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Payers Fall Short in Effective Beneficiary Communication

Two-thirds of beneficiary communication is more complex to read than Moby Dick, causing issues for patients with low health literacy.

beneficiary communication health literacy

Source: Thinkstock

By Sara Heath

- Healthcare payers’ beneficiary communication efforts leave a lot to be desired, as organizations let considerations for low patient health literacy and other best practices fall by the wayside, according to a recent report from Visible Thread.

The report, which included an analysis of Medicare documents from 30 of the top US payers during November 2018, outlined the bleak state of beneficiary communication.

Currently, 86 percent of insurers are not effectively communicating with the 65 and older population, despite strong incentive to do so. With 15 percent of the country eligible for Medicare coverage, it’d behoove payers to cater to this population, the report authors explained.

Special considerations would include using language that is simple and easy-to-understand in different patient-facing materials, such as in explanation of benefits (EOB) documents and on the payer’s website.

Calls to use simple language come as health literacy becomes a focus in healthcare. One-third of Americans who cannot read are in the 65 and older age bracket, the report noted, and half of patients over 65 have a low or basic level of health literacy. Across all age brackets, only about 12 percent of patients have proficient health literacy levels.

READ MORE: Nurses Must Be Involved in Patient Health Literacy Support

But healthcare payers are not creating copy that meets those patient needs, the report continued. Six of the 30 surveyed payers use the recommended word density level. Fifty-six percent use the passive voice too often, and the average sentence is two times longer than recommended. Two-thirds of payers produce patient-facing content that is more complex to read than Moby Dick.

These readability limitations pose a significant problem as patients question their trust in their insurance providers, the report authors said. Trust in payers dropped between 2017 and 2018, the authors said, citing statistics from Edelman’s 2018 Trust in Healthcare report.

And with the payer industry in flux due to certain policy issues, it is important that patients believe they are getting the most out of their coverage. Patients who understand EOB documents and other critical consumer-facing information are more likely to spend their money on that product, the Visible Thread report authors noted.

But complex explanations of benefits and other payer documents are making that trust difficult to come by. Payers that do not use adequate language to explain policies around pre-existing conditions, for example, are big stressors for patients. Patients who do not know what will and will not be covered in their plan have difficulty selecting an adequate plan.

What’s more, using plan language is the law, the report added. The Plain Writing Act of 2010 came as a part of the Affordable Care Act and called on health payers to present plan information in a manner most patients can easily understand.

READ MORE: How to Test Digital Health Literacy in Older Adult Patients

Health payers looking to improve their beneficiary communication should work to reduce their sentence length, eliminate passive voice from their writing, choose less complex vocabulary, and adopt technology that can simplify copy, the report authors recommended.

Separate studies have suggested health payers need to account for low health literacy levels when it comes to their beneficiary engagement materials.

A 2018 Accenture report indicated that low health literacy cost health plans $4.8 billion in administrative costs each year.

Beneficiary communications and engagement tools do not communicate critical information in plain enough language, the Accenture report suggested. As a result, patients need significant administrative help navigating their benefits.

“Instead of forcing people to continue to battle complexity, payers can invest in simplifying the ways consumers interact and engage with healthcare,” wrote report authors Jean-Pierre Stephan, Loren McCaghy, and Michael Brombach.

READ MORE: Payers Face Disconnect in Beneficiary Engagement Preferences

“Because it’s not Americans who are failing in healthcare system literacy. It’s the complexity of the system that’s failing them,” added Stephan, McCaghy, and Brombach, who are Accenture’s managing director of CRM solutions, director of consumer engagement & product insight, and manager of Accenture strategy, respectively.

Another study, conducted by NORC at the University of Chicago, revealed that complex benefits documents have led to numerous surprise medical bills.

A surprise medical bill is a charge the patient believed their insurer would cover or believed would not be so expensive. These unexpected costs often arise when a patient is unaware of their covered procedures and which physicians are and are not in-network.

The NORC at the University of Chicago survey found that 57 percent of patients had received a surprise medical bill as a result of unclear benefits explanations and low health literacy.

“Most Americans have been surprised by medical bills that they expected would be covered by their insurance,” Caroline Pearson, senior fellow at NORC at the University of Chicago, said in a statement. “This suggests that consumers may have difficulty understanding their insurance benefits or knowing which providers are included in their plan’s network.”

As consumerization continues to loom large in healthcare, it will be important for patients to be fully informed of all aspects, including access to clinical care and access to comprehensive payer coverage. To do this, payers must employ simpler language in beneficiary communication and engagement documents and be mindful of current patient health literacy levels.

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