🔒Health literacy and why it matters

Sometimes it's the little things that make the most difference. In health care, where costs are soaring and overtaking a greater share of the gross national product each year, maybe it's time we begin to take a look at simple remedies as well complex ones.

Consider, for instance, that the Institute of Medicine estimates that up to 40 percent of adults in the United States have limited health literacy and that this statistic increases U.S. healthcare costs by as much as $73 billion a year. Maybe this is something we should pay attention to.

Health literacy is the degree to which an individual has the capacity to obtain, process, understand and communicate health information in order to make appropriate healthcare decisions. It has been shown that adults with low health literacy fail to seek preventive care, have fewer doctor visits — but use significantly more hospital resources — remain hospitalized nearly two days longer than average, are less likely to follow treatment plans and self-care recommendations, and make more medication and treatment errors. Those in fair or poor health tend to have the lowest health literacy.

We also know that low health literacy contributes to racial and ethnic disparities in care, and, we know that there is a clear relationship between health literacy and age. More than half of Gen Y members exhibit lower health literacy than those of Medicare age.

In 2013, Harvard Pilgrim launched a health literacy initiative to address educational and linguistic disparities. It includes development of a corporate health literacy policy, verbal health literacy skills training for our customer service staff and mandatory training in health literacy for all of our employees. Training in plain language writing skills is also part of this effort. By the end of 2013, over 90 percent of our staff had completed mandatory health literacy awareness training.

An example of one of our initiatives was the creation of an easily understood monthly communication and quiz for members with high blood pressure reminding them of steps — like exercise, limiting salt and taking medicine as prescribed — to get their blood pressure under control. It hit the mark, enabling us to reduce an educational disparity gap in the percentage of members with hypertension whose blood pressure was under control from more than 15 percentage points to less than 2 percentage points. This means that those members with lower educational levels were able to achieve results closer to those with higher educations.

We also found that outreach to improve colorectal cancer screening rates using postcard reminders in plain language has again contributed to another reduction in educational disparities, reducing the gap between higher- and lower-educated individuals from 10 percentage points to 4 percentage points.

Since implementing our health literacy initiative, use of postcard reminders and secure email messages focus on brevity, clarity and visual presentation. We also have a health literacy Member Learning Center that helps members with difficult to understand health insurance terminology and function, such as the meaning of deductibles and how they work, how to choose a health plan, and how to find and access primary care providers.

Healthcare literacy has to have a special place in the work of all health insurers if we are to expand our capacity to provide equally excellent care and services to our members of all backgrounds. 

Eric H. Schultz is the president and CEO of Harvard Pilgrim Health Care.