EVALUATION OF COVERAGE TO CARE
Appendix A
Organization Survey: Informed Consent and Survey
(CMS-10632; 0938-New)
NOTE: This survey is annotated to show (1) headers for each module; (2) the objective for that section; and (3) question numbers and instructions to the survey programmer.
PRA Disclosure Statement
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OMB No.: 0938-XXXX
Expiration Date: MM/DD/YYYY
INFORMED CONSENT FOR ORGANIZATIONS
Thank you for agreeing to participate in this survey. The RAND Corporation is conducting a study for the Centers for Medicare & Medicaid Services on From Coverage to Care, or C2C. As you may know, From Coverage to Care aims to help people with new health care coverage understand their benefits and connect to primary care. It is also designed to help community organizations and providers support people as they connect to care.
Purpose of the survey
You have been selected to take this survey because our information suggests your organization has previously ordered C2C materials from CMS. [IF RELEVANT: Your name was provided as the person most appropriate to complete this survey on behalf of your organization.] The goal of this survey is to provide feedback on the C2C materials and messages from the perspective of the organizations that have used them to help CMS understand how the materials are being used and how they can be improved.
The goals of this survey are to learn more about:
How your organization has used or uses C2C materials.
Which materials or messages are most helpful and suggestions you have for improvement.
How C2C materials and messages reach people, and how individuals seem to respond to them.
Procedures
The survey should last approximately 15-20 minutes. We will not collect personally identifiable information, and your answers cannot be linked back to you. This survey contains questions related to your experiences with C2C. Question types include multiple choice (single and multi-answer options) and fill in the blank questions. You may skip any questions you do not feel comfortable answering.
This survey does not require the assistance of outside resources. Completing the questions to the best of your ability, or based on minimal information searching, is acceptable for this survey.
Potential risks and discomforts
There are no identifiable risks associated with this survey. All information will be kept confidential. Your name will not be collected or linked to the data you provide at any time. The researchers will provide an electronic copy of this written consent directly to all research participants prior to conducting the survey.
Potential benefits
This research is not designed to help you directly, but the results may help improve C2C materials, messages, and outreach practices to encourage improved community health. We hope that, in the future, other people and organizations might benefit from this study.
Confidentiality
We will not collect any identifiable information, thus confidentiality will be maintained, except as required by law. Should you choose not to participate in the study, information on your refusal to participate will not be released to CMS or your organization. The data collected through this survey will be summarized in aggregate form, grouped with data others provide for reporting and presentation.
Survey responses will be securely stored on password-protected computers. Any hard copies of the data will remain in the possession of the principal investigator in a locked office. All data will be destroyed (i.e., shredded or erased) after a minimum of five years after data collection.
Compensation
You will receive a $25 gift card electronically upon completion of the survey for your time. At the end of the survey, you will be provided with a link to access the gift card.
Right to withdraw and questions
Your participation in this research is completely voluntary. You may choose not to take part at all. If you decide to participate in this research, you may stop participating at any time.
If you have questions or concerns about this study please contact the Principal Investigator of the study, Tom Concannon at 617-338-2059 x8615 or by emailing tconcann@rand.org
Participant Rights
If you have questions about your rights as a research participant or wish to report a research-related concern, you can contact RAND Human Subjects Protection Committee (HSPC) toll-free at (866) 697-5620 or by emailing hspcinfo@rand.org. If possible, when you contact the Committee, please reference Study #2015-1002.
This research has been reviewed according to the RAND Corporation HSPC procedures for research involving human subjects.
Module 1: Organizational Module
Research questions addressed:
What kinds of organizations were reached by C2C?
What best describes your organization? (Please choose most appropriate)
Health care provider —primary or preventive care
Health care provider — urgent care, emergency care or hospital
Health care provider — mental or behavioral health care
Health care insurer
Social service agency
Public health organization (local, state, or federal)
Consumer/patient advocacy organization
Other community organization such as school or faith-based organization
Navigator/assister/certified application counseling organization
Other (please specify) ____________________
What best describes your organization’s funding or tax status? (Please choose most appropriate)
Private, not for profit (501c status) organization
Private, for profit organization/company
State government organization
County governmental organization
Local/city governmental organization
Other (please specify: ___________________)
How many employees does your organization have in total? (Please choose most appropriate)
Small (less than 25 employees)
Medium (26-99 employees)
Large (100-249 employees)
Very large (250+ employees)
Module 2: Organizational History with C2C and CMS
Research questions addressed:
What are effective strategies for dissemination from CMS to organizations?
How did your organization first learn about C2C? (Please choose one)
CMS website
CMS correspondence such as newsletter or distribution list
Webinar where C2C was discussed
CMS regional office/distribution
From another organization in my community
From a professional organization/society
From a person in your community
From the media
Oonline search
Don’t know
Other (please specify: _________________)
When did your organization first learn about C2C? (Choose most appropriate estimate)
a. In the last six months
b. Between six and twelve months ago
c. More than a year ago
e. Don’t know
Module 3: C2C Ordering and Distribution Practices
Research questions addressed:
What did organizations do with the C2C materials and messages?
Which C2C materials and messages did they use?
Now we are interested to learn a little more about your organization’s experience with C2C.
Why did your organization decide to use C2C materials? (Please choose all that apply)
Addressed a knowledge gap in my community
Addressed a knowledge gap in our organization/helped us to know how to talk about these issues
Easy to use formats/easy to understand
Free resources
Other (Please specify: ____________________________)
Which C2C materials did your organization order? Please select all that apply (Include categorized list of materials in drop box)
A Roadmap to Better Care and a Healthier You Booklet
Roadmap Poster
5 Ways to Make the Most of Your Health Coverage
Step 1: Put Your Health First
Step 2: Understand Your Health Coverage
Step 3: Know Where to Go
Step 4: Pick a Provider
Step 5: Make an Appointment
Step 6: Be Prepared for Your Visit
Step 7: Decide if the Provider is Right for You
Step 8: Next Steps After Your Appointment
Sample Insurance Card
Differences Between Your Provider’s Office and the Emergency Department
Sample Explanation of Benefits
Preventive Service Flyers
Put Your Health First Infographics
Partnership Toolkit
Enrollment Toolkit
Discussion Guide for Community Partners
How did your organization determine what types of C2C materials to order? (Please choose all that apply)
We selected materials that address the questions our community members have
We selected materials that come in a language (other than English)
We selected materials that can be easily handed out to community members
We selected materials that address the needs of our staff
Other (please specify: ________________________)
For how many sites or locations does your organization place orders of C2C materials? (Please choose most appropriate)
1 site
2-5 sites
More than 5 sites
Was your organization satisfied with the time it took to receive C2C materials?
Yes
No
Don’t know
Does your organization plan to order more C2C materials in the future?
Yes (go to next question)
No (skip to question 13)
I do not know if my organization plans to order more C2C materials (go to next question)
How does your organization figure out when to order more C2C materials? (Please choose most appropriate, then skip to question 14)
We order them when our existing supply is low
We order them before community events or open enrollment season
We have regularly scheduled orders
Our organization’s leadership tells us when to order more
Unknown – we have not ordered more materials yet
Other (please specify: __________________________)
Why did your organization stop ordering C2C materials? (Please choose all that apply)
Our organization has enough C2C materials to last us for a long time
The materials were not helpful to my community
We use other materials to address these topics (If checked, what is the name of those materials? _______)
We did not have the resources (such as staff, storage space, etc.) to use C2C materials
The materials were not available in a language we use (If checked, what language is needed? ____________________)
We no longer provide services relevant to C2C (for example, we do not provide patient navigation services anymore)
Other (please specify: __________________________)
(If any of options b-k selected in question 13 above:) In the space below, briefly describe the most important factor causing your organization to stop using C2C materials? (1-2 sentences, Fill in blank)
Thank you. We would now like to understand just a bit more about how your organization may communicate or disseminate C2C information in your community.
Research questions answered:
How did organizations share the information with other organizations and what are best practices?
How did organizations use the materials with community members and what are best practices?
How does your organization share C2C information and materials with patients and other members of your community? (Please choose all that apply)
Hand out materials and talk about them during community health fairs
Hand out materials and talk about them during health insurance enrollment sessions
Use materials in courses/training we offer
Place materials on table or wall displays in our organization or other public spaces for community members to pick up
Distribute materials to other partner organizations who pass them out
Mail materials to community members
Hand out or mail materials in response to community member requests
Other (please specify: _________________________)
Of the ways selected in the last question, in your experience, what forms of sharing C2C materials were most helpful to community members? (Please choose top 3)
Hand out materials and talk about them during community events/health fairs
Hand out materials and talk about them during enrollment sessions
Place materials on table or wall displays in our organization or other public spaces for community members to pick up
Distribute materials to other organizations who pass them out
Mail materials to community members
Hand out or mail materials in response to community member requests
Other (please specify: _________________________)
How has your organization shared C2C materials and messages with other organizations in your community? (Please choose all that apply)
Told colleagues or other community organizations about C2C
Mailed C2C materials to other organizations
Distributed C2C materials to other organizations at community events (for example, at a health fair)
Presented C2C information to organizations (for example, at a local meeting)
Other (Please specify: _______________)
In your experience, what forms of sharing C2C materials with other organizations were most helpful to them? (Please choose one)
Told colleagues or other community organizations about C2C
Mailed C2C materials to other organizations
Distributed C2C materials to other organizations at community events (for example, at a health fair)
Presented C2C information to organizations (for example, at a local meeting)
Other (Please specify:_____)
Has working with C2C made your organization form or strengthen any relationships with other organizations in the community?
Yes, we formed relationships with organizations we haven’t worked with before
Yes, we strengthened existing relationships
No (SKIP to question 21)
Do you plan to continue these relationships in the future?
Yes
No
Not sure
Was use of C2C a burden for your organization?
Yes, a large burden (please describe: ____________________)
Yes, a small burden
Not a burden
Did your organization train any of its staff to give out the C2C materials or talk about its topics?
Yes, for all staff
Yes, for some staff
No (Skip to question 23)
Did this training use CMS partner and presentation tools, such as the C2C Partner Toolkit or the C2C Community Presentation slide deck?
Yes
No
Don’t know
Has your organization ever tried to order C2C materials that were unavailable or out of stock?
Yes
No (skip to Q26)
Don’t know
Did you use the “notify me” button on the CMS ordering website to learn when the materials were available?
Yes
No (skip to Q26)
Don’t know
Did you receive an email from CMS telling you when the materials were in stock?
Yes
No
Don’t know
What would be most useful to your organization to help you use and distribute C2C materials and messages? (1-2 sentences, open response)
Module 4: Perceptions of Community Needs and Value of C2C
We are interested in getting some feedback on the most pressing needs in your community at this point in time.
Research questions answered:
What factors influenced which materials and messages organizations decided to use and how to use them?
When it comes to health care in your community, what would you say are the biggest barriers individuals face? (Please rank up to 3)
Individuals do not know how to access health care services
Individuals do not know how to find a regular provider or source of care
Individuals do not understand the importance of health care
Individuals do not understand the importance of health insurance
Individuals do not understand how to use their insurance benefits
Individuals do not understand when it is appropriate to use emergency or urgent care services
Other (please specify:)______________
For the next four questions, consider if the following issues would be considered a priority for your organization and if any messaging was used on the topic.
|
A. Is this topic an area of focus or a top priority of your organization? |
B. Did your organization use any messaging or materials in its work on this topic? (Please choose all that apply) |
28. Access to health services |
(Yes/No drop down menu – SKIP part B if NO) |
|
29. Find a regular provider or source of care |
(Yes/No drop down menu – SKIP part B if NO) |
|
30.Understand insurance benefits and how to use insurance |
(Yes/No drop down menu – SKIP part B if NO) |
|
31. Access appropriate care/services |
(Yes/No drop down menu – SKIP part B if NO) |
|
Module 5: Perceptions of Community Engagement with C2C
Research questions answered:
Did C2C contribute to a change in community members’ knowledge and understanding of health insurance and how it works?
Did C2C contribute to a change in community members’ knowledge and understanding of how to access care as a result of C2C materials or messages?
Now we want to ask you about whether you think the community better understands health insurance and how to access care
In the next question, please think about your community members’ reactions to C2C. Then please rate how much you agree or disagree with each statement.
1 Strongly disagree |
2 Disagree |
3 Neutral |
4 Agree |
5 Strongly agree |
99 Don’t know/I don’t work with the community directly |
32. After using C2C materials …
Members of my community understand why prevention and primary care is important for their health
Members of my community gain a better understanding of health insurance and how to use it
Members of my community can choose coverage that best meets their needs and expectations
Members of my community reduce the inappropriate use of emergency or urgent care
Members of my community engage in more regular and or/preventive care
Members of my community are more able to find a provider and make an appointment
The topics covered in C2C materials are helpful to members of my community
In the next question, please think about organizations you shared C2C materials with in your community. Then please rate how much you agree or disagree with each statement.
1 Strongly disagree |
2 Disagree |
3 Neutral |
4 Agree |
5 Strongly agree |
99 Don’t know/I didn’t share materials with other organizations |
33. After seeing or using C2C materials…
The topics covered in C2C materials are helpful to other organizations in my community
Organizations in my community felt more prepared to talk to people about why prevention and primary care is important for their health
Organizations in my community felt more prepared to talk to people about health insurance and how to use it
Organizations in my community felt more prepared to help people choose coverage that best meets their needs and expectations
Organizations in my community felt more prepared to help reduce the inappropriate use of emergency or urgent care
Organizations in my community felt more prepared to encourage the use of more regular and or/preventive care
Organizations in my community felt more prepared to help people find a provider and make an appointment
Now we are interested in your organization’s feedback about C2C materials and messages. Please tell us about your organization’s experience with the C2C materials with which it is familiar.
Research questions answered:
Which C2C materials did they use?
Which materials and messages did organizations find most helpful, and why?
What factors influenced what materials and messages organizations decided to use and how to use them?
For each of the materials you ordered, please rate how helpful the material was to your organization? [Populated with list selected from Q7]
1 Very helpful |
2 Helpful |
3 Neither helpful nor unhelpful |
4 Unhelpful |
5 Very unhelpful |
[For responses of very helpful or helpful, ask] Why was that material helpful to your organization? (please choose all that apply)
It addressed one of the biggest health care-related problems or needs in my community
It was the easiest set of materials for our organization to communicate with community members
It was the easiest set of materials for community members to understand
Other (please specify: _____________________)
[For responses of very unhelpful or unhelpful, ask] Why was that material unhelpful to your organization? (please choose all that apply)
It did not address relevant needs in my community
It was the most difficult set of materials for our organization to communicate with community members
It was the most difficult set of materials for community members to understand
Other (please specify: _____________________)
Has your organization used any of the C2C online resources? (check all that apply)
Someone in our organization has visited the C2C website
Someone in our organization has downloaded C2C materials
Someone in our organization has watched the C2C videos available on the website
Our organization uses the C2C website or other online resources to discuss C2C topics with community members/patients
Other (please specify): _________________________
What additional topics or issues do you think should be added to C2C? (1-2 sentences, open response)
What additional C2C materials or products would be helpful for community members (for example, materials for a special population or health concern)?
Module 6: Respondent Demographics
Please answer some brief questions about yourself.
How long have you worked at the organization? (________) Years
Thinking about your organization’s use of C2C, what were your roles? (Please choose all that apply)
I placed the C2C product orders for my organization
I trained staff in my organization to communicate C2C topics and materials with community members
I provided management support for the use of C2C in my organization
I used C2C materials with community members
Other (please specify:) ____________________
What is your job title? (open response) : ____________
Is there anything else you would like to tell us about your experience with C2C? (open response)
THANK YOU FOR COMPLETING THIS SURVEY.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Emily Hoch |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |