Health Literacy Month Gets a Boost from Payers

Consumers need to become more knowledgeable about managing their health and making healthcare decisions as they become bigger economic agents in the healthcare system. Health plans are providing the tools to enable them.

At any given moment, "the rise of the consumer" is on the tip of wagging tongues in every nook and cranny of the healthcare industry. For accuracy's sake, they really should be talking about "the thrusting of the consumer."

October is Health Literacy Month. Last week, I spoke with this noble effort's founder, Helen Osborne, an occupational therapist who saw the health literacy light in 1995. Inspired by one of the first scholarly articles written on the topic of health literacy, she has been hooked ever since.

Osborne told me she launched Health Literacy Month in 1999 with a "small grant" from the pharmaceutical giant Pfizer Inc. and money she raised on her own.

"It was really to join together the early adopters like me. That grew and grew into what it is today," she says, noting that she also created a health literacy consultancy enterprise. "I've been in business for 18 years, and my passion for it has not stopped."

As individuals are thrust into a more expansive decision-making role in managing their health, executives across the healthcare industry should be listening to what Osborne has to say about health literacy.

For starters, she says health literacy involves much more than fostering an understanding of medicine's esoteric terminology by consumers with known numeracy challenges: "It's much more than just reading."

I am obsessed with pressing my sources for examples, and the conversation quickly turned to one of my favorite issues: the health impact of obesity.

"It's not just knowledge," Osborne says of health literacy's limitations in addressing the problem. "We have to have that sense of personal relevance; and who knows what's going on in the home… and a whole bunch of other things. You need to explain [obesity risks] clearly, but there are a lot of other factors."

Now, she had me going.

I love it when experts open up about the bounds of possibility in which they operate. We turned our attention to the supposed cost-saving benefits of thrusting the individual into a more prominent role in healthcare decision-making.

"The problem for this field is people are going to look to health literacy to solve this whole mess. It's a start, but it's not a panacea that is going to solve all of our healthcare woes in this country," Osborne says. "Knowledge has to feel relevant, and you have to know what to do with it."

Now, she was going.

"I think shared decision-making is a good model," Osborne says. She argues for a fine-tuned balance between having doctors in charge of medical decisions and patients getting whatever they want. "The meter has gone too far. People spend a lot of time in medical school. I prefer some guidance. I don't want to make every decision on my own."

Watertown, MA-based Tufts Health Plan recently initiated two efforts to fill the guidance gap, adding quality information to the doctor-finder feature on the company's website and launching a pricing tool.

Massachusetts is in the forefront of healthcare pricing transparency. A law that went into effect this month requires all private insurers to begin making price estimates public. To that end, Tufts has launched EmpowerMe, an online health service pricing tool for its members.

Tufts has 90 hospitals in its provider network and nearly one million covered lives.

"So many of our members are now on high-deductible plans and tiered plans, where their costs are going to vary depending on who they see," Athelstan Bellerand, Tufts' director of commercial product strategy, told me last week. He cites colonoscopy as an example. "Depending on where they go, the cost could be hundreds of dollars to them."

The EmpowerMe pricing tool requires health plan members to log in with an ID and password. "This is personalized to the member," he says. "In order to get that personal information, we need to know what their plan is… The personalization of this tool is very important because it's the only way we can give actionable information."

The tool gives beneficiaries information for out-of-pocket costs. "It will help them make decisions on where to get their care. In addition, it helps them budget for those decisions," Bellerand says. "They can plan for those expenses. Often, the beneficiaries are surprised by just how much [a healthcare service] costs."

To help beneficiaries make even better decisions on value, Tufts has added physician quality information to its online doctor-finder tool. "Quality is very difficult to define. It means different things to different people," he says. "We've tried to distill this in the simplest way to communicate it to our members."

The quality information Tufts is offering online is based on standard metrics established by state officials. "We're able to rank our highest-quality to lowest-quality providers in our networks," Bellerand says, noting that a "quality ribbon" is placed next to the online listing of all physicians who score in the top quartile of the state metrics ratings.

"Over time, the cost of healthcare has slowly but surely shifted from employers in the form of premiums to individuals in the form of cost sharing," Bellerand says. He believes online tools and other informational efforts need to be at the top of health plan agendas. "Members have not become more informed as part of that process."