Many Americans still labor under a number of healthcare misconceptions, especially as they pertain to health insurance, Health Savings Accounts (HSAs) and other coverage products. Others suffer from "health insurance illiteracy." Unfortunately, good information can be difficult for consumers to access — and even more difficult for many consumers to understand. But in our national move toward a consumer-based model, Americans have more reason than ever to educate themselves about the delivery of healthcare.
Healthcare illiteracy has reached critical mass.
According to a Kaiser Family Foundation survey released last year, nearly 3 out of 4 organizations that help consumers enroll in health coverage report having to explain basic healthcare terminology to the majority of the people they assist. According to a Harris poll of 2,000 American adults, 38 percent of consumers report that they don't have a good understanding of which services are covered under their current plans.
Insurance (and health insurance in particular) has always been a somewhat opaque environment for the average consumer. Coverage is delineated in mind-numbing declaration pages. Exclusions and eligibilities are explained in impenetrable legalese. Successful appeals require resources to mount — resources often not possessed by the people who need the most redress.
Not only do consumers need to have a high level of literacy to read their contracts, they would need to have a basic understanding of the principles of finance and law in order to, on their own, make the insurance purchases that would be best for them.
Luckily, agents exist to bridge that gap for most insurance products. Agents ask questions to match customers' coverage needs to products available on the market. They curate a manageable number of best choices for the customer to choose from. And they serve as a contact point for questions, education and customer service.
Most health insurance, however, isn't purchased on an individual plan basis. Most of it is chosen either by employers' benefit administrators or government administrators, then passed along to consumers on a near take-it-or-leave-it basis. In many cases, consumers think they only have one or two choices. Some don't even know that health insurance can be purchased on an individual basis.
The Affordable Care Act (ACA) sought to change some of those misconceptions and acclimate consumers to the availability of alternatives, but the rollout has been difficult, uneven and controversial.
As things stand, health insurance can be even more difficult to understand than property and casualty or life insurance lines. Not only might a consumer need to have basic knowledge of law and finance, he or she would need somewhat sophisticated knowledge of medicine and of the healthcare system in order to choose proper coverage for him or herself. At the same time, the ACA has cut profit margins for health insurance providers and agents enough that some are beginning to exit the market. Budget-conscious middle and lower-class Americans continue to demand simplified, consumer-direct purchasing models — placing additional pressure on agents. It's a perfect environment for health insurance illiteracy to breed.
Whose responsibility is it to educate consumers about healthcare utilization and insurance, anyway?
Some say employers.
According to the 2015 Acclaris Consumer Education Survey Report, a slim majority of responding healthcare professionals — 53.1 percent — believe that employers are responsible for educating consumers about how to use their HSAs or flexible spending accounts. They noted that many consumers don't even know basics like how and when an HSA can be used or which healthcare are costs are reimbursable.
There are several issues that could arise from this approach:
- Do most companies' benefits experts have enough understanding of preventative medicine, acute medicine and chronic disease management to be able to proffer the necessary education? Of course not.
- Are most companies willing to staff healthcare navigators? No, they're not. Nor do many HR executives have the insights into the American healthcare system necessary to make sound hires.
- What about people who do not get health coverage through an employer? Are they out of luck? Is it the government's job (There’s certainly some accountability here given all its regulations and system changes)? Survival of the fittest?
Providers and insurers must step in to help, recognizing and correcting those areas in which the industry itself is contributing to the difficulty.
Let's take a look at 6 ways we can effectively (if not ideally) educate our consumer base and improve healthcare literacy levels.
1. The healthcare industry needs to speak in language most consumers can understand.
That means developing better ways of distilling complicated healthcare terminology and concepts into everyday parlance. Consumers also need help envisioning hypothetical health situations and potential consequences. The healthcare industry, as a whole, needs to do a better job of helping consumers ask and answer questions about their health needs. It also needs to frame its messaging in a way that is motivating and instills a sense of accountability with healthcare consumers. The healthcare industry typically takes a “one size fits all” approach to its communications, diluting its effectiveness with many consumers. Psychographic segmentation allows healthcare organizations to interact with consumers in a way that facilitates understanding and motivates behavior change. Psychographics, which pertain to consumers’ values, attitudes, personalities and lifestyles, are a powerful key to effective engagement.
2. The industry needs to up its web game.
According to Harris, 62 percent of American consumers said they felt they would be more likely to understand their health plan information if they had access to websites that would help them navigate that information. This, of course, would depend on the first suggestion in this list being well-met. There are promising strategies — for example, gamification and mHealth apps — that developers could use to convey such complicated information over an easily-accessed portal, using easily-consumed language.
For example, EdLogics is an innovative health literacy gamification platform that incentivizes consumers to learn about health issues in a fun and engaging way. Once participants enroll in the EdLogics platform, nearly ninety percent complete the learning modules, and subject matter understanding generally improves from a C- or D grade to an A.
3. Insurers and healthcare systems should staff 24-7 phone support by qualified healthcare navigators.
Healthcare questions happen all day, every day. Health insurers and healthcare providers should offer continuous, qualified phone support to healthcare consumers. That support should include explanation of coverages, provider searches and recommendations, pricing estimates, communication and even coordination with the patient's primary care doctor.
4. Providers and insurers must develop viable healthcare shopping platforms.
How can we expect healthcare consumers to make responsible healthcare usage decisions if they haven’t been empowered with reliable means to make meaningful healthcare value comparisons? Sites like Healthgrades and RateMDs are dependent on subjective, voluntary self-reporting. Hospital and provider rankings by US News & World Report or Consumer Affairs are based too heavily on reputational surveys and, thus, fail to present a complete picture of quality. CMS outcome reports are opaque to the average consumer.
So what do we need? We need to develop an Amazon for healthcare. That’s more easily said than done—and may seem more than a little cliché. However, Amazon understands shopper psychology and continually improves upon the user experience, to the point that many people default to shopping Amazon like people default to Google for search.
5. Providers need to continually scrub patients' electronic medical records.
An ED nurse notices that a patient's charted medication list includes levothyroxine, Synthroid and Levothroid. To the unsophisticated consumer, these all seem like different drugs. But providers and, in fact, many insurers know them to be the same medication entered several different ways over the years (likely due to prescriptions having been filled at different pharmacies or history-taking providers clicking different checkboxes over a series of encounters). The consumer is left befuddled.
There should be a means of consolidating, condensing and standardizing these inputs. Some could likely be programmed and accomplished automatically in end-of-day system checks. Some of the work could — and should — be reviewed by qualified providers who can sort out and fix discrepancies. If hotels can run daily reports that identify room reservation duplicates, why can't hospitals and insurers do the same for chart discrepancies? Electronic Health Records are relatively new, so we’ll get to a place where this is feasible; however, it’s been like steering an aircraft carrier.
Effective patient education and engagement will require some simplification.
It's clear that we have a health illiteracy crisis in the United States. Such doesn't bode well for a successful transition to a consumer-driven healthcare delivery model. If we really want to achieve savings and weed out inefficiencies, we must foster a well-informed healthcare consumer base.
To do so, patient communication must be personalized and simplified, healthcare jargon must be removed from consumer-facing products and services and medical records must be closely monitored for accuracy. Patient-consumers need more convenient and meaningful access to their health information and to resources that will help them to make informed care decisions.
All the fixes do not rest solely on the shoulders of providers and insurers. Regulations (well-intentioned or otherwise) often represent a barrier to effective consumer communications. Moreover, consumers themselves should accept responsibility for educating themselves sufficiently; however, the healthcare industry shouldn’t get in the way.