Design communication with health literacy in mind

October 1, 2008

A recent study by the University of Connecticut indicates that the cost of low health literacy to the U.S. economy is as high as $238 billion annually. It's imperative that health plans and systems drive new efforts.

A recent study by the University of Connecticut indicates that the cost of low health literacy to the U.S. economy is as high as $238 billion annually. With 36% of the adult U.S. population having basic or less than basic health literacy levels, it's imperative that plans and healthcare systems drive new efforts.

"We're not talking about a small issue here," explains Carolyn Cocotas, director of Community Health Innovation for Affinity Health Plan. "It's very challenging, and it's tough to get it right."

Two years ago, Affinity Health Plan, a New York City-based insurer of underserved populations, began an organizationwide assessment of health literacy. A touch-point analysis found that the health plan overall communicated with members an average of 12 times a year.

Affinity began developing a partnership with the Literacy Assistance Center of New York (LAC), the organization responsible for preparing all the English as a Second Language and adult literacy programs for the city. LAC built a curriculum so that staff could be trained on how to exchange effective communication with members, in writing, on the telephone, or face to face. The organization also helped Affinity staff recognize low health literacy and respond appropriately.

An interactive health literacy software tool was put to use that links to other applications and contains a database of more than 10,000 medical words, disease names, and health plan and insurance vocabulary which has been simplified into plain English.

"Our regulatory requirement is that we write between the fourth- and sixth-grade reading level, but in fact, some of our materials were at a much higher level than that," says Cocotas.

Members of Affinity's recently formed Health Literacy Guiding Coalition quickly recognized the tool's potential impact on all written materials, including scripts used by the organization's clinical outreach staff.

Group Health Cooperative, a nonprofit healthcare system based in Seattle, is also embarking on a long journey of enhancing health literacy. It began three years ago when Jessica Ridpath, research communications coordinator with the organization's Group Health Center for Health Studies, couldn't shake a "nagging feeling in my gut" that people weren't understanding what they were asked to do.

An audit of the center's print materials revealed that they were written mostly at an 11th grade level, well above guidelines. Ridpath began revising print materials-especially the center's consent forms-into plain language, while simultaneously training staff to do the same. In the process, a readability toolkit was developed containing strategies, real-world examples, and related resources to aid researchers and others in the healthcare setting to create printed materials in plain language.

"We didn't really hinge our dialogue around the term 'health literacy,' but instead focused on using plain language," says Ridpath. "The onus isn't on the patient to get a medical dictionary every time they read something we give them. Instead, we wanted to change our communication pattern so we leveled the playing field."

Roger Foreman, executive vice president and chief marketing officer for Blue Cross Blue Shield of Kansas City, has been working in marketing for 37 years, and he acknowledges that communicating effectively with different constituents-from members and brokers to healthcare providers-has been an ongoing challenge. In July, as a way to address that challenge, BCBSKC became an early adopter of a healthcare video-communication service.

He says video technology is a new opportunity to get messages to constituents and cut through "all the insurance garble."

It's also a very popular medium. According to measurement research firm comScore Inc., U.S. Internet users viewed more than 12 billion online videos in May, a 45% increase over a year ago.