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Knowledge Center

Episode 158: Slow and Steady, How Health Care is Progressing Toward Value Based Care. Lynn Carroll, HSBlox

September 28, 2021

Written by Samantha Holvey

Universal health care might be out of the question for the U.S. but what about a universal ability of patients to understand the health care system?

WEDI President & CEO, Charles Stellar mentioned to me that he was trying to help a family member understand their health insurance benefits package to decide what physical therapy services were available to them. This is not the first time I have heard that friends and family need help understanding their medical records and insurance information.

In response to the increasing desire of patients for more transparency in health care, the federal government enacted the No Surprises Act to protect patients from surprise medical bills and arm them with cost information prior to service delivery. One of the difficulties facing health plans seeking to implement the No Surprises Act is how to effectively communicate the advanced explanation of benefits to the patient via web portal, email, or in letter. Beyond the issue of how to communicate this information, however, is the issue of the information even being understood by the patient.

Health literacy is a real concern in our country. According to the U.S. Department of Education, 54% of U.S. adults 16-74 years old - about 130 million people - lack proficiency in literacy, reading below the equivalent of a sixth-grade level. Perhaps the critical factor in any effort to create more transparency in health care for patients is to first ensure that they can understand the information.

As we continue to work towards providing better care and creating a more transparent health care system, perhaps we should pause to consider how much more helpful it would be to ensure that health plan policies, medical records, and other critical health information is presented to the patient at a level they can comprehend. As the industry moves to implement the requirements of the No Surprises Act, sending incomprehensible messages to the patient will result in a lost opportunity for increased patient engagement. Giving patients more information will not solve the problem if they can’t understand it.

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