Now that the United States is embracing a consumer-driven care delivery model, the healthcare industry must remember that health technology, clinical environments and better staff training aren’t the only opportunities for performance improvement. Attention needs to be given to improving the skills, knowledge and priorities of the consumer base itself.
One of the real challenges facing our consumer-driven healthcare market are the relatively low health literacy levels that many Americans have. Lack of basic understanding of wellness practices, healthcare terms, health insurance and billing issues can negatively — and significantly — impact the care choices that consumers make.
Consumers with low health literacy can be difficult-to-manage patients.
Consumers with low health literacy might go to the doctor, misunderstand or forget their post-discharge instructions and take the wrong actions once at home. They might, for example, fail to understand the importance of completing an entire course of an antibiotic prescription and stop taking the medication mid-course (once they begin to feel better). They might take the wrong medication, do the wrong rehab exercise, fail to report results back to the clinician or fail to understand the importance of making it to a follow-up visit.
As a result, when the treatment ultimately yields less-than-satisfactory results — or fails outright — such patients might blame the provider or hospital and seek care elsewhere. They might tell friends, family members or co-workers that the provider isn’t effective, resulting in a degraded care reputation.
Low health literacy can discourage some consumers from seeking care. They may be intimidated or embarrassed by their lack of healthcare knowledge and thus intentionally stay away from the doctor.
And low health literacy can result in poorer outcomes. Patients may not understand the meaning of their symptoms and fail to seek help, or fail to grasp the importance of receiving care for a given condition.
Now that the industry is becoming more tied to performance-based reimbursement models, providers and hospitals simply can’t afford to allow misunderstandings, misapplications of therapy or patient discouragement to prevent successful treatments. America’s providers need to take a more active role in promoting health literacy.
Low health literacy is a widespread problem.
The majority of American adults are, to some degree, health illiterate. In fact, the first-ever National Assessment of Adult Literacy (NAAL) in 2006 found that only 12 percent of American adults are proficient in health literacy.
More than 1/3 of American adults were found to have difficulty completing even the most basic self-management tasks like following the instructions on a prescription bottle. Of the remainder, most would be able to complete some basic self-management tasks, but have various degrees of difficulty doing everything they would need to do to realize the optimal outcome.
That doesn’t mean that the majority of American healthcare consumers are ignorant — it just means that many don’t have the experience or basic learning necessary to be effective partners in their own care.
Healthcare literacy is in many respects related to — but not dependent upon — basic literacy. The NAAL found that even high school and college grads who are proficient in reading and writing can exhibit healthcare illiteracy. The problem for these consumers isn’t the words — it’s most often the understanding and application of basic science concepts.
The NAAL also found that the problem isn’t endemic to any one demographic group, although some groups are more at risk than others. White adults, for example, were found to have a 28 percent low literacy rate, whereas 65 percent of Hispanic adults exhibited low health literacy.
Socioeconomic factors, language and cultural barriers probably play a part in low health literacy rates. More and closer engagement with community organizations, cultural organizations and social work agencies could help the industry to overcome some of those community-based challenges.
Lack of understanding of various consumer segments by providers themselves probably also plays a large role in the disconnection between doctors, insurers and healthcare consumers. There’s certainly room to improve the way communications are drafted and delivered.
Provider-patient communications often aren’t tailored to individuals’ literacy levels.
Communications need to be clear if they are to be understood, but clarity can be subjective.
Many healthcare providers and insurers take a one-size-fits-all approach to discharge instructions and marketing pieces — they’re often written at about a fifth grade reading level. Some patients aren’t able to read at fifth grade level and can’t comprehend what they’re given; some patients with higher proficiency may be put off by “dumbed down” pieces and disregard them outright, thus missing out on critical information about their care.
And, if there’s anything the national education debate has taught us, a fifth grade reading level in one region, state, or city may be drastically different than a fifth grade reading level in another.
Moreover, healthcare communications aren’t often tailored to individual healthcare consumers’ channel preferences (e.g., e-mail, text, mHealth apps, etc.). They’re not usually optimized to use the language that is most motivating to a consumer.
But that shouldn’t be the case — especially now that providers can have access to those deep insights that would allow them to tailor their provider-patient communications, their marketing collateral and their patient engagement efforts to individual consumers’ needs.
Psychographics, which pertain to consumers’ attitudes, values, personalities and lifestyles, are a key to unlocking the language that is most motivating for patients. Psychographic insights can inform the messaging behind patient engagement efforts to make them resonate more effectively with patients.
Innovative companies like EdLogics improve health literacy by using gamification to educate healthcare consumers in a fun and engaging way. EdLogics uses psychographic messaging to motivate healthcare consumers to participate on its platform, then uses games and incentives to drive an 88 percent completion rate of its education modules among its participants. Education focuses on a wide variety of topics, including health conditions, prescription medications, nutrition, exercise, physiology and many more subjects.
The industry is focused on patient engagement, but patient competency is necessary for engagement.
A patient may be engaged and willing to actively participate in his or her own care, but if barriers to understanding exist and impede treatment, he or she is little better off than another, disengaged patient would be.
So what does that mean? It means that increasing patient engagement is only one part of the strategy needed to make American healthcare consumers into better patients.
Too often, in the past, provider-patient relationships have been based on asymmetrical information. The provider knows much more than the patient does, and either ineffectively communicates or (in some cases, often out of liability concerns) deliberately withholds information. Patients often pick up on that, though — and it can intimidate or even anger them. It’s a surefire way to disengage a healthcare consumer.
Let patient engagement and patient education proceed hand in hand.
Providers’ and insurers’ engagement efforts could — and probably should — first teach consumers the basics of health literacy, then continue improving consumers’ literacy until they become proficient. If hospitals, doctors and insurers can help their consumers to become more health literate, they could begin to tackle the biggest barriers to patient engagement.
They could help their consumers to become better informed about the care being provided to them, so that consumers can see its quality and understand the provider’s or insurer’s value proposition. They can help their consumers to become more confident about in their own healthcare choices, thereby reducing patient attrition levels and increasing market share. And, most importantly, they can help their consumers to become more active, more proficient self-managers, which would probably improve outcomes (and, by extension, improve reimbursement levels under performance-based care models).
When American providers and insurers can better understand their patients, they can better educate them and support them. They can better communicate with healthcare consumers. And, when healthcare consumers feel supported and knowledgeable, they inevitably stay engaged in their own care.