Health Insurance and Insights from
Health Literacy
HELPING CONSUMERS UNDERSTAND
Proceedings of a Workshop
Joe Alper, Rapporteur
Roundtable on Health Literacy
Board on Population Health and Public Health Practice
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by contracts between the National Academy of Sciences and AbbVie Inc.; Aetna Foundation; Agency for Healthcare Research and Quality (HHSP23337024); American Dental Association; Bristol-Myers Squibb; East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Health Literacy Missouri; Health Literacy Partners; Health Resources and Services Administration (HHSH25034011T); Humana; Institute for Healthcare Advancement; Merck & Co., Inc.; National Institutes of Health (HHSN26300054); National Library of Medicine; Northwell Health; Office of Disease Prevention and Health Promotion (HHSP23337043); and UnitedHealth Group. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-45473-5
International Standard Book Number-10: 0-309-45473-5
Digital Object Identifier: 10.17226/24664
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Health insurance and insights from health literacy: Helping consumers understand: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: 10.17226/24664.
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PLANNING COMMITTEE ON HEALTH CARE REFORM AND HEALTH LITERACY: A WORKSHOP1
JUDITH HIBBARD, Research Professor, University of Oregon
CATINA O’LEARY, President and Chief Executive Officer, Health Literacy Missouri
KAVITA PATEL, Managing Director for Clinical Transformation and Delivery, The Brookings Institution
LYNN QUINCY, Director, Healthcare Value Hub, Consumers Union
MICHAEL VILLAIRE, Chief Executive Officer, Institute for Healthcare Advancement
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
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ROUNDTABLE ON HEALTH LITERACY1
BERNARD ROSOF (Chair), Chief Executive Officer, Quality in Healthcare Advisory Group, LLC
MARIN P. ALLEN, Deputy Associate Director for Communications and Public Liaison and Director of Public Information, National Institutes of Health
WILMA ALVARADO-LITTLE, Principal and Founder, Alvarado-Little Consulting, LLC SUZANNE BAKKEN, Alumni Professor of Nursing and Professor of Biomedical Informatics, Columbia University
CINDY BRACH, Senior Health Policy Researcher, Agency for Healthcare Research and Quality
GEM DAUS, Public Health Analyst, Office of Health Equity, Office of Special Health Affairs, Health Resources and Services Administration
TERRY DAVIS, Professor of Medicine and Pediatrics, Louisiana State University Health Sciences Center
CHRISTOPHER DEZII, Director, Healthcare Quality and Performance Measures, Bristol-Myers Squibb
JENNIFER DILLAHA, Medical Director for Immunizations, Medical Advisor, Health Literacy and Communication, Arkansas Department of Health
JAMES (JAY) DUHIG, Head, Risk Communication and Behavioral Systems, Office of Patient Safety, AbbVie Inc.
ALICIA FERNANDEZ, Professor of Clinical Medicine, Department of Medicine, Division of General Internal Medicine, University of California, San Francisco
LAURIE FRANCIS, Senior Director of Clinic Operations and Quality, Oregon Primary Care Association
LORI HALL, Advisor, Health Literacy, U.S. Medical Staff, Eli Lilly and Company
LINDA HARRIS, Director, Division of Health Communication and ehealth Team, Department of Health and Human Services
BETSY L. HUMPHREYS, Acting Director, National Library of Medicine
LAURIE MYERS, Global Health Literacy Director, Merck & Co., Inc.
CATINA O’LEARY, President and Chief Executive Officer, Health Literacy Missouri
MARYLYNN OSTROWSKI, Executive Director, Aetna Foundation
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
MICHAEL PAASCHE-ORLOW, Associate Professor of Medicine, Boston University School of Medicine
TERRI ANN PARNELL, Principal and Founder, Health Literacy Partners, LLC
KIM PARSON, Strategic Consultant, Proactive Care Strategies, Humana
KAVITA PATEL, Managing Director for Clinical Transformation and Delivery, The Brookings Institution
ANDREW PLEASANT, Senior Director for Health Literacy and Research, Canyon Ranch Institute
LINDSEY A. ROBINSON, Thirteenth District Trustee, American Dental Association
STACEY ROSEN, Associate Professor of Cardiology, Hofstra Northwell Health School of Medicine and Vice President, Women’s Health, The Katz Institute for Women’s Health
RIMA RUDD, Senior Lecturer on Health Literacy, Education, and Policy, Harvard School of Public Health
STEVEN RUSH, Director, Health Literacy Innovations, UnitedHealth Group
MICHAEL VILLAIRE, Chief Executive Officer, Institute for Healthcare Advancement
EARNESTINE WILLIS, Kellner Professor in Pediatrics, Medical College of Wisconsin
MICHAEL WOLF, Professor, Medicine and Learning Sciences, Associate Division Chief, Research Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University
WINSTON WONG, Medical Director, Community Benefit, Disparities Improvement, and Quality Initiatives, Kaiser Permanente
Consultant
RUTH PARKER, Professor of Medicine, Pediatrics, and Public Health, Emory University School of Medicine
Health and Medicine Division Staff
LYLA M. HERNANDEZ, Senior Program Officer
MELISSA FRENCH, Program Officer
ALEXIS WOJTOWICZ, Senior Program Assistant
ROSE MARIE MARTINEZ, Senior Director, Board on Population Health and Public Health Practice
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published Proceedings of a Workshop as sound as possible and to ensure that this Proceedings of a Workshop meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain privileged to protect the integrity of the process. We wish to thank the following individuals for their review of this Proceedings of a Workshop:
May-Lynn Andresen, QHC (Quality in Health Care) Advisory Group
Ignatius Bau, Health Care Policy Consultant
Rima E. Rudd, Harvard School of Public Health
Carol Teutsch, University of California, Los Angeles, Anderson School of Management
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the Proceedings of a Workshop before its release. The review of this Proceedings of a Workshop was overseen by Georges C. Benjamin, American Public Health Association. He was responsible for making certain that an independent examination of this Proceedings of a Workshop was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of the Proceedings of a Workshop rests entirely with the rapporteur and the institution.
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Acknowledgments
The roundtable is grateful to the sponsors of the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Health Literacy who made it possible to plan and conduct the workshop on the relevance of health literacy to health insurance, which this Proceedings of a Workshop summarizes. Federal sponsors included the Agency for Healthcare Research and Quality; Health Resources and Services Administration; National Institutes of Health; National Library of Medicine; and Office of Disease Prevention and Health Promotion at the Department of Health and Human Services. Non-federal sponsorship was provided by AbbVie Inc.; Aetna Foundation; American Dental Association; Bristol-Myers Squibb; East Bay Community Foundation (Kaiser Permanente); Eli Lilly and Company; Health Literacy Missouri; Health Literacy Partners; Humana; Institute for Healthcare Advancement; Merck & Co., Inc.; Northwell Health; and UnitedHealth Group.
The workshop presentations were both interesting and stimulating, and we would like to thank each of the speakers and panel moderators for their time and effort. Speakers and moderators were, in alphabetical order, Elisabeth Benjamin, Renée Bougard, Amy Cueva, Terry Davis, Eric Ellsworth, Janette Robinson Flint, Erin Hemlin, Judith Hibbard, Cara James, Mila Kofman, Robert Krughoff, Janet Mentesane, Laura Morris, Catina O’Leary, Ruth Parker, Kim Parson, Karen Pollitz, Bernard Rosof, and Dara S. Taylor.
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Contents
Organization of the Proceedings
2 LESSONS FROM 3 YEARS OF EXPERIENCE
3 CHALLENGES FACED IN HELPING THE UNINSURED GET AND USE HEALTH INSURANCE
What Is Your Role in Enrolling People and What Is Unique About Your State?
What Resources Are Needed Now to Improve the Enrollment Process for More People?
What Steps Are Needed to Help People Retain and Use Health Insurance?
Health Literacy and Health Insurance Literacy Can Contribute to Addressing the Challenges
A Continuum of Strategies to Help Low-Literacy Consumers Use Comparative Information for Choice
5 SUCCESSFUL EFFORTS TO ADDRESS CHALLENGES
Attracting the “Young Invincibles”
Human-Centered Design to Produce a Readable Medical Bill
Libraries and Librarians as Trusted ACA Information Sources
6 MODERATED PANEL DISCUSSION TO REVIEW LESSONS FROM THE DAY
From Where You Are Sitting, What Are the Front-Line Lessons and Opportunities?
How Can We Encourage Networking and the Sharing of Best Practices?
B Biographical Sketches of Workshop Speakers, Moderators, and Reactors
Box and Figures
BOX
FIGURES
2-1 Eligibility status of 32.9 million remaining non-elderly uninsured, 2015
2-2 Knowledge of health insurance terms and concepts
2-3 Percentage of those polled who say their health insurance is a good, fair, or poor value
2-4 Satisfaction with health insurance plan for those with high- and low-deductible plans
4-1 Organization of the Cover Missouri Coalition
4-2 Worksheet for structuring a conversation on calculating modified adjusted gross income
4-3 Consumer-tested graphic to explain the Medicaid gap
4-4 Understanding insurance terms about cost by numeracy level
4-5 Calling out options helps people to make smarter choices
Acronyms and Abbreviations
| ACA | Patient Protection and Affordable Care Act |
| ADHD | attention deficit/hyperactivity disorder |
| CMS | Centers for Medicare & Medicaid Services |
| CSS | Consumer Service Society |
| FAQ | frequently asked question |
| HHS | Department of Health and Human Services |
| HMO | health maintenance organization |
| NIH | National Institutes of Health |
| NN/LM | National Network of Libraries of Medicine |
| PPO | preferred provider organization |
| SBC | Summary of Benefits and Coverage |
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