Health Insurance and Insights from Health Literacy Helping Consumers Understand: Proceedings of a Workshop (2017) / Chapter Skim
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Pages 31-50
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From page 31... ...
HEALTH LITERACY AND HEALTH INSURANCE LITERACY CAN CONTRIBUTE TO ADDRESSING THE CHALLENGES1 For O'Leary, there is significant overlap between health literacy and health insurance literacy when thinking about the three tasks people are being asked to accomplish with regard to health insurance: get health insurance, keep it, and use it. Each task requires a certain skill set and each is complex.
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From page 32... ...
"It is a big job we are asking folks to do," said O'Leary, "but these tasks are all associated with basic health literacy skills, and we have strategies that we apply to other parts of health care that can be used to help people here." With the intent of using Missouri as an example of what is possible, O'Leary described the Cover Missouri Coalition, a project of the Missouri Foundation for Health with the goals of promoting quality affordable health coverage for every Missourian, lowering the rate of uninsured state residents to 5 percent by 2018, and improving the health insurance literacy of Missourians. She noted that Missouri is a non-expansion state and not much progress would be made in getting people enrolled unless some other organization got involved, and in this case it was a foundation with the resources to focus attention on a problem of this magnitude.
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From page 33... ...
Health Literacy Missouri's role in the coalition is to provide health insurance literacy support by developing clear resources to help consumers understand health insurance and improving assisters' interactions with consumers. O'Leary and her colleagues also provide support and training to assisters.
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From page 34... ...
These successful strategies, she said, rely on relationships among diverse stakeholders, including patients and consumers, insurers, government organizations, hospitals, community organizations, and the assisters and coalition health literacy working group. The insurers are important stakeholders because, as was noted in the previous session, they have a great deal of information.
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From page 35... ...
The assisters in the working group wanted worksheets, checklists, and other materials they could use to help consumers sort through all of the plan options. Not only did Health Literacy Missouri create those materials but they branded them, made them look good, and applied other strategies to improve health literacy so that, when the assisters saw the materials, they would feel good about using them with their clients.
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From page 36... ...
Health Literacy Missouri also created 10 videos to help health care professionals explain insurance topics such as preventive care, the Explanation of Benefits document, and appeals. These videos are all available online at www.youtube.com/covermissouri.
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SOLUTIONS 37 FIGURE 4-2 Worksheet for structuring a conversation on calculating modified adjusted gross income. SOURCES: Cover Missouri, September 2015, presentation by O'Leary, July 21, 2016.
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38 HEALTH INSURANCE AND INSIGHTS FROM HEALTH LITERACY FIGURE 4-3 Consumer-tested graphic to explain the Medicaid gap. SOURCES: Cover Missouri, September 2015, presentation by O'Leary, July 21, 2016.
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From page 39... ...
"We are working with the Missouri Department of Social Services on the food stamp program and others to help make these forms, materials, and letters more readable and usable." Health Literacy Missouri also has a partnership with the State of Oklahoma to provide technical assistance to increase health insurance literacy and health literacy for Oklahoma state employees. Referring to the idea that health insurance literacy is not just something for the uninsured, O'Leary said there are 38,000 State of Oklahoma employees and they, too, have a hard time understanding how to pick a health insurance plan.
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From page 40... ...
That is the lens she used to look at solutions for helping low-literacy consumers select the appropriate insurance plan. Using information to inform choice, said Hibbard, requires understanding the meanings of terms, processing multiple pieces of information, applying the information to one's personal situation, and differentially weighing factors according to personal preferences.
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From page 41... ...
"Again, there was a real difference in numeracy impacting the ability to make a high-value choice," said Hibbard Nudges and strategies that reduce the cognitive burden did help both high- and low-numeracy consumers choose high-value plans. In one experiment, for example, Hibbard's team looked at the effect of summarizing information on premium and cost compared with presenting four different cost measures on the ability to choose a high-value plan, and the summarized information helped people choose high-value plans (Greene et al., 2016)
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From page 42... ...
What her team also observed is that people with fair and poor health are making decisions based on premium alone, which is probably undermining their self-interest because their costs are going to be higher unless they pay attention to some of the other cost factors. To address this problem, she and her collaborators conducted experiments to see if they could present information in a way that would draw people's attention to their estimated total cost, not just the plan premium.
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From page 43... ...
Small nudges, explained Hibbard, can help people in cases where it is known that they are more likely to make decision errors and draw their attention to information they are not likely to use in making their choice. Going further, highlighting best options, and using decisions tools informed by the client's stated criteria about what is important to them remove even more of the cognitive burden from the consumer.
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44 HEALTH INSURANCE AND INSIGHTS FROM HEALTH LITERACY FIGURE 4-6 Word icons help the best options pop out. SOURCE: Presentation by Hibbard, July 21, 2016.
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From page 45... ...
O'Leary responded that the coalition has created supports for language interpretation, and one of the videos her team prepared discusses how to work with interpreters. She noted, too, that, during the early part of Health Literacy Missouri's health literacy work, they had a subcontract with the International Institute of St.
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From page 46... ...
In that regard, he asked O'Leary how health literacy plays out in a non-Medicaid expansion state and whether there are real or subtle differences in terms of how health literacy is able to convey the evidence that people will be healthier if they have access to health insurance against a cultural and political background that wants the choice of having or not having health insurance. "I think this is really critical in terms of understanding the interplay between these different aspects and how health literacy gets expressed within that context," said Wong.
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From page 47... ...
She and her colleagues are finding a great deal of the attention on the ACA is focused on coverage while little attention is paid to encouraging people to take advantage of the free preventive services. She wanted to know if the videos Health Literacy Missouri created help people make decisions about the preventive services people can access and which ones they need if the evidence is not clear.
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From page 48... ...
He asked how financial literacy is incorporated into training and into the information conveyed to consumers. In particular, he noted that people who live in Health Professional Shortage Areas are concerned less with getting preventive care than they are about avoiding financial disaster in the event of a medical emergency.
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From page 49... ...
She noted that the goal, then, should be to design a decision process that walks them through each of those pieces of information, and then talk about affordability and order the plans based on affordability if that is a key issue for a particular individual. Amy Cueva asked O'Leary if the community coalitions include houses of worship, Walmart, and frontline clinical workers.
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From page 50... ...
"This is the layering of health literacy and health insurance literacy," she said. Cindy Brach remarked that there was a great deal of discussion in this session about not choosing plans based just on premiums, but there is still the underlying assumption that money is the driving force behind choice.
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