding Vital Statistics • HRSA-Blanket contract for • HIV/Aids • Maternal Infant Health Care • Rural Poor

40. Thank You Joan N. Gardner Jodi M. Duckhorn jng@appgeo.com Jduckhorn@cms.hhs.gov 617 292-7125 410-786-1820