HealthJanuary 23, 2024

Deciphering medical jargon: How payers can help members bridge the information gap

Member engagement videos and education that meet members where they are with plain language and relatable content can help care managers improve outcomes and achieve priorities of the Health Equity Index.

Challenges in care management: Rebuilding trust and cutting through medical jargon

Within a health plan, care managers create the closest person-to-person connection to members. When they can cultivate relationships with members, they play a critical role in defining the member experience, enhancing wellness, and helping improve health outcomes.

However, making connections with members is easier said than done. The role of care managers is increasingly difficult when many consumers are skeptical of healthcare and are distrustful of health plans:

It’s a challenging cycle to break, in which care managers could help improve the member experience and yet it can be difficult to create and develop those relationships. McKinsey studies found that 80% of identified at-risk members are not reached, and 60% of members who are reached by care management do not follow through on recommended care plans. Health plans are exploring different ways to evolve their care management functions, and the level of urgency is rising as new regulation is leading them to prioritize closing gaps in health equity.

One key consideration is whether members understand the information being shared with them. Among recently hospitalized patients surveyed by McKinsey who experienced unplanned, high-cost follow-up care, 24% said they didn’t understand their post-discharge instructions.

“Language barriers and the seeming inaccessibility of medical jargon is a likely factor in member difficulty with care compliance and feelings of unease or even distrust with healthcare professionals,” says Mitch Collier, Associate Director of Technology Product Management who focuses on payers and care management at Wolters Kluwer, Health.

“If materials are written by clinicians for clinicians, they can be technical,” Collier explains. “Members need someone to translate clinical terms into plain language, and then into the language they speak at home. This is essential for care management to be able to connect with people,” he says.

How is the Health Equity Index impacting health plans?

Improving the accessibility of language and educational materials for health plan members could affect performance related to the Health Equity Index.

There are two different benchmarks related to health equity that health plans will be encouraged to pursue over the next several years:

NCQA accreditation is a quality assurance program for technology organizations that deal with state Medicaid and similar programs. Some states and some larger, national plans that cover many regions are requiring accreditation among affiliated organizations to help advance health equity.

The CMS Health Equity Index is a different concept, Collier notes, although sometimes conflated as another accreditation or certification one can earn. Rather, it is a 10-year effort to encourage improvements in health equity among CMS stakeholders, and much like Star Ratings, tie those improvements to reimbursements. By standardizing specific health equity priorities for health plans and other stakeholders to achieve, those structural changes no longer seem like a “philanthropic effort,” Collier says. “Tying it to Star Ratings gets payers to take some real action. That can impact significant revenue to these health plans. The goal here is, ultimately, not just to have healthcare professionals talking about health equity, but actually doing things that have measurable outcomes.”

The Health Equity Index sets five initial priorities for CMS stakeholders:

  1. Expand the collection, reporting, and analysis of standardized data to increase understanding of the needs and risk factors in the communities CMS serves.
  2. Assess causes of disparities within CMS programs and address inequities in policies and operations to close gaps to help develop and invest in sustainable solutions.
  3. Build capacity of healthcare organizations and the workforce to reduce health and healthcare disparities.
  4. Advance language access, health literacy, and the provision of culturally tailored services to help improve patient experience and safety within the healthcare system.
  5. Increase all forms of accessibility to healthcare services and coverage to help improve access to services and outcomes.

Health literacy initiatives and language accessibility fall directly into the fourth priority.

CMS will collect data related to these criteria in 2024 and 2025. In 2027, plans and other stakeholders will begin to be assessed for the upcoming year based on previous data collection.  “I think this upcoming year is important for these insights,” Collier says. “Payers who are actively looking at ways they can move the needle on these criteria being measured need to start now with solutions that can reinforce education and provide outreach to their targeted areas and populations.”

Strategies for effective member education: Language access, health literacy, and personalization

Collier sees the Health Equity Index as shining a spotlight on the importance of treating each plan member as an individual, particularly when it comes to education and engagement.

“Eliminating that generic information – I think that’s really what they’re trying to focus on,” he says. “How can we better target information to underserved communities that can help to meet their specific health needs?”

Care managers are essential to these efforts, he says, not just initial engagement, but continued health maintenance and ongoing relationships with patients and members.

“We use the phrase ‘Meeting the member where they are,’ and I always think that’s about being able to connect,” Collier explains. “People can tell when you’re just handing them some sort of boilerplate education, one-size-fits-all. And I think that for any of us, when you feel like something is more personalized to you, that tends to resonate more than if it’s just kind of general information.”

That personalization can take several forms, Collier notes:

  • Critical to health equity initiatives, “education that is more inclusive and representative is more engaging.” He explained that in his work with Emmi® member engagement solutions, they have observed a higher completion rate of member engagement videos and programs that feature diverse patient representation (e.g., race/ ethnicity, gender/sexual identity, abilities, living situation, etc.) that match the members to whom they’ve been prescribed.
  • Viewing members as more than their primary diagnosis or condition. “It can be tempting to segment people into conditions – these are the cardiac patients, these are the diabetics,” Collier explains. “But that doesn’t need to happen. We should all strive for personalization, where the patient and human side of care them comes first.”
  • Providing education in plain language to help improve health literacy. “This is one of the areas we've invested a lot of effort in at Emmi,” Collier says. “Translating complex medical terms to be user-friendly and focused on diversity, equity, and inclusion in our programs. It helps to tell a story rather than relying on complex clinical terms. We try to speak less about the disease or test and more to the human, about what should you expect and what you need to do."
Payers who are actively looking at ways they can move the needle on these criteria being measured need to start now with solutions that can reinforce education and provide outreach to their targeted areas and populations.
Mitch Collier, Wolters Kluwer, Health

Implementing care management solutions to improve member relationships and outcomes

Care management solutions are valuable tools to help reinforce the one-on-one interaction between care managers and members, Collier believes.

“I think what is most likely to be successful is when you employ a blend of in-person and digital interactions where you have a care manager that’s guiding you through information, and then you have a solution like an Emmi program that works in conjunction with your care manager to reinforce that, because you get hit with a lot of information.”

Collier describes one of his favorite Emmi programs: one that encourages movement and exercise. He notes that instead of showing hyper-athletic characters running marathons, it depicts patients of varying ages and body types and abilities. It encourages members to move at their own pace, even if that’s just starting with a slow walk around the block or to the mailbox, by clearly and simply explaining the importance of even basic movement to their mental and physical well-being.

A member engagement solution like EmmiGuide™, which is designed specifically for care management teams, offers both digital outreach and interactive multimedia educational programs that care managers can personalize to members at scale. It can help prioritize engagement when heavy caseloads make it difficult to maintain those much-needed connections.

“If somebody engaged with that Emmi program, the care manager can talk to them about the particular areas where they had questions and then reinforce that messaging with the member instead of having to start from zero with each new call,” he says.

Learn more: Download the eBook

To learn more about solutions for member engagement, download our eBook, Care management: Building trust through personalized member engagement.

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