Case Studies

From multi-year task orders with a team of subcontractors to smaller-scale individual research efforts, L&M has led dozens of research projects from government agencies, as well as private clients.

Centers for Medicare & Medicaid Services (CMS), September 2017 through September 202


Support CMS outreach and education efforts related to the “Health Insurance Marketplace” – a consumer-facing website that helps individuals shop for and enroll in affordable individual or family health insurance – by providing actionable insights on the information needs of “Marketplace-eligible” consumers.


After a highly-publicized national debate about proposed changes to the Marketplace, enrollment in Marketplace plans has gradually declined year to year. CMS needed to assess current attitudes and perceptions of the program and gauge awareness of the changes that have been implemented as well as proposed. In addition to measuring current attitudes and perceptions, CMS wanted to understand how consumers’ information diets and communication contexts may have shaped attitudes about the Marketplace. Finally, CMS sought to understand how these factors may have differed among two broad segments of the “Marketplace-eligible” populations: uninsured individuals and Marketplace enrollees who recently purchased a Marketplace plan. All of these insights would help inform message development for future enrollment efforts.


L&M first conducted an environmental scan, reviewing relevant grey literature to understand current perceptions of the Marketplace, gauge public awareness of and reaction to changes to the Marketplace (real or proposed), and summarize factors that might explain the decline in the most recent open enrollment period. L&M then conducted seven focus groups in two different cities to assess overall attitudes about and knowledge of the Marketplace. In each research location, the team conducted two focus groups with uninsured individuals (one with younger individuals age 19 to 34 and one with older individuals age 35 to 64). The team conducted three focus groups with Marketplace enrollees age 19 to 64. One of the three groups consisted only of “new enrollees” who had signed up for a Marketplace for the first time in the most recent enrollment period. The other two included a mix of new and reenrollees. These 90-minute discussions focused on consumer perspectives on the Marketplace and knowledge of recent changes to the Marketplace, barriers to enrollment for uninsured participants, and the “communication context” of participants with regard to health insurance and health care.


Our Team:

  • Summarized the research available on current perceptions and attitudes about the Marketplace and key factors driving enrollment declines.
  • Generated actionable insights that helped generate guidelines for communicating differently with older uninsured populations, younger uninsured populations, Marketplace re-enrollees, and those newly-enrolled in Marketplace plans.
  • Identified areas of future research to explore unanswered questions raised by the research.