How Blue Cross NC Improves Health Literacy

by Rashi Venkataraman

October 5, 2017

Health care is complex. The irony is that with information becoming more widely available, consumers can feel both more informed and more confused. Health insurance providers have the ability and responsibility to convey health in a way that makes sense to their members and their families—and they are taking the lead.

Ingrid Morris (pictured), a Healthcare Program Developer at Blue Cross and Blue Shield of North Carolina, shared insights about her company’s approach to improving health literacy in the community.

How would you define Health Literacy?

Ingrid Morris: Beyond understanding health information, health literacy is about a customer’s ability to find, read, and then use health information to make informed decisions about their care. These could be clinical decisions about medical care, or coverage decisions about health insurance benefits. At Blue Cross and Blue Shield of North Carolina, we’re dedicated to helping our members better navigate the health care system, so they can get the care they need and get the care that is most affordable.

Why is Health Literacy important?

Morris: Research from the National Assessment of Adult Literacy tells us that nearly 9 out of 10 people have a tough time understanding everyday health information. Even individuals with advanced degrees can struggle with complex health information. This is particularly important with numeracy, or the ability for our members to understand numerical concepts within health care, such as monthly premiums, health risk statistics, or lab results. Research has shown that people have a harder time understanding numbers in health care, as compared to the banking industry. So, it’s especially important for all health care professionals to keep literacy in mind when communicating.

Can you describe how your health plan is improving health literacy for members?

Morris: Here at Blue Cross NC, we’ve launched a “language simplification” initiative. Our goal is to make member communications easier to understand. This includes letters, websites, forms, booklets/flyers, and much more. We are aiming to bring the majority of Blue Cross NC member materials to the 6th to 8th grade reading level, whenever feasible.

We began by reviewing our materials—assessing hundreds of items. Beyond providing actionable feedback to departments, we also trained employees on how to assess content. We offer a popular course for employees on how to write or speak more clearly. As an example, we train employees to avoid health care jargon and to use shorter sentences. We also use formatting to make messages easier to follow, like bullets and numbers, larger font size, and visually illustrating information.

In member surveys, we are finding that we are on the right track—our members are better able to understand simplified communications. For example, we recently revamped our Preventive Care webpage, bringing it from a college reading level to 8th grade. The layout and visuals were also improved, making key information easier to find.

What are the major challenges to improving health literacy?

Morris: The most challenging communications to improve are those with regulatory language. In some cases, state and federal agencies have mandates for language that we have to use in member communications. Oftentimes these requirements have little leeway for making changes and the language has not been written at the 6th to 8th grade reading level.

These days, consumers can receive health information from a variety of resources beyond just print materials (e.g., the Internet, mobile apps, etc.). Have these new resources improved health literacy for members?

Morris: In many ways, these newer sources of information can be very beneficial for members, and health plans are investing in the creation of digital tools to support members with their decision making. However, the challenge lies in member awareness of these online tools. Further, these tools may not target those members with lower literacy that are most at risk.

With the increasing attention on social determinants or influencers of health, how can efforts to improve health literacy support those populations that may be at risk?

Morris: We know that with regards to health literacy and numeracy, there are populations that are more vulnerable, such as older adults and those with a lower socioeconomic status. Within these populations, health literacy becomes more important in the context of chronic care management. In addition, lower numeracy and lower literacy often correlate with decreased medication adherence and lower use of preventive services. And while many online tools and mobile apps have been designed to help inform consumers, often those with lower literacy are less likely to use these tools. Health plans and health care providers have a responsibility to make information as clear and as accessible as possible.