“Does this come in other flavors? It tastes a little unpleasant.”
The young woman slid the object in question to my side of the pharmacy counter. It was a rectal suppository. Apparently, she had taken it orally. As her pharmacist, I maintained my composure and explained how the suppository was properly administered and how it would work. Her head hinged forward, absorbing the information and clearly wanting to shield our conversation from the people in line behind her. Though this was the only time in my career a suppository was the cause of an improper health choice, her confusion and embarrassment were all too common. My patient was suffering the effects of low health illiteracy.
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As defined by the U.S. Department of Health and Human Services’ “Healthy People 2030” initiative:
- Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
- Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
Every entity in the healthcare ecosystem — providers, payers, employers and drug manufacturers — has a responsibility to address the impact of low health literacy on patient health and help solve this crucial issue. CMS expects all materials to be issued at a 6th grade comprehension level or below. However, the reality is that, in most cases, the entities that don’t serve CMS populations don’t adhere to CMS guidelines.
What is the cost of low health literacy? (a.k.a. why this matters)
A Personalized Approach to Medication Nonadherence
At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.
For the consumer experience, low health literacy is like being lost in a foreign land. How can you get the most out of a trip to Paris if you don’t speak the language and don’t have a map or a guide? By the same token, how much better would your experience be if you had a translator?
Health literacy is a Social Determinant of Health affecting therapeutic interventions like medication adherence and the overall ability of patients to navigate and engage in the complicated healthcare system. Low literacy is more prevalent among older adults, and minority, low socioeconomic and medically underserved populations. Nationally, more than one in three Americans have low health literacy, while 80 percent of patients have difficulty understanding the information on a drug label. Even if medication were provided for free, if a consumer doesn’t understand how to take it, there is no value.
The drug adherence problem is an element of the larger health experience of misunderstanding resulting from poor communication. Additionally, in the digital age, there are so many point solutions, with each app requiring its own login and passwords to remember, it’s asking too much of consumers.
Poor comprehension starts with the average time a patient spends with a doctor in their office — less than 10 minutes. Most of the discussion is around symptoms and diagnosis, only the last minute is around prescription, and it’s the last time a question is asked until the patient is at the pharmacy counter.
Beyond the doctor’s office, health illiteracy causes “silent diseases” like high blood pressure — that challenge a person’s ability to intake information — to worsen, negatively affecting patient health and driving up the eventual cost of treatment. In other situations, such as musculoskeletal conditions, some patients will undergo surgery without getting all the information needed or seeking a second opinion before going forward. Thirty percent of surgeries are unnecessary, and it’s worth asking what number of them are the result of poor patient literacy. The cost to the healthcare system and to employers due to low health literacy is exorbitant, estimated at up to $236 billion annually. Studies have consistently shown that employees with low health literacy can cost the plan four times as much as more health-literate employees due to ill-informed choices.
Making a healthcare literate consumer experience
The challenge is universal, and the solution must be, as well, for everyone from white collar to blue collar workers, from native language speakers to recent immigrants, from people who are health-language fluent to those who are health illiterate. How can we transform health literacy to raise patient empowerment and engagement, so that participation in care is the Esperanto of American healthcare? When you look at companies like Oscar, they are paying attention to the challenge of literacy, using illustrations to graphically communicate, and that is helpful.
Addressing health literacy will rely on the following:
- Implementing high-touch solutions that include both digital and human in-person support.
- Expanding information and guidance into other languages for non-English speakers.
- Giving caregivers the proper tools to support managing care for age 65+ patients.
- And, most critically, providing patients with translators — health guides, live people who can interpret, explain and direct appropriate care.
It’s in this last area where providers and employers can have the firmest hand in transforming the consumer experience: implementing a system that provides patients with 24×7 access to comprehensible information, personal assistance in explaining information and getting questions answered that builds confidence towards making appropriate choices. The expansion of clinical care to retail locations, such as Walmart, and virtual care can be the engines for a better guided experience.
I’ve never forgotten the expression on the face of the young woman at my pharmacy counter. She knew she had a problem; she just needed someone to help her understand the answer. That’s the kind of literacy that the healthcare system needs to provide throughout the continuum of care. Regardless of the starting point, patients need simplification and clarity across the whole healthcare journey.
Photo: sdecoret, Getty Images
Snezana Mahon is Chief Operating Officer of Transcarent, leading the company’s operational functions, and product development. She brings over 15 years of progressive experience in the healthcare industry including pharmacy benefit management, product development & management, Government Programs, vertical & horizontal enterprise integrations, clinical innovation and operational excellence.
At Express Scripts, Snezana held various leadership and management positions within the Clinical Product and Government Programs organization. Most recently as Vice President and General Manager Evernorth Care Solutions, she was responsible for all clinical initiatives and utilization management programs that help make the use of prescription medications safer, more affordable and more accessible for patients and payers. Previously, Snezana was Senior Director of Medicare strategy, where she guided Medicare Advantage and Part D plans on CMS guidelines, regulations and Star Ratings requirements.
Snezana is a registered pharmacist and holds a doctorate in pharmacy from the St. Louis College of Pharmacy. Her earlier retail pharmacy career included positions with Walgreen Company.
She resides in St. Louis, MO with her husband and two children. When Snezana is not championing operational excellence and innovation in solutions development, she can be found cheering on her kids sports teams. She also enjoys cooking, home projects, and traveling.
