Healthcare in America emphasizes patient-centered choice. It is up to individuals to understand the benefits and risks of different medical options and make informed decisions. Seniors in particular are bombarded by healthcare statistics and choices. But being exposed to facts is not necessarily the same as being informed.
An example of the complexity that seniors face in the healthcare marketplace is the Medicare prescription drug program (Part D) which offers substantially subsidized insurance for individuals over 65 years of age. To take advantage of the cost savings, senior citizens must choose from a buffet of plans with different premiums, deductibles, drug prices, pharmacy networks, and coverage options. Many simply fail to enroll.
A new initiative promises to provide researchers, practitioners, and administrators with comprehensive information to assist older adults in making complex healthcare decisions. The project will examine decision strategies that lead seniors to make better, more satisfying healthcare decisions and test information presentation methods that facilitate optimal decision making. The undertaking is part of a multidisciplinary project that combines the expertise of faculty in psychology, sociology, and economics within the College of Human Ecology and includes collaboration with the Weill Cornell Medical College.
This unique collaboration is being led by Joseph Mikels, Assistant Professor of Human Development, and Kosali Simon, Assistant Professor of Policy Analysis and Management. The project builds on Simon’s health economics research that analyzed Medicare Part D plans and information presentation methods and Mikels’ work that examined age-related changes in cognitive and emotional processing and how these apply to healthcare decision making.
The research will explore the information sources older adults use in health care decisions. Given the complexity of healthcare options available today, older individuals are likely to seek information from a variety of sources including information tools like report cards and fact sheets as well as advice from their physician, family, senior centers, outreach clinics, and friends. Although there is a large investment of public funds into developing information tools, there is little evidence on the effectiveness of these tools relative to other sources. The researchers will conduct a series of focus groups and surveys to gain a comprehensive understanding of where seniors turn to gather information when making healthcare decisions.
The research will examine strategies that may improve the healthcare decisions older adults make. Work in the laboratory of Joseph Mikels indicates that when making complex healthcare decisions (e.g. choosing physicians, treatments, etc.) older adults benefit from strategies that focus on emotional reactions and intuitions rather than on memory and reason. Not only do older adults make better decisions when “going with their gut,” but they actually subsequently feel better about their decisions. In a series of studies, the researchers will further explore how emotional decision strategies may improve the quality of older adults’ decisions about Medicare Part D. The findings of this project have important implications for the design of counseling programs available to aid seniors in health care decision making.
The research will look for information presentation methods that are more effective for older adults. Healthcare decisions (especially with respect to Medicare Part D) are typically very complex, with all relevant information often presented simultaneously. Such presentation methods place an overwhelmingly high burden on individuals’ cognitive capacity. In the final series of studies, the researchers will examine whether different presentation methods (such as paper versus computer presentations, restricted information presentations, and quantitative versus qualitative presentations) result in improved decision quality.
The research findings will have direct implications for the optimal presentation of healthcare related information to seniors. This is an important concern for policy – for instance, advising the Center for Medicare Services how best to administer the Medicare program – as well as for programs and professionals engaged in assisting seniors.
Other participating Cornell researchers include Karl Pillemer, Professor of Human Development and Director of the Cornell Institute for Translational Research (CITRA); Mark Lachs, Irene F and I. Roy Psaty Distinguished Professor of Medicine at Weill Cornell Medical College; and William White, Professor of Policy Analysis and Management. The pilot project is being funded by the College of Human Ecology Pilot Award Program to Encourage Multi-departmental Research Activities. For
Further Information
Emotion and Cognition Laboratory http://www.human.cornell.edu/che/HD/mikelslab/
Cornell University Resource Education on Medicare Part D (CURxED) http://curxed.human.cornell.edu/