Research Questions

  1. What was the extent of C2C's spread and uptake?
  2. What did organizations do with C2C materials and messages?
  3. How did consumers use C2C materials and messages?
  4. To what extent is C2C associated with changes in care utilization?

From Coverage to Care (C2C) launched in 2014 with the dual goals of helping consumers understand their health insurance coverage and connect to care and supporting organizations in the community as they assist consumers at various points in this process. The Centers for Medicare and Medicaid Services asked a team of RAND researchers to evaluate the effectiveness of C2C in meeting these goals. The authors present the results of their mixed-methods analysis, which included secondary analyses of product-ordering and other data, a survey of organizations placing C2C product orders, a survey of consumers who had and had not reported C2C, and four case studies in communities using C2C products tailored to meet their language or cultural needs.

The authors detected a positive association between C2C dissemination and flu vaccination but did not detect associations between C2C and six other measures of primary care and emergency care utilization. Findings from the consumer survey, which asked individuals whether they had ever seen C2C materials, suggest that those who were exposed to C2C were more likely to have high health insurance literacy, routine checkups, regular blood pressure monitoring, and flu vaccinations. Findings from the survey of organizations, which asked about dissemination channels, suggest that most organizations shared C2C materials with others in their community through distribution at events, talking to colleagues informally, or presenting C2C in a meeting or at an event. However, it is unclear how many of these efforts resulted in uptake by other organizations. RAND recommends a strategic planning approach to guide future dissemination efforts.

Key Findings

Data from the CMS product-ordering database and the organization survey revealed several findings regarding the extent of C2C's spread and uptake

  • Organizations that ordered C2C materials were most commonly nonprofit.
  • Most organizations reported sharing C2C materials with others in their community.

The organization survey and four case studies revealed several findings regarding what organizations do with C2C materials and messages

  • Many organizations use C2C to help consumers overcome barriers to accessing care, including not knowing how to use insurance benefits, not knowing how to access health care services, and not understanding when it is appropriate to use emergency or urgent care services.
  • Many organizations reported that C2C filled a knowledge gap among staff working to support consumers and expanded organizational capacity to discuss these issues with consumers.

The consumer survey and four case studies revealed several findings regarding how consumers used C2C materials and messages

  • Self-reported exposure to C2C was associated with greater confidence in engaging with insurance and health care.

The consumer survey and data from the CMS product-ordering database and other sources revealed several findings regarding the extent to which C2C is associated with changes in care utilization

  • Exposure to C2C materials was not associated with consumers' self-reports of having a primary care provider or with increases in routine checkups or blood pressure monitoring.
  • There was a modest association between area C2C saturation and population-level estimates of flu vaccination among eligible individuals.
  • There was no evidence that exposure to C2C influenced overall emergency department or urgent care use.


  • Consider adding a limited number of questions to the product-ordering page to learn more about organizations placing product orders.
  • Consider ways to help strengthen uptake of C2C after lateral dissemination has occurred.
  • Consider ways to ensure that organizations already engaging with C2C are aware of the full suite of C2C materials, particularly those that were more recently developed or revised.
  • Support more active forms of dissemination. This could include ready-made social media posts for organizations to reach younger populations.
  • Broaden C2C's reach through translations in additional languages.
  • Revisit translations and the literacy level of materials. Some populations, including the Haitian Creole population studied as part of this evaluation, may benefit from simplified translations that use terminology shared across sublanguage groups. In areas of especially low literacy, organizations recommended visual aids, YouTube channels, radio spots, and other forms of nonverbal communication.
  • Consider changes to the format of C2C materials. For example, developing graphics-heavy messages that appeal to younger, particularly college-age, consumers may help to expose more consumers to C2C messages.

Table of Contents

  • Chapter One


  • Chapter Two

    Evaluation Approach

  • Chapter Three

    What Was the Extent of C2C Spread and Uptake Among Organizations?

  • Chapter Four

    How Did Organizations Select, Use, and Disseminate C2C Materials and Messages to Consumers?

  • Chapter Five

    What Did Consumers Gain From C2C Materials and Messages?

  • Chapter Six

    Were C2C Materials Associated with Changes in Health Care Utilization?

  • Chapter Seven

    Insights for C2C Strategic Planning

  • Appendix A

    Insights About Exposure and Uptake from Case Study Populations

  • Appendix B

    Multivariable Analyses Predicting Utilization

  • Appendix C

    Comparison of the Area Deprivation and Health Literacy Indexes Used in a C2C Strategic Planning Plan-Do-Study-Act Cycle

  • Appendix D

    Counties with High Need for C2C: Data Tables

  • Appendix E

    Multivariable Analysis Predicting Health Insurance Literacy

Research conducted by

The research described in this report was sponsored by Medicare & Medicaid Services Office of Minority Health (CMS OMH) conducted by the Access and Delivery Program within RAND Health Care.

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