Published by Managed Healthcare Executive
Health literacy is a lifeline. It represents the ability of patients to access, comprehend, and effectively use health information to make informed decisions. As healthcare becomes increasingly complex, the need for clear, accessible communication grows, and the responsibility is placed on healthcare organizations to make health-related information available and comprehensible.
This challenge has grown in the 21st century as organizations wrestle with patient and member expectations for personalization while remaining compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Unfortunately, this combination leaves the current state of health literacy with much to be desired, leading to costly consequences for both patients and the healthcare system at large.
As Barry Volin, co-founder and CEO of the Managed Care Resource Alliance (MCRA) explains “with the increased importance of ‘member experience’, merely focusing on a 'message delivered or not delivered’ metric is not enough. Ensuring the message is received, understood, and appropriately acted upon is the new set of challenges facing payers.”
Speaking with its key leaders, MCRA uncovered what the companies at the heart of transforming health literacy believe the future will hold.
The current state of health literacy
Health literacy is a critical issue, with far-reaching implications for the healthcare system. Defined by the Centers for Disease Control and Prevention as the degree to which individuals can obtain, process, and understand basic health information needed to make appropriate health decisions. Health literacy is a foundational element of effective healthcare delivery. Yet, despite its importance, it remains a significant challenge. The U.S. healthcare system incurs an estimated $236 billion annually due to poor health literacy.
The challenges are manifold, explains Alison Lyne, senior director of growth at Ushur:
“Medical language is often complex and filled with jargon that can confuse even the most diligent patients. Information is frequently inaccessible, whether due to poor design, lack of clarity, or being spread across fragmented communication channels.”
This underscores the urgent need for improved health literacy, as understanding health information is essential to managing these conditions effectively.
Low health insurance literacy remains a barrier to the effective utilization of essential healthcare services, such as primary care, preventive services, and medication adherence. By improving benefits literacy at the point of care navigation, health plans can encourage more effective and cost-conscious use of healthcare services.
Regulatory landscape and compliance
The regulatory landscape surrounding health literacy is continually evolving, creating both challenges and opportunities for healthcare organizations. Kathleen Ellmore, co-founder and managing partner at Engagys, explains, “Recent regulations, such as the CMS Final Medicare Advantage Rule for 2024, have introduced requirements for digital health education for enrollees with low digital health literacy. This is a significant step forward, but it also places additional demands on healthcare providers to meet these new standards.”
In fact, several government-led initiatives now emphasize organizations’ responsibility to equitably address health literacy to improve care quality and access. For example, the Healthy People 2030 initiative has updated its definition of health literacy, emphasizing the responsibility of healthcare organizations to make health-related information accessible and comprehensible. These regulations highlight the need for healthcare communications to be clear, culturally and linguistically appropriate, and delivered through the channels that best meet the needs of the audience.
The role of AI and automation in transforming health literacy
The landscape of health literacy is evolving, driven by emerging technologies. Among these, artificial intelligence stands out as a particularly promising solution. Explainable AI, in particular, is lauded for its potential to increase transparency and build trust, which are crucial for effective healthcare communication and action.
By leveraging AI, healthcare providers can simplify complex medical information, deliver timely and relevant content, and personalize interactions to meet the specific needs of each patient. Ellmore notes that, “the challenge is that healthcare is different from any other industry, as a member’s healthcare decisions and circumstances are an n of 1. Therefore, any AI tools put into place will need to be specifically trained on healthcare communications and best practices.”
However, concerns about accuracy, information security, and protected health information have slowed widespread adoption of AI.
“These concerns highlight the need for robust, domain-specific applications that can address these challenges while maintaining high standards of data security and patient confidentiality," Lyne explains
Automation, particularly in healthcare, is crucial for delivering personalized, HIPAA-compliant messages. In a landscape where 65% of members prefer digital channels like short message service, AI-powered automation can ensure that patients receive timely appointment reminders and health alerts through their preferred communication methods. This not only improves engagement but also enhances the overall patient experience.
The evolution of patient and member expectations
The expectations of patients and members have evolved dramatically over the past two decades, according to Ellmore
“Twenty years ago, healthcare interactions were largely transactional — patients received information, often in complex forms, with little guidance or personalization. Ten years ago, there was a shift towards more patient-centered care, but the tools to deliver personalized experiences were still in their infancy,“ Ellmore notes
"Today," she continues, "patients expect the same level of personalized service in healthcare that they receive from consumer brands, such as Amazon and Netflix. These companies have set the bar high, offering personalized recommendations and seamless user experiences. In healthcare, this translates to a demand for tailored benefits communications and a more engaging, user-friendly interaction with health information.”
Furthermore, AI and automation can play a crucial role in creating more coordinated and person-centered healthcare experiences. By enabling patients to make well-informed decisions, regardless of their social and economic status, these technologies can contribute to better health outcomes and a more equitable healthcare system.
Conclusion
When deployed with intention and expertise, AI and automation can be transformative forces with the potential to revolutionize health literacy. However, AI must not be thought of as a silver bullet for improving health literacy. It is both the quality of the AI in areas such as domain expertise and security as well as knowing how to appropriately deploy it, which will enable the healthcare organization to deliver value. By making healthcare information more accessible, personalized, and actionable, these technologies could significantly improve health outcomes and overall health equity. As healthcare organizations continue to navigate the complexities of this digital age, embracing AI and automation will be crucial to meeting the growing demands of members and patients and delivering better health for all.
Barry Volin is CEO and co-Founder of the Managed Care Resource Alliance, Alison Lyne is senior director of demand and growth of Ushur, and Kathleen Ellmore is co-founder and managing partner at Engagys.
Comments