Health insurers, under fire, take 'very positive' step on literacy

If nothing else, the health care reform debate has produced a reliable punching bag: the insurance companies.

Lawmakers, consumer groups, and journalists (me included) have inflicted a flurry of blows upon insurers' collective chin -- for their huge rate increases, for dropping people from coverage and for the endless family nightmares dealing with pre-existing conditions.

It's only fair, though, to acknowledge when the industry does the right thing -- in this case, helping to tackle the nation's significant problem with health literacy.

An estimated one in three Americans has trouble reading, understanding, and acting on medical information and instructions. People with health literacy problems have difficulty filling out medical forms, managing a chronic disease and understanding how to take medication correctly.

This lack of understanding translates into big money. One estimate puts the avoidable costs from literacy problems at more than $100 billion a year.

The insurance industry, responding to the literacy problem, is now sending out a new questionnaire to health plans nationally to assess how well they communicate with patients. The assessment tool, developed by Emory University epidemiologist Julie Gazmararian, questions health plans about their written forms and materials, Web sites, nurse call lines and disease management programs.

"The health care system has not been adequately attuned to providing information that's easy to use,'' says Susan Pisano, spokeswoman for America's Health Insurance Plans, the leading industry trade group. AHIP is sending out the questionnaires to improve insurers' communications with patients, she says. "I think it's the industry trying to do good.'' The effort ''can save money and improve people's health status,'' Pisano adds.

Literacy is not just reading ability -- writing, listening, and arithmetic skills are also important. Patients may have to evaluate medical information for credibility, analyze risks and benefits, calculate dosages and interpret test results. And patients' health often depends on their ability to perform activities needed to manage a chronic disease such as diabetes.
One study found that asthma patients with low literacy were less likely to understand how to use their inhaler properly. Medicare enrollees with low literacy have been found less likely to receive a flu shot or a regular mammogram than members with higher literacy.

Meanwhile, insurance forms and coverage limits can confound even a high IQ. Health insurance has its own jargon -- often inscrutable. Try reading your benefits handbook sometime.

Health insurers may have to train their employees to communicate better, Pisano says. And written materials have to be readable, including using white space, she adds.

Among the most likely groups to have low literacy are older adults, people with less education and low income, and those with limited English proficiency.

Costs can easily mount as people with health literacy gaps ''are more likely to use the health system inappropriately,'' such as going to an emergency room for routine care, says Gazmararian, designer of the assessment tool.

Efforts to improve health literacy have accelerated in the past 15 years, focusing especially on doctors' interactions with patients. Now it's health insurers' turn.

"Health plans have the opportunity to make sure people understand their coverage and how to access [services],'' says Dr. George Isham, medical director of HealthPartners, a Minnesota-based health plan. He's also chairman of the Institute of Medicine Roundtable on Health Literacy.

Low literacy can lead to increased hospitalizations, increased death rates, higher rates of medical complications and increased readmissions to a hospital, he says. "It's a pervasive issue,'' Isham points out.

Gazmararian gives kudos to insurers for the literacy drive, saying, "Health plans are doing something very positive.''
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