Can Health Literacy Programs Cut Costs?

July 1, 2005

Prescription bottle directions, medical jargon and varied interpretation can cause unintended health problems

Research reveals that only those with a 9th-grade education level or higher actually understand, for example, that “cardiac” and “heart” are used interchangeably. Challenges in health literacy-specifically word meanings, and how healthcare consumers interpret the information-define this growing public issue.

Health disparities, language barriers and medical jargon coupled with confusion about what a doctor says keeps some consumers away from the healthcare delivery system.

In 1998, healthcare expenditures linked to low health literacy skills equaled about $73 billion.

A new healthcare subindustry addresses these problems, and many healthcare providers and other businesses are creating programs to improve health literacy as one among many tools to enhance patient safety, reduce medical errors, and to otherwise give patients more information in the new consumer-focused arena.

For example, merchandiser Target launched its ClearRX program in May, which helps consumers read and understand information on prescription containers. RelayHealth is forging insurance coverage of on-line consults. Pfizer’s big investment to brand health literacy is the numerous on-line rating, decision support systems, and medical information sites to help consumers better understand provider quality and health conditions. Few organizations are dealing with the nuts and bolts of content-to either define complicated medical terminology or offer health consumers vital information about what that information means or just what to do.

In health communication, where even words and pictures are often not reflective of real life situations, seasoned health literacy consultant Jann Keenan, founder of the Keenan Group, Inc, Experts in Health Literacy, Ellicott City, Md., warns about a potential misdirect in health literacy.

“If combating health literacy were as simple as teaching consumers that ‘heart’ and ‘cardiac’ are the same, healthcare might be altogether safer,” says Keenan.

As an example, she questions the meaning of, “take on an empty stomach,” a simple phrase which routinely appears on medication containers. According to Keenan, this simple directive can mean different things to different people.

“To eradicate limited health literacy and to make sure our messages are clear for medical adherence, the industry needs to embrace this full force,” she says.

“Money spent by managed care organizations on health literacy efforts is money wasted,” says David E. Williams, partner and founder of MedPharma Partners LLC, Boston. “Plans will get a better return on investment when they focus on helping physicians improving the clarity of communications with patients. That means being simple, consistent and concise in all forms of communication.”

Increasingly, good examples continue to crop up where health providers are making sure patients understand or providing information in a way they will understand.

In June, the city of Boston, acknowledging differences in health status between races, unveiled a $1 million comprehensive initiative to begin detailed tracking of racial and ethnic differences in the care patients receive, and to specifically underwrite training designed to make physicians more culturally sensitive.

Highmark Blue Cross Blue Shield, a Blues Plan in Pittsburgh, is funding grants, including the Southwest Pennsylvania Health Literacy Consortium’s eight-week literacy courses, which helps patients understand and manage their medication.

To educate migrant workers, the Joslin Diabetes Center, an independent nonprofit institution affiliated with Harvard Medical School in Boston teamed up with the U.S. Department of Agriculture to start diabetes education “On the Road” in five states. Working with the USDA’s Cooperative State Research, Education and Extension Service, the team works with migrant workers and Native Americans in Washington State and New Mexico; people in rural parts of West Virginia; and native Hawaiian Islanders to help them better understand and manage diabetes.

As one grass-roots approach, this program trains local community workers and others to deliver diabetes information to patients in non-medical settings. There are great discrepancies in language, culture, race and education in health, and to appropriately deliver care, special efforts must be made.

As better health education strategies, these programs could work. But will they reduce plans bottom line? Over the long haul, industry expert Williams thinks not.

“Managed care organizations should let the schools and the governments worry about health literacy. MCO programs aren’t likely to have real impact beyond their PR value,” Williams says.

Aileen Kantor is a public relations and communications consultant based in Bethesda, Md. She frequently writes about healthcare administration, finance trends and e-health initiatives.