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Payers understand health literacy is fundamental to improving quality and medication adherence. How can we better empower members with lower literacy rates to take an active role in their own care?
Health literacy is a person’s ability to obtain, understand, process, and act on the basic information necessary to make good decisions about their own health. From understanding prescription drug instructions to knowing when to see a doctor, health literacy is crucial for navigating the healthcare system.
Unfortunately, too many vulnerable Americans are missing the necessary health literacy skills to engage with their providers and health plans while maintaining adherence to recommended care.
A 2020 report from UnitedHealth Group found notable variation in health literacy rates among Medicare beneficiaries on a county-by-county basis. In some regions, up to 59 percent of the Medicare-aged population had low health literacy levels, creating a huge challenge for health plans and providers looking to provide optimal care.
Low health literacy rates are closely correlated with poor clinical outcomes and higher spending. Compared to counties with the lowest literacy rates, the most literate regions saw 26 percent fewer avoidable hospitalizations and 18 percent fewer ED visits, resulting in a 13 percent lower costs per beneficiary. If every county mirrored the most literate counties, Medicare could save more than $25 billion per year in preventable costs, the report predicts.
It will come as no surprise to learn that people living in the regions with the lowest health literacy rates also struggle with significant socioeconomic challenges. Limited literacy is strongly linked to lower rates of educational attainment, higher amounts of economic instability, and limited English proficiency. Older adults and minority communities are particularly affected.
Healthcare providers and health plans can overcome these barriers by taking a more proactive role to address health literacy for vulnerable and underserved individuals. As we celebrate Health Literacy Month in October, we want to share some proven strategies to help health plans take the lead in evaluating and improving the health literacy of their members.
Here are four tips for health plans to foster personal health literacy and help members better manage their health.
Leverage data analytics to identify and connect with at-risk members
Since low health literacy is more common in people with unmet socioeconomic needs, health plans should start by identifying members struggling with common social determinants of health (SDOH). Food and housing instability, lower levels of educational achievement, and limited care access can all signal that health literacy and member engagement are potential problems.
Historically, health plans haven’t had the tools or trustworthy data sources to effectively analyze non-clinical information and reliably stratify members using comprehensive risk scores. This is changing rapidly as value-based care prompts more providers and plans to collect and share increasingly standardized SDOH data.
Using advanced analytics tools that incorporate SDOH data will allow health plans determine the scope and scale of their members’ health literacy issues and develop effective, targeted interventions for those who need them most.
Use simple language and visual aids to deliver high-impact education
In the United States, more than half (54 percent) of adults aged 16 to 74 read at or below the sixth-grade standard. For these individuals, even understanding basic health information is next to impossible.
Even “simplified” health education is often too complex: studies show that the many materials are presented at a tenth grade reading level, exceeding the capabilities of millions of members.
Health plans benefit from using simple, clear language at all times when delivering education about medications, procedures, financial responsibility, or benefits. Pictures and visual aids, such as cartoon figures, graphs and charts, or color coding, can help patients process and understand basic information and help to convey more complex information.
Audio-only telehealth is a particularly effective tool for breaking down post-discharge or medication instructions.
Experts recommend that health education materials should be written at a fourth to sixth grade reading level and presented in a shame-free manner. Plans can assess the reading level of their materials using widely accepted readability scoring systems such as the Flesch-Kincaid grade level score.
Employ the “teach back” and “show me” methods to assess understanding
Currently, just 26 percent of people say their healthcare providers actively check their understanding of care instructions, according to the Healthy People 2030 initiative, indicating a huge opportunity for health plans and providers to more actively assess comprehension.
The “teach back” and “show me” strategies are two methods of ensuring that the member understands what they have been told. “Teach back,” asks the member to explain what they have been told in their own words. Similarly, the “show me” technique encourages the member to actively illustrate how to complete a task, such as organizing their medications or checking their own blood sugar.
Combined with motivational interviewing techniques that get to the heart of member challenges and expectations, “teach back” and “show me” allow health plans to identify potential pain points, focus on personalized solutions, and reinforce important concepts for those with lower literacy rates.
Create a community of continuous care around every individual
Health education is not a one-and-done affair. People with lower health literacy rates will need comprehensive, continuous support to ensure they have retained key information – and that they are applying their new knowledge consistently and correctly. And that support is most effective when it is available across multiple channels and personalized to meet the needs of each individual patient. A growing number of providers are also tapping the power of technology, as well as specialized pharmacists to conduct audio-only telehealth outreach to vulnerable populations. While they are on the phone, the pharmacists can also help the consumer overcome barriers to close gaps in care. For example, a consumer may not know how to reach or find information to arrange for food delivery.
Plans should brainstorm about how to get each member’s entire care community involved, from family caregivers and social workers to local service organizations and trusted clinical professionals, including pharmacists. Consider integrating telepharmacy outreach to ensure multiple touchpoints throughout the year and promote better engagement and ensure that members are continuing to follow instructions, remaining adherent to their prescription drug regimens and other care activities. These interactions can go a long way in increasing consumer satisfaction as well, which in turn will help plans perform better on the increasingly important CAHPS patient experience surveys.
If a member is struggling to stay on track with medications, plans may consider offering helpful alternatives, such as switching traditional pill vials with easier-to-understand compliance packaging, to give their populations some extra support.
Enhancing health literacy through community building and ongoing interactions can give members the confidence they need to engage more fully in their own care. With commitment from health plans and partnerships from providers, pharmacists, caregivers, and more, Health Literacy Month can become a true celebration of successful education and better outcomes for individuals and their communities.