Health Insurance Navigators for the Low-Income Elderly

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DESCRIPTION (provided by applicant): The candidate for this Paul B. Beeson Career Development Award in Aging is a general internist with formal clinical research training. He proposes a research and career development plan to build on existing skills and develop expertise in patient-oriented aging-related research, with a focus on financial barriers to care for the elderly and the development of interventions to lower these barriers. The complexities of healthcare coverage for the elderly pose a significant challenge for choosing coverage that meets individual needs, especially for low-income, inner-city seniors because of low education, literacy problems, and other barriers. The new Medicare prescription drug benefit will add greatly to this challenge because of the myriad factors one must weigh to make an optimal plan selection. Previous efforts to facilitate insurance decision making for the elderly have had only modest effects. One reason may be that these efforts have lacked theoretical grounding or strong empirical data to support the approach. The goal of this application is to empirically identify factors that influence insurance decision making among low-income, inner city seniors, and devise a method to facilitate decision making. The 4 specific aims are 1) to determine the influence of cognitive impairment and health literacy on healthcare coverage decisions; 2) to develop measures of the impact of healthcare costs on the elderly, and of their insurance information and decision making support needs; 3) to test the validity of applying the Transtheoretical Model's stages of change construct to the process of healthcare coverage decision making; 4) to develop and evaluate an intervention that applies the findings from Aims 1-3 to provide insurance coverage decision making support that is tailored to the individual's specific needs, and takes into account their readiness to make a change in healthcare coverage. For Aims 1-3, we will conduct focus groups to develop a survey instrument, and will survey 400 elderly adults from hospital and community-based clinics and senior centers in East Harlem and the Bronx, NY. For Aim 4, we will develop a health insurance navigator intervention that uses trained layperson volunteers to assist patients, who have been screened for need, with making optimal healthcare coverage decisions. We will evaluate the intervention in a randomized controlled trial. This research would provide clinicians and investigators with new research and clinical tools, expand understanding of the insurance decision making in older adults, and create an efficient, low cost method to help seniors optimize insurance decisions. Study findings would also give policymakers insight into the real world experience of some of the most vulnerable elderly patients participating in the largest expansion of Medicare since its inception. The career development plan includes didactic courses, expert advising, and mentored research to develop skills in qualitative and survey research methods, and to expand the candidate's clinical geriatrics knowledge base.