Marketplace Dental Survey Form

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0938-1185)

T ITLE OF INFORMATION COLLECTION:

Focus Groups to Inform the Development of a Marketplace Dental Survey

PURPOSE:

The Centers for Medicare & Medicaid Services (CMS) is responsible per section 1311(c)(4) of the Affordable Care Act (ACA) for assessing the experience of consumers with regard to the Health Insurance Marketplaces (HIMs). The Health Insurance Marketplace Consumer Experience Survey (HIM CES) project is designed to assist CMS by creating surveys that provide consumer assessments of the services provided by the Marketplaces, as well as evaluating the Qualified Health Plans (QHPs) that they purchased through the Marketplaces. To date, two major surveys have been created through this effort: the Qualified Health Plan Enrollee Experience Survey (QHP Enrollee Survey) and the Health Insurance Marketplace Survey (Marketplace Survey), OMB Control Number for the surveys is 0938-1221. At present, neither the QHP Enrollee Survey nor the Marketplace Survey examines the consumer experience with dental insurance purchased through the Marketplaces.

The goal of the current project is to develop a patient experience survey for individuals purchasing dental insurance through the Marketplaces, called the Marketplace Dental Survey, which will address this need. Similar to the QHP Enrollee Survey, the Marketplace Dental Survey will take a Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) survey as its starting point. Specifically, the Marketplace Dental Survey will build upon the comprehensive work done to create the CAHPS Adult Dental Plan survey (D-CAHPS Survey)¹.

In the first phase of the project, American Institutes for Research (AIR) conducted a literature review and environmental scan to determine which domains should be considered for inclusion in the Marketplace Dental Survey, and to gather data to inform the survey structure. The findings from the literature review and environmental scan will be used to inform three formative research activities: 1) stakeholder interviews, 2) focus groups, and 3) the Technical Expert Panel (TEP) review.

This fast track request to conduct four focus groups with consumers who purchased dental insurance through a Marketplace is part of the HIM CES project. Although we are working with experts to develop this survey, consumers are the best sources of information on the following topics:

• Candidate Domains: Learn which aspects of dental insurance and information about insurance are most important to consumers;²

• Characteristics: Understand the demographics of the Dental Marketplace consumers;³

• Characteristics: Consider whether and how to address consumers' potentially low health literacy and low health insurance literacy;⁴ and

• Administering the Survey: Determine the ideal survey mode (e.g., paper versus online), and how often it should be administered.

DESCRIPTION OF RESPONDENTS:

In each geographic area, we will use recruitment firms to recruit focus group participants. Eligible individuals will be identified using a screening questionnaire (Attachment A). We plan to recruit diverse panels, so that we can explore whether there are any meaningful differences in results by personal characteristics of participants. Specifically, we will work to recruit individuals of different genders, ages, races, ethnic backgrounds, educational attainments, and urban versus rural residence. We also plan to recruit individuals who have purchased a stand-alone dental plan and individuals who purchased dental insurance as part of their overall health plan (also known as embedded plans). Our eligibility criteria for focus group participants will include the following (see Attachment A for our respondent recruitment screener):

• Purchased a dental plan through a Marketplace,

• Received dental care within last year,

• No participation in market research in last 6 months, and

• Must be between the ages 18 and 64

Focus groups will be held in Los Angeles, California and Chapel Hill, North Carolina. The focus groups will be conducted on both the East and West Coasts to see if themes emerge by location. According to data published by the U.S. Department of Health Services in May 2014, both California and North Carolina are among the five states with the largest total number of individuals who selected Marketplace plans.^5-6 In addition, California operates a State-Based Marketplace, whereas North Carolina operates a Federally-Facilitated Marketplace, allowing us to represent both state and federally-facilitated Marketplaces. Both of these locations have ethnic and economic diversity, as well as nearby regions that are rural or semi-rural.

We plan to conduct four focus groups, with a target goal of no fewer than eight and no more than 9 participants per group. In each of the two selected locations, we will hold two focus groups with consumers who purchased dental insurance through a Marketplace. One of these two focus groups, per location, will be with individuals who purchased a stand-alone dental plan, and the other will be with individuals who purchased dental insurance as part of their overall health plan (also known as embedded plans).

Respondent contact information will only be obtained for purposes of recruitment.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[X] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: __Nidhi Singh-Shah and Kimberly Kufel____________________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [X] Yes [ ] No

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [X] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ X] Yes [] No

System No. 09–70–0591 and System No. 09–70–0590

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [X] Yes [ ] No

Focus group participants will receive $100 for their participation. This amount will help to recruit the desired range of respondents described above, by addressing the following challenges:

• Participants from the diverse socioeconomic backgrounds we are seeking may not otherwise be able to afford forgoing income during the time required to both participate in, and travel to and from, the focus group.

• The focus groups will require participants to travel to a centrally located site and the stipend is intended to help compensate participants for their travel costs (e.g., train, bus, mileage, and parking).

• This may be a difficult-to-recruit study population, and the stipend may make it easier to attract hard-to-reach participants who face unanticipated barriers to participation (e.g., child care)

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time (min.)	Burden (hr.)
Individuals or Households	36	120	72
Totals	36	120	72

FEDERAL COST:

The estimated annual cost to the Federal government is $40,000.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ ] Yes [X] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

See Attachment A, “Focus Group Eligibility Screener.”

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[ ] Telephone

[X] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [X] Yes [ ] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

Attachment A – Focus group eligibility screener

Attachment B – Informed consent form for focus group participants

Attachment C – Focus group protocol

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

T ITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the request. (e.g. Comment card for soliciting feedback on xxxx)

PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information. These groups must have experience with the program.

TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions. Note: Agencies should only collect PII to the extent necessary, and they should only retain PII for the period of time that is necessary to achieve a specific objective.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households; (2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected per row.

No. of Respondents: Provide an estimate of the Number of Respondents.

Participation Time: Provide an estimate of the amount of time (in minutes) required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of Respondents and the Participation Time then divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

Submit all instruments, instructions, and scripts are submitted with the request.

1 Keller, S., Col Martin, G. C., Evensen, C. T., & Capt Mitton, R. H. (2009). The development and testing of a survey instrument for benchmarking dental plan performance: using insured patients’ experiences as a gauge of dental care quality. Journal of the American Dental Association (1939), 140(2), 229–237.

2 Information from consumers will be gathered by asking which characteristics of dental care and dental insurance are most important to them. Stakeholders and Technical Experts will be asked to rank candidate domains and suggest additional topics as necessary.

3 We will examine demographics of consumers recruited for Focus Groups and ask Stakeholders and Technical Experts what they suspect the demographics of consumers are.

4We will ask consumers in Focus Groups whether they have had difficulty obtaining information on dental plans and ask Stakeholders and Technical Experts whether and how to address these issues.

5 Kaiser Family Foundation (2014). Standalone Dental Marketplace Plan Selection, April 2014. Retrieved from http://kff.org/other/state-indicator/standalone-dental-marketplace-plan-selection-2014/

6 U.S. Department of Health Services (2014). ASPE Issue Brief: Addendum to the Health Insurance Marketplace Summary Enrollment Report for the Initial Annual Open Enrollment Period. Retrieved from http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/ib_2014Apr_enrollAddendum.pdf

6