4 Ways the Doctor-Patient Relationship is Changing

It is often said that the relationship between the doctor and the patient is the foundation of the American medical system. Consider your typical Americana small town circa 1950’s. One stoplight on Main  Street, everybody knows everybody, and high school football is the main attraction. You know what I mean. In this scenario, I can tell you exactly who the 3 most important people in town are. The mayor, the priest, and the doctor.  Why? Because these are the people that are the most trusted and are the cornerstone figures in people’s lives.

Let’s leave the analogy there and take a look at the doctors. Do we still place implicit trust in them? Do we still invite them over for casseroles on Sundays? Sort of. In today’s America, we’ve largely diverged from the ask-no-questions mindset. We’ve got the ability to get an instant (self)diagnosis on our phones. We’ve read all about the perils of getting wrong surgeries and being on the wrong medications. While a lot of this has been beneficial for the patient, a lot of it hasn’t. In some cases, it can even be dangerous, as people may be incorrectly self-diagnosing.

Current studies have consistently shown that doctors are more “personable” consistently getting higher ratings from patients. They are, after all, in a “power” position and people want to feel like they are being heard.  Seems pretty fair, right?

It’s not for me to say whether or not the changing doctor-patient landscape is a positive or a negative thing. But I do want to show you a few ways in which it will continue to change:

1.       Patient- doctor relationships will be more important – doctors will be incentivized to receive proper ratings from their patients, otherwise risk receiving financial penalties from Medicare (check that out here).

2.       People are growing more “consumer centric” – a nationwide shift to higher deductible plans has really increased  people’s exposure to possible big bills. With that in mind, the idea is that with increased exposure comes increased consumerism (more on that). Simply put, people are more responsible for making sure that they are getting positive outcomes with their care. As such, we can expect that people will increasingly come to their doctor appointments armed with knowledge (good or bad).

3.       Increased information – we’re not just relying on WebMD anymore. Both public and private institutions are increasing the amount of knowledge that they are putting forth. Expect to see information on a doctor’s payment scheme (who pays them), costs and success rates.

4.       Independent tools and services – outside of seeing your traditional GP, there are a number of services to assist with the “consumerism” aspect of care. Think telehealth, second opinion services and patient literacy training. While most of these are available independently, a lot of them can be purchased for your entire company. With healthcare costs and consumerism rapidly rising, many of these services can offer a compelling case for ROI.

Sure, this isn’t an exhaustive list. But rest assured that the healthcare landscape is definitely changing. And with that comes new responsibilities on behalf of both the patient and the company (who pays for the health plan). Click here for more consumerism and cost containment info.

3 (Free) of the Most Important Preventive Services You Can Get

They say that the best things in life are free. And when it comes to healthcare, that’s no exception. If you haven’t heard, preventive care is free – as in, covered by your insurance. And since we’ve already used one adage, let’s use another: There’s no such thing as a free lunch. Well this time there is. Preventive care really is free, because your insurance company doesn’t want you to get sicker and have extortionately high claims. Makes sense, right? In terms of healthcare, what’s good for your insurance company is often good for you – not being sick. As always, it’s good to check with your insurance company before you get anything done to make sure that everything is within your network and is specifically covered.

With that in mind, we thought it pertinent to look at the most important preventive services that you can get. Even though we’d all love to take advantage of each free service, there’s only so much time in a day, and some services are more important than others. Very important, in fact. If you don’t get these things done, it could cost you much more than the extra cash.

  1. Flu Shot – your immune system isn’t always capable of handling the flu each year. Different flu strains change and you’ve got to get vaccinated for the right one. If you don’t you could be setting yourself up for a few weeks of feeling nasty (yes, stomach stuff). Last year the CDC (center for disease control) estimated that vaccines prevented over 5 million illnesses and over 71,000 hospitalizations. That’s crazy when you consider how much that would cost you, your company, and your insurance provider.
  2. Colonoscopy – this one isn’t so fun. The typical recommendation is that everybody goes in for a colonoscopy at about age 50. And while it’s not fun to prepare for or have a colonoscopy, the results are worthwhile. Colorectal cancer is now the second leading cause of cancer deaths in the US. Prevention and screening is pretty straight forward as well, as it usually takes about 10-15 years for the polyps (the abnormal growth) to turn into cancer.
  3. Mammogram – Unfortunately, we’re up for another screening that isn’t very fun. But mammograms are, simply put, the best way of detecting breast cancer early on. Just checking for lumps isn’t enough according to the American Cancer Society. The society also states that 1 in 8 women will develop breast cancer. Those are scary odds and well worth the checkup.

Even though you may not love dealing with your insurance company, they do offer some pretty nice freebies every now and again. And if you’re less concerned about the money, just think about how much you don’t want to get cancer. The tests are free, go out and get them.

 

 

 

Check out our list below of services made free by the Affordable Care Act:

COVERED SERVICES – FOR MEN AND WOMEN:

Abdominal aortic aneurysm screening for people who smoke or who have smoked

Alcohol abuse screenings and counseling

Aspirin use in men and women

Blood pressure screenings in adults

Cholesterol screenings for adults in certain age ranges or at high risk

Colorectal cancer screenings for men and women over 50

Depression screenings in adults

Diet counseling for those who are at high risk for chronic conditions

HIV screenings for adults at high risk

Immunizations for adults:

Hepatitis A

Hepatitis B

Herpes Zoster

Human Papillomavirus (HPV)

Influenza (Flu)

Measles, Mumps, Rubella (MMR)

Meningococcal

Pneumococcal

Tetanus, Diphtheria, Pertussis

Varicella

Obesity screenings and counseling

STI (sexually transmitted infections) prevention counseling

Syphilis screenings

4 Reasons why Your Health Insurance is not the same as Healthcare

 

Think about your health insurance for a moment. Would you be able to tell me exactly where your insurance ends and your actual healthcare begins? Believe it or not (and you may be a part of this group,) most Americans don’t really understand the difference between healthcare and health insurance. Most people would group them together and assume that it’s all part of one big package. Let’s take a look at why the two can be confusingly intertwined: 

  1. Most National Initiatives Encourage Increased Coverage – We’re looking at you Affordable Care Act. When the healthcare conversation starts, it goes immediately to the amount of covered Americans and the affordability of the coverage.  See what we did there? We aren’t talking about where people get care or how much they pay for care. We’re talking about how much we pay for coverage. Very different. 
  1. Insurance Companies Have Contracts with Providers – This is called your “network” (even PPO) of doctors that you’re able to see on your plan. Sure, they aren’t owned by the provider (mostly), but they do work hand in hand. When thinking of your doctor, you’re forced to think about your insurance. 
  1. 20% of Economic Spending goes to Healthcare – why does this matter? Because what the consumer sees is simply the point of sale, and it happens primarily at 2 intervals: 1 being your bill from your doctor, and 2 being your monthly paycheck deduction for health coverage (interesting take on that here). 
  1. It’s not a True Insurance – Think about the things that you insure for yourself. Your car, your home. These are things that are covered in the unlikely event that they were to be destroyed in a fire. Your health insurance runs the gamut of your care. Each piece of the pie is covered (to some degree), leaving you with more of a payment plan. 

With these thoughts in mind, it’s important to consider that without understanding the degree of separation that happens between health care and health coverage. I’m a huge proponent of turning people into educated healthcare consumers. This means shopping around for your healthcare like you would for any other commodity. In order to do this, especially on a large scale (say, larger than you and your significant other,) you have to make people understand that your healthcare is not your health insurance. 

So if you’re reading this for yourself, just understand that your doctor and your insurance plan aren’t part of the same organization. If you’re reading this because you’re in charge of a company health plan – you should help your employees understand this differentiation. Ask them about their doctor, and who they work with, explain to them that their “network” is an arrangement with your insurance firm, and not a direct company affiliate.

4 Ways to Make Healthcare Less Complicated

Every once in a blue moon I think its interesting to get an outsider’s perspective of things. In this case, let’s talk about our healthcare system. At the moment I’ve got this article in mind. In short, it’s a bit of a comical analysis of a few British people trying to use the American healthcare system. Jokes aside, their biggest concern is how bureaucratic and confusing our system is. And let’s think about that for a minute. I think we’re all aware that getting healthcare can be tricky, but we’re used to it, so we often don’t do anything about it. Our system is confusing and frankly hard to use sometimes. After all there are a lot of players in this game, and we don’t always know who to turn to.

With that in mind, we’re presented with a set of obstacles when we’ve got an employee benefits plan. A few of the things that come to mind: we have to keep costs down this year, make sure costs don’t go up next year, help employees understand their benefits and make sure that they all can afford them.

So that’s the picture I’ve painted. Now let’s look at the more relevant material: What can we do about it? And if you’re so bold, what kinds of things can a benefit solution (an independent company that you hire outside of your health insurance) do for your employees?

  1. Combine everything into one place – I’m going to be very high level here and just look at the big stuff. If you can find a service that brings all of your beneits information into one place, you’re off to a good start. If you can take that one step further and find a product that puts it into one “voice”, you’re doing even better. What do I mean by one voice? I mean that you can find products that house, explain, and allow you to use different benefits on their site. This makes life much easier.
  2. Provide one communications platform – ok so this is a bit trickier,  but its aimed at improving people’s benefits literacy (check out our article on that) so that they have a better idea of what they’re doing when getting care. People can only retain a certain amount of information, and you can communicate each element of your benefits plan in one single voice, your chances of having an impact are improved greatly.
  3. Train people on the most important programs – people get training on almost everything they do. But nobody trains people how to use their benefits. One of the best ways to combat confusion in the healthcare space is to provide some usable training. And the best part- people actually want to learn how to get better care. Finding a benefits program that takes benefits literacy seriously should be at the top of your list.
  4. Give people better solutions – ok so this is a tricky one. One of your biggest goals should be to get better products in front of your people to help them get care easier. Introduce things like telehealth or a second opinion service. Better yet if you can give them a portal to access their benefits in one place. Better solutions drive outcomes. It’s that simple.

3 Reasons Why You Should be Engaged in Your Healthcare

Believe it or not, one of our biggest hurdles in making impactful change is getting people to understand why they should care about their healthcare and about their care process. Realistically, we know what our goals are: save money and get better care. This is the case for both those paying for (employers and individuals) and those receiving (the patients) the care. The issue at hand is this: most people don’t want to engage. And you know what? That’s ok, and it’s not their fault. Healthcare is complicated and, frankly, not designed with the user in mind. And we shouldn’t feel unprepared just because we aren’t a doctor ourselves.

Let’s look at a few things that can happen if you choose not to engage in your care process:

1.       Being treated for the wrong illness – believe it or not this happens more than you’d think. Doctor’s use their god given powers of deduction to make their best, most educated guess as to what’s going on with you. Most people have been through the process of going back and forth with their doctors trying to diagnose whether you’ve got a flu or if its something different. Now imagine if you’ve got a more serious condition, say Cancer. Imagine going through treatments just to realize that you’ve got something else…

2.       Taking the wrong medication – we all know what kinds of side effects each medication has. If you’ve got a wrong diagnosis, chances are you’re taking medication that is meant to fix something that isn’t wrong with you. This could have serious implications.

3.       Having a “never event” – These are defined as “serious medical errors or adverse events that should never happen to a patient. Consequences include both patient harm and increased cost to the institution” and definitely include wrong surgeries.  It might seem like a slim chance that this could happen, but a little bit of engagement from the patient’s end can have seriously positive implications.

Why is this all important? For two reasons:

1.       It costs money – simply put, the easiest way to reduce medical costs is to get the correct care every time. The more errors, the more money.

2.       It hurts – who likes surgery? Heck, who likes the dentist? Nobody wants to go within a mile of a drill or scalpel if they don’t absolutely have to. Getting incorrect care means more procedures, whether they fix you or not.

3.       You’re still not getting any better – if you’re getting the wrong care, it means that you’ve been missing out on the correct care

 

At the end of the day, it’s up to you to make the decision to engage with your doctor. And if you’re responsible for running an effective benefits plan and need somewhere to start, you can check out this link.

Healthcare + Consumer Education – What You Can Do

Here at Trig we’re all about consumer education. That being said, we get a lot of pushback when we talk about things like “education” or “learning”, almost as if this is simply an unnecessary step in the care process (it is a process, you know). It’s as if we are actively taking ourselves out of the equation, and leaving the decisions to the sole discretion of the doctor. Now you may be thinking, “yeah, they went to med school, and I didn’t”. And you’re right, you probably didn’t go to medical school. But you also didn’t go to mechanic school, or get your degree in I.T. (ok, maybe you did), but you still work with those professionals and shop around for price for fixing whatever symptom your computer or car is having. So why not do that with your body?

The answer? Because it’s too complicated. Most people feel overwhelmed and unprepared for working with their doctors and for shopping around. And it’s not their fault, healthcare is confusing. But I’m here to tell you that you can make a difference, and that your role in your care is extremely important. A recent study found that only 13% of Americans admit to shopping for healthcare. That’s pretty bleak, especially considering that 1/3 of Americans insured through their work have high deductible plans (click here for more on that) designed to “introduce” consumerism.

So let’s run with the example of “shopping around” for you healthcare in a similar fashion to shopping for auto repairs. One of the best places to start is on a cost and quality comparison website. Think about Angieslist.com or even Yelp! But for healthcare. A few that we’d recommend are:

  • Healthcare Bluebook – This directory tells you what you should be paying for a given service in your area and where you can find a good price.
  • OkCopay.com – This one is kind of neat. They show you what the prices are for a service, and lets you book online. Nice and seamless.
  • Guroo – Guroo lets you get an overall price analysis for a procedure in your area. This one is set up by the Health Care Cost Institute (a neat non-profit) and actually compares average claims.

I think its pretty safe to say that if you’re doing all of these things you you’re off to a very good start. Now let’s say that you’re not reading this for yourself. Maybe you’re the head of HR and you want to find a few ways to lower your company’s annual healthcare cost. Maybe you’re looking for someone else that (for one reason or another) doesn’t want to do this for themselves. Here are a few more basic tips that you can help give to people to make sure that their costs don’t go running wild.

  • Make sure your doctor is in your network – For those of you that are healthcare veterans or are really analytical, this one may seem really basic. But if you’re if you’ve just been visiting your regular GP for the last 15 years, you may want to look into this before seeing another doctor (like a specialist).
  • Request a cost estimate – Chances are you might not feel like “shopping around”. Simply call your doctor and ask what they charge for the service you’re going in for. If it doesn’t seem right, maybe then you (or whomever your looking for) will want to check out some of the above resources.

The Value of a Second Opinion

If I could tell you one thing, and one thing only to make your healthcare experience better [cheaper], it would be this – when it comes to medical treatments, be sure. I could end the article there, but I’m long winded.

I’d be willing to bet that if you took your car into the shop and the mechanic told you that he had to replace your transmission for $5,000 you’d go and get 5 quotes from any mechanic you can find. But when it comes to our bodies we do no such thing. Perhaps it’s our desire to get better at all costs, perhaps it’s that we’re more comfortable blindly trusting our doctors and believing that they (and only they) know what is truly best. We all have to sleep at night, after all.

Think about a typical diagnosis at your doctor’s office – you go in, they see you, they provide answers and administer treatments. Isn’t it odd that they always know what’s wrong? I mean, how is that possible? Its not.  Your doctor doesn’t always know what’s wrong with you. Now, I don’t want to be accusatory or give the impression that I don’t believe in doctors, so I’m going to let this Mayo Clinic study do the talking. In short, they found that 88% of people had a diagnosis change when they sought another opinion.

The study found that:

  • 21% of individuals had a completely new diagnosis – this means that patients would have pursued the wrong treatment, paid for it, and had to suffer the medical consequences. Imagine if their treatment had involved removing an organ or two. Or if they had to go through chemotherapy only to find out that they didn’t have cancer.
  • 66% of people had to refine their diagnosis – ok, so at least we’re in the ballpark for the diagnosis is. But even if we’re close, that doesn’t mean its right, and when you’ve got surgeries or heavy treatments involved, you’ve got to be right.

88% needed some kind of adjusting – even a minor adjustment to your diagnosis has large implications. Consider this – if you’re actively treating the wrong disease, your correct disease is still going untreated. That means that you’ll have increased symptoms to treat when you do finally get it right.

Dr. Naessens (the research lead) says that primary care providers may be a touch overconfident when giving a diagnosis – “This may prevent identification of diagnostic error, and could lead treatment delays, complications leading to more costly treatments, or even patient harm or death”. That’s pretty serious.

There are a few things that you can do to help to mitigate this risk.

  1. Ask for a referral – you can get a second opinion from a specialist if you’re seeing your GP or primary care physician, they can point you in the right direction. Dr. Naessens warns that lots of people may not feel comfortable asking for this opinion.
  2. Go to a second opinion service. There are a multitude of these available. They’ll look at your current records and any files associated with the treatment to determine if they agree with your doctor. Its nice to have a second set of eyes checking everything over. These guys are usually pretty fast and you don’t even have to see another doctor.

 

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How to Plan for Future Cost Increases

I want to pose a question: Why do health insurance premiums go up? Probably a lot of reasons, right? People get more sick, procedures cost more money, medication costs rise… The list goes on. But I want you to consider this fact for a moment – Over the past 13 years salaries have risen at a rate of 43%. Pretty good, right? Now consider that over the same time period, insurance rates have risen 180%. That is a serious chunk of money going towards health insurance premiums. And it doesn’t seem to be getting any better (sad face).

The good news is that I’ve got a few ideas on how you can help to prevent future increases. There’s no such thing as a simple fix when it comes to healthcare costs (just look at every American election for the last 25 years), but there are steps that your company can take to help combat some of the real issues.

1.       Increase your deductible

Ok, so this one has been explored before (by me, and by many others). The problem is that most people screw up the implementation. In order to introduce the idea of “consumerism” to healthcare, you need to give people the tools and education to succeed. Simply charging them more doesn’t count, and will probably land a few angry people in your office. What can you do? 2 things – lower your coinsurance and out-of-pocket costs, and read on. We’ll dig further into it.

2.       Fund a savings account

You’ve got to help people pay for that higher deductible right? What better way to do it than to use HRA accounts. You can use HSAs as well, but it’s easier to let your plan costs run wild. When people have a health account to fall back on, they aren’t as worried about going bankrupt. Don’t think that’s an issue? Most people have less than $1,000 to spend on medical expenses. Most high deductible plans (especially for family) are far more expensive than that. Check out more on HSA vs HRA accounts here.

3.       Introduce hardship loans

I know, this one sounds weird. But think about that last statistic mentioned above. Your employees are probably living closer to the edge than you thought. Health insurance is really here for your protection, and you don’t want anybody to go bankrupt. These loans can help people avoid dire circumstances and afford your higher deductible plan. Even if you don’t have a high deductible, this can still be a beneficial option to ease future stresses.

4.       Teach your employees how to shop for care

This is one that we’re big believers in. We’ve got articles o’plenty when it comes to teaching people how to “buy” healthcare. Why? Because healthcare is expensive for a reason. Most people don’t know about the ridiculous amount of wrong procedures given, or that there are “levels” of care (think ER vs. Minute Clinic). Want to learn more about this? Check out our article on cost reduction.

 

How to REALLY Reduce Your Health Insurance Cost [Company]

I want you to think very deeply about the last time your company went through your annual health insurance renewal. The massive rate increases, the sleepless nights, the PTSD from your meeting with your broker… Ok maybe it’s not a warzone, but I digress.

One of the biggest things that people complain about not really knowing what to do to bring costs down for you company. I mean, it is the second largest expense that your company will incur this year, right behind payroll. Sure, you’ve got a few ideas on how to reduce costs, maybe your broker has reassured you that “next year will be better”. But do you really really know that next year will be better? I would call this the plight of the American healthcare system, but I’ve already used up my drama quota for this article.

At the end of the day, we’re all just poker players hoping to play the best hand that we can. And some years we get lucky, but most years the house wins. Fortunately I’ve outlined a few things that you can actually do to help and reduce your claims for next year, and not just let Lady Luck manage your health plan. But first let’s look at a few of the ways that people tend to manage their claims now, the “status quo” if you will.

 

What’s Currently Being Done

  1. Get a “Better” Broker

After the affordable care act came into play companies started changing brokers just “because”. People thought that by shopping around for a new broker they could ensure that they’d be covered when new regulations came into play. Its not necessarily a logical step but the process of shopping around for makes people feel proactive. It doesn’t always work (of course it depends on the quality of your old and new broker) but it could be an opportunity to find a broker that will introduce new products that you can actually use.

  1. Change Carriers

This is a big one that we see all the time. You’ve had a bad year and your current medical carrier wants to increase your premium by 15% over last year. Not cool, right? They must be so corrupt… so you turn to another carrier. The problem is that this new carrier might “buy” your business this year only to increase the premium (because they have to) next year. It’s a quick fix but not one that is going to have a positive impact in the long run.

  1. Introduce “Consumerism”

Perhaps the newest kid on the block, high deductible health plans or new plan designs that introduce “consumerism” into the mix is growing quite popular. While this is a pretty neat idea, it doesn’t always work (check out our article on that here). And it can leave certain people in pretty dire circumstances if not executed properly. Ultimately, it is another quick fix that probably leads to more money spent in the long run.

 

What You Should Be Doing (in addition to the above)

  1. Verifying the Right Doctor

Getting better care (i.e. the right care) means getting cheaper care. One of the biggest things that you can do to reduce your annual claims bill is to help people find the right doctors and verify that their diagnosis is correct. Your carrier’s website probably has a lot of this info, even things like cost and user ratings for doctors. If your carrier doesn’t have that, check out Vitals.com.

  1. Give People Tools When They Need It

Business 101 tells you to meet people where they are. Don’t give them a giant document from your carrier and expect that your employees are going to know how to get healthcare. Getting people to engage with things like telemedicine or second opinion services can all be done online, even over the [smart]phone. We know that people spend the majority of their brainpower on their phones and ipads. Lets engage with them there.

  1. Educate on Levels of Care

This is something that we call the “levels of care”. Teach your employees that there are different “levels” for different ailments and needs. One of the easiest ways reduce your overall claims is to teach people not to use the ER unless they have an ER need. This stuff is so easy that you could just hang a poster or two and start saving money. After all, it’s not their fault that they don’t know, we have to be the ones to teach them.

5 facts about healthcare literacy I bet you didn’t know

Think about the last time that you read something (whoa, how cool is that, you’re reading something right now!), and think about how valuable that skill is. Without it you wouldn’t be able to keep up with the news, do your job or even send a text message. Now consider that most people aren’t what we call “health literate”.

–> Health literacy is really all about being able to properly communicate with your doctor, understand what your doctor is telling you, and make an informed decision (or even follow directions) – don’t trust me, trust the CDC.

Now, before you discount this gibberish and “somebody else’s problem”, check out these stats…

 

 

  • Who’s HIGHLY Health Literate?

 

Let’s start with the crème de la crème of the population, those with very high health literacy rates. How many of us are there? About 12% of the population. That’s ok, right? Not really. This is the group of people  that is deemed capable enough to calculate their insurance premiums for the year and be able to maintain a good standard of health. Only 12% of people can do this. Scary, huh?

 

 

  • Who has a “below basic” level of literacy?

 

14% of the population. Yep, more people are unable to “read a short list of instructions” than are able to feasibly communicate with and find a doctor (the highly literate). This is a seriously low level of capabilities and results in a very poor overall condition of health. With levels of literacy this low, it creates issues for those with chronic conditions being largely unable to manage over a long period of time.

 

 

  • How about the rest of us?

 

Most of us (over 50% in fact) fall into the category of intermediate. This means that we know what medications to take and how often to take them. Pretty minimal stuff, really.  But can we manage the more complex stuff? Can we be reasonably expected to make an informed decision for bigger things like surgeries or procedures? Probably not.

 

 

  • Why should I care?

 

Limited health literacy has been described as an “epidemic” by more than a few researchers. It means that most people will have some difficulty in getting care, and that the care provided may not be very impactful. And to top it off, this “epidemic” impacts a wide cross section of the population, not just the undereducated. In reality, any company is going to have a significant amount of their employees that fall well below “proficient” in their literacy and this translates into big dollars and poor health. For those of you that manage employer health plans, impacting health literacy means better benefits for your employees for less money. That’s something that everybody can get behind.

 

 

  • Is there anything that we can do?

 

Short answer – yes. Long answer – you’ve got to help people get relevant information when they need it. No, your 60 page SPD (that huge document that “explains” your benefits) doesn’t count, you really have to meet people halfway and give them information where they are (on their phones). Technology has come a long way and can help people with things like tracking medications and doing doctors visits over the phone. People want to take their health seriously, we just need to give them the tools to do it.

 

 

Source: health.gov

Health Literacy Level Task Examples Percentage
Proficient Using a table, calculate an employee’s share of health insurance costs for a year. 12%
Intermediate Read instructions on a prescription label, and determine what time a person can take the medication. 53%
Basic Read a pamphlet, and give two reasons a person with no symptoms should be tested for a disease. 21%
Below Basic Read a set of short instructions, and identify what is permissible to drink before a medical test. 14%