Welcome to the Webinar

 Health  Communica/on  Ma1ers!    Applying  Health  Literacy  to  Health  Insurance:  

How  We  Can  Help  Consumers  

We  will  begin  shortly…  

Today you’ll be hearing from. . .

Nancy Murphy, MSHC Metropolitan Group

Moderator

Kathy Paez, RN, Ph.D. American Institutes for Research

Principal Researcher

Jennifer Messenger Heilbronner,

Metropolitan Group Exec. Vice President

Agenda    1.  Review  of  session  objec0ves  2.  Introduc0on  of  today’s  speakers  3.  What  do  consumers  know  –  and  what  do  they  think  they  

know  –  about  health  insurance?  4.  Q  &  A  5.  Cover  Oregon:  Real-­‐0me  case  study  on  consumer  outreach  6.  Q  &  A  7.  Specific  ac0ons  and  resources    8.  Next  steps  &  conclusion  

Objectives •  Describe  what  consumers  do  and  don't  understand  as  they  

are  shopping  for  and  using  private  health  insurance    •  Describe  what  consumers  should  understand  to  be  health  

insurance  literate    •  Understand  how  audience  segmenta0on  informs  outreach  

and  enrollment  strategies    •  Describe  the  marke0ng  mix  used  to  build  awareness,  educate  

and  drive  enrollment      

Who is speaking today: Kathy Paez

Kathy Paez, RN, Ph.D. Principal Researcher American Institutes for Research Email: kpaez@air.org Website: http://www.air.org

Who is speaking today: Jennifer Messenger Heilbronner

Jennifer Messenger Heilbronner Executive Vice President, Public Health Practice Lead, Metropolitan Group Email: jmessenger@metgroup.com Website: http://www.metgroup.com

Who is moderating our discussion today:

Nancy Murphy

Nancy Murphy, MSHC Executive Vice President Metropolitan Group Email: nmurphy@metgroup.com Website: http://www.metgroup.com

Introducing Kathy Paez

Kathy Paez, RN, Ph.D. Principal Researcher American Institutes for Research

CALPACT Webinar: Applying Health Literacy to Health Insurance

September 2013

Copyright © 20XX American Institutes for Research. All rights reserved.

How we can help consumers September 25, 2013

“The capacity to find and evaluate information about health plans, select the best plan given financial health circumstances, and use the plan once enrolled.”

Health Insurance Literacy Expert Roundtable, 2011.

What is Health Insurance Literacy?

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“I don’t know what’s

covered, the information saying what is covered is

like a bible, I neglect to read it and try to avoid the

doctor.” -Man in his 30’s

Why measure Health Insurance Literacy?

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•  Tailor outreach communications •  Compare effectiveness of outreach approaches •  Assess effectiveness of training consumer assistants •  Evaluate changes over time in consumers’ ability to select,

use health insurance

Why measure Health Insurance Literacy?

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Domains of Health Insurance Literacy Knowledge Information

Seeking Document Literacy

Cognitive Skills

§  Insurance terms

§  Insurance concepts (e.g. premium pays for insurance that protects you against an unexpected medical event)

§  Types of healthcare services (e.g. screening vs. diagnostic)

§  Beneficiary rights

§  Locate information (e.g. eligibility, coverage requirements)

§  Evaluate credibility of information sources

§  Navigate information sources (insurer telephone trees, and exchange web sites, decision support tools)

§  Articulate questions

§  Complete forms (enrollment, claim, mail order prescription, appeal)

§  Read and follow directions

§  Interpret summary of benefits and explanation of benefit documents

§  Use schedules (e.g. provider and drug tiers)

§  Assess preventive care needs and personal risk

§  Apply benefit structure to personal situation

§  Project utilization

§  Calculate out-of-pocket costs

§  Assess value

§  Formulate questions

Self-Efficacy The confidence to perform the tasks noted above

Copyright © 2013 American Institutes for Research All rights reserved.

Self report questions How likely are you to understand what you would have to pay for prescription drugs? a. A) very likely b. B) likely c. C) unlikely d. D) very unlikely

Knowledge and skills “test” questions

Which of the following plans would you recommend to a person with a chronic condition? This person visits their doctor twice a month and is taking three prescription drugs. a. Plan 1: Premium is $50/month and the

deductible is $2,500. b. Plan 2: Premium is $70/month and the

deductible is $1,000. c.  Plan 3: Premium is $100/month and the

deductible is $300.

Two Types of Questions

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§ Adults age 22-64 § Currently insured or previously insured through:

•  Employer/family member’s employer or •  Non-group insurance or •  Medicaid Sample size 824 people, representative of U.S population

Who we surveyed

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What we learned Characteristics Gestalt

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•  Men or Women •  Younger adults or Older adults •  Whites or Blacks or Hispanics •  More educated or Less educated •  Lower income or Higher income

Who’s more health insurance literate?

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•  Men or Women •  Younger adults or Older adults •  Whites or Blacks or Hispanics •  Less educated or More educated •  Lower income or Higher income •  Employers purchasers or Self-purchasers

Who’s more health insurance literate?

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•  Employer coverage or Self-purchasers •  Staff model enrollees or PPO enrollees •  Rare healthcare users or More frequent healthcare users

Whose more health insurance literate?

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•  Employer coverage or Self-purchasers •  Staff model enrollees or PPO enrollees •  Rare healthcare users or More frequent healthcare users

Whose more health insurance literate?

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§ Choosing Insurance: General understanding

Question: “How confident are you that you would choose the health plan that is best for you?”

11.5%

27.2%

40.1%

12.0% Very confident

Moderately Confident Slightly confident

Not at all confident

Global HIL Questions

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§ Using health insurance: Knowing how

Question: “You know most of the things you need to know about using health insurance.”

Global HIL Questions

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4.5%

20.0%

58.6%

16.7%

Strongly agree

Agree

Disagree

Strongly disagree

A  ques0on  for  Kathy  

The percentage of people who think they know all they need to seems pretty high to me. Were you surprised by that? What concerns you about that response?

Overarching Theme: Not knowing what you don’t know

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Insurance Experience

Costly health event

It’s a hard knock life.

Health Insurance Literacy

Confidence

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Overall Knowledge and Skills Test Results

62%

39%

68% 57%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Health Insurance Terms Knowledge of Plan Types

Skills Choosing Plans Skills Using Plans

Percent Correct Responses

A  ques0on  for  Kathy  

What are the implications of people not knowing what they don’t know, and how can practitioners help adjust that gap?

Understanding of Terms

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a)  Very confident b)  Moderately confident c)  Slightly confident d)  Not at all confident

How confident do you feel that you understand insurance terms

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How confident do you feel that you understand insurance terms

33.7%

29.1%

26.8%

10.1% Very confident Moderately confident Slightly confident Not at all confident

§ How confident are you that…

•  Question: “You understand health insurance terms?”

a)  The payment your health plan makes for covered care. b)  The amount you pay each month to your health plan for

your health insurance. c)  The amount you must pay for your health care before

your health plan begins to pay. d)  Not sure

A premium is:

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a)  The payment your health plan makes for covered care. (5%)

b)   The amount you pay each month to your health plan for your health insurance. (78%)

c)  The amount you must pay for your health care before your health plan begins to pay. (7%)

d)  Not sure (9%)

A premium is:

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a)  A type of therapy not often covered by health plans. b)  A health plan policy that requires your doctor to request

the plan’s approval of an increase in the dose of medicine you take.

c)  A health plan policy that encourages members to try effective but less expensive medicines to treat their condition before trying more expensive ones.

d)  Not sure

Step therapy is:

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a)  A type of therapy not often covered by health plans. (3%) b)  A health plan policy that requires your doctor to request

the plan’s approval of an increase in the dose of medicine you take. (5%)

c)  A health plan policy that encourages members to try effective but less expensive medicines to treat their condition before trying more expensive ones. (35%)

d)  Not sure (59%)

Step therapy is:

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Using Insurance

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35

Using Insurance: Being Proactive

11.8

14.9

5.4

4.4

28.7

32.1

13.9

13.65

28.6

30.7

23.8

23.8

28.4

19.6

54.3

51.2

2.1

2.4

3.0

6.9

Not at all likely Somewhat likely Moderately likely Very likely Not applicable

Review the statements you get from your health plan showing what you owe and what they paid for a service? Find out if a doctor is in-network before you see him/her?

Look to member services to tell you what medical services your health plan covers?

Look into what your health plan will and will not cover before you get health care services?

When using your health insurance plan, how likely are you to…(%)

You think you might have injured your knee, so you go the doctor and she takes an X-ray. The bill is $200 for the doctor and $100 for the X-ray. Your health plan covers both of these services. You have 20% coinsurance for doctor visits and 10% coinsurance for diagnostic tests, such as X-rays. Coinsurance is the percentage of a health care bill that you pay. What is your part of the bill? a)  $40 b)  $50 c)  $90 d)  Not sure

Question: Using Insurance

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You think you might have injured your knee, so you go the doctor and she takes an X-ray. The bill is $200 for the doctor and $100 for the X-ray. Your health plan covers both of these services. You have 20% coinsurance for doctor visits and 10% coinsurance for diagnostic tests, such as X-rays. Coinsurance is the percentage of a health care bill that you pay. What is your part of the bill? a)  $40 (6%) b)   $50 (63%) c)  $90 (5%) d)  Not sure (25%)

Question: Using Insurance

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63% were correct

Early in January, Robert visits an in-network doctor to get a wart removed from his foot. The bill for this visit is $530, which is the member rate the doctor agreed to charge his health plan for that service. Robert has a $30 co-pay, a $100 deductible, and 20% coinsurance that apply for this visit. His co-pay does not count towards the deductible. How much will Robert pay for the visit? a)  $130 b)  $210 c)  $236 d)  Not sure

Question: Using Insurance

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Early in January, Robert visits an in-network doctor to get a wart removed from his foot. The bill for this visit is $530, which is the member rate the doctor agreed to charge his health plan for that service. Robert has a $30 co-pay, a $100 deductible, and 20% coinsurance that apply for this visit. His co-pay does not count towards the deductible. How much will Robert pay for the visit? a)  $130 (18%) b)   $210 (19%) c)  $236 (33%) d)  Not sure (30%)

Question: Using Insurance

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19% were correct

•  Frequent healthcare use, age, higher education, and income are related to higher health insurance literacy

•  About 2/3 of people age 22 - 65 have a basic understanding of routine care coverage

•  People struggle to understand complex benefit structures •  People tend to be overly confident about their ability to

choose and use health insurance

Take home points

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Kathy Paez 301-592-2229 kpaez@air.org 10720 Columbia Pike, Suite 500 Silver Spring, MD 20901-4449 General Information: 301-592-8600 www.air.org

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Introducing    Jennifer  Messenger  Heilbronner  

Jennifer Messenger Heilbronner Metropolitan Group Executive Vice President

HEALTH LITERACY AND MARKETING

Jennifer Messenger Heilbronner, Metropolitan Group

SEPTEMBER 25, 2013

HEALTH INSURANCE LITERACY •  "Little systematic research has been done to date to

assess health insurance literacy.” §  Center for Rural Health

•  Not a single concept or skill. §  Prose literacy

§  Numeracy

§  Document literacy

§  Etc.

SOME CLUES

• Older adults more comfortable with insurance info than younger

SOME CLUES

• Most help needed § comparing different plans § calculating costs

SOME CLUES

• Helpful: case studies showing what the plan will do for different people

CALCULATIONS ARE TOUGH

Office visit

Co-insurance

Co-pay

A  ques0on  for  Jennifer  

Do you have any insight yet on what’s most important to people about health insurance, especially insight that might help frame messages?

EARLY RESEARCH MOST IMPORTANT

Insured •  More can get insurance, even

with pre-existing condition

•  Financial help available

•  Costs and what is covered in simple language

•  What plans cover

•  Main concern = Quality + cost

EARLY RESEARCH MOST IMPORTANT

Insured •  More can get insurance, even

with pre-existing condition

•  Financial help available

•  Costs and what is covered in simple language

•  What plans cover

•  Main concern = Quality + cost

Uninsured •  Financial help available

•  More can get insurance, even with pre-existing condition

•  Costs and what is covered in simple language

•  What plans cover

•  Main concern = cost

LANGUAGE GUIDES

• Key messages developed by RWJF to help all exchanges

• Healthcare.gov/glossary

• Community input

AUDIENCES

•  Young and healthy

•  Passive and skeptical

•  Sick and worried

•  Experienced and enthusiastic

•  Isolated and independent

DEMOGRAPHIC, BEHAVIORIAL, PSYCHOGRAPHIC

ENGAGING OUR AUDIENCES

INTEGRATED CAMPAIGN

Research

Paid Media

Earned Media

Online Outreach

Statewide+ Grassroots Partners

Marketing Materials

Community Meetings All

Oregonians

Multi- cultural communities

Customized approach

• Play/show Matt Sheehy, Lifesavas, education ads

PAID MEDIA & CREATIVE

• Editorial boards

• Priority pitching – Young and healthy

– Women/moms

– Small biz and entrepreneurs

– Multicultural communities

• Social Media

• Avoiding fraud

EARNED MEDIA

• Reaching traditionally underserved audiences

• Range of trusted organizations § Oregon State Library § OSU Extension § Multicultural organizations

• Events and paid sponsorships

GRASSROOTS

§ Culturally relevant and highly customizable

§ Community tells us what motivates, makes sense

MATERIALS

Starting in October 2013, you can enroll in coverage even if you already have a health condition or have been turned down before.

COVER OREGON™ IS A NEW ONLINE MARKETPLACE WHERE YOU CAN COMPARE AND ENROLL IN MEDICAL AND DENTAL COVERAGE, AND ACCESS FINANCIAL HELP.

UNINSURED? WE CAN CHANGE THAT.

CoverOregon.com | 1-855-CoverOR (1-855-268-3767)

• Focused language and outreach in underserved communities –  African American - Latino –  Asian and Pacific Islander - Russian/Slavic –  LGBTQ - Tribes

MULTICULTURAL OUTREACH

• Robust network of community partners § Online dynamic search to find assistance from an

agent or community partner

• Multilingual capacity in call center

• Multilingual paper applications

MULTICULTURAL CAPACITY

• Transcreation

• Languages: Chinese, Korean, Vietnamese, Japanese, Spanish, Russian

• Collaborative process

• Customizable

MULTICULTURAL MATERIALS

Cover Oregon es un mercado donde hallar seguro médico y ayuda económica para pagarlo

Un seguro médico te protege a ti y tu familia de tener que afrontar una gran cantidad de gastos médicos y te ayudará a cuidar tu salud.

Seguro médico para ti y tu familia

CO-C-00020 (7/13)

Pide ayuda a una organización comunitaria o agente de Cover Oregon para completar la solicitud. Ellos pueden explicarte las diferencias entre los planes de seguro médico y ayudarte a presentar la solicitud a través de Cover Oregon.

Llama al 1-855-CoverOR (1-855-268-3767) para hablar con un representante. Podrás transmitir tus necesidades y recibir instrucciones sobre cómo solicitar el seguro médico a través de Cover Oregon. También te pueden ayudar a encontrar una organización comunitaria o un agente en tu área EGTVKƂECFQU�RQT�%QXGT�1TGIQP�

Visita nuestro sitio web: CoverOregon.com para saber cómo Cover Oregon te puede ayudar a tí y a tu familia. Usa la calculadora para ver la ayuda económica que puedes recibir. Si usas el sitio web, tu privacidad está protegida por la legislación federal. La información suministrada será EQPƂFGPEKCN�

Incluso si tienes alguna enfermedad, como diabetes o asma, o si te negaron la posibilidad de contratar un seguro médico antes, ahora puedes encontrar opciones de seguro en Cover Oregon.

También podrías recibir ayuda con el pago del seguro.

¿Cómo accedo a Cover Oregon? Puedes obtener asistencia sin cargo de varias maneras:

Tenemos la obligación de brindarte ayuda en tu idioma. No dudes en consultarnos cómo te podemos ayudar.

Puedes registrarte en un plan de seguro médico a partir de octubre de 2013. La cobertura y ayuda económica tienen vigencia desde enero de 2014.

¡Regístrate!

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CO-C-00020 (7/13)

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Puedes registrarte en un plan de seguro médico a partir de octubre de 2013. La cobertura y ayuda económica tienen vigencia desde enero de 2014.

Sign up!

A  ques/on  for  Jennifer  

Do you have an example of how you adapted materials for a specific group and how that worked?

•  New tagline/title

•  More “what is insurance”

•  AI/AN exchange specifics

EARLY SUCCESS: TRIBAL MATERIALS

Cover Oregon is a marketplace for Tribal communities to find health insurance and financial help to pay for it

Cover Oregon can help you and your family if:

You currently receive services at your Tribal or Urban Indian clinic, and do not have insurance coverage.

You or your family do not have private health insurance or coverage through a public medical program.

You cannot get affordable health insurance through work.

You buy your own health insurance and want more choices.

You own a small business and employ 50 or fewer people.

Online:

CoverOregon.comToll-free:

1-855-CoverOR (1-855-268-3767)

SIGN UP

Cover Oregon is here to help you find the right health insurance for you and your family, and financial help to pay for it. Even if you receive services from your Tribal or Urban Indian clinic, Cover Oregon will work for you.

Honoring Traditions of Health

Visit CoverOregon.com to learn more and use a website calculator to see how much financial help you might receive. When you use the website, federal law protects your privacy. The information you provide will be treated confidentially.

Call 1-855-CoverOR (1-855-268-3767) to speak with someone about your needs for health insurance and how to use Cover Oregon. We can help you find a tribal community partner near you.

Visit your local Tribal oganization, clinic, or community partner. People there can explain the differences in health insurance options, and can help you use Cover Oregon.

How Do I Access Cover Oregon?

You can enroll in a health insurance plan starting in OCTOBER 2013. Coverage and

financial help begin in JANUARY 2014.

Name of OrganizationAddress line 1Address line 2

555.555.5555Email Address

website.com

LOGO

LOGO

CO-C-00020-RP-NA (7/13)

• Awareness up from 5% in May to 37% today

• Greatest appeal: § No pre-existing conditions.

§ More people can have insurance.

§ Easier process.

• Focus group participants demonstrate fluency in basic insurance concepts

WHAT’S WORKING

• Cover Oregon = plan? (skepticism)

• Tax credits and financial assistance?

• Connection to mandate/penalty

• Additional segmentation and specifics § Transgender

§ Women

WHAT’S STILL NEEDED

•  “Place where you can shop for health insurance.”

•  “Find savings to help pay for insurance.”

•  “Insurance agent”

•  “No cost to use Cover Oregon or get help.”

LANGUAGE ADJUSTMENTS

• Make it real with examples

• Look to the community

• Share messages through many channels, with different levels of info

• Be ready to learn and adapt

KEY TAKEAWAYS

WWW.COVEROREGON.COM

Thank  you  to  our  speakers!  

Kathryn Paez, RN, Ph.D. American Institutes for Research

Jennifer Messenger Heilbronner Metropolitan Group

Health  Literacy:  Undervalued  by  Public  Health?  A  tool  for  public  health  professionals.                                                      Prepared  for  the  American  Public  Health  Associa0on  Community  Health  Planning  &  Policy  Development  Sec0on  

Tammy  Pilisuk,  MPH        AUG  2011  

Resources  •  HIL  Issue  Brief  and  informa0on  about  the  HIL  measure  h_p://aircpce.org/airs-­‐work-­‐in-­‐cpce/health-­‐insurance-­‐literacy/  

 •  Training  modules  University  of  Maryland  developed  to  prepare  consumers  to  choose  and  use  health  insurance  h_p://www.extension.umd.edu/insure  

 •  Kaiser  Family  Founda0on        h_p://www.kff.org/health-­‐reform  

 

       

73

Resources  •  RWJF  Medicaid  studyh_p://www.rwjf.org/content/dam/farm/reports/surveys_and_polls/2012/rwjf73113  

 •  Enroll  Americah_p://files.www.enrollamerica.org/best-­‐prac0ces-­‐ins0tute/public-­‐educa0on-­‐resources/EA_Final_Report.pdf      

 

       

74

Speaker  Contact  Informa0on    

Kathyrn  Paez,  RN,  Ph.D.  kpaez@air.org    h1p://www.air.org    Jennifer  Messenger  Heilbronner  jmessenger@metgroup.com  h1p://www.metgroup.com    

Thank  you  to  our  Sponsors!  

 

Community Health Planning and Policy Development Section, APHA

Thank  you  to  our  planning  commi1ee  

•  Tammy  Pilisuk,  MPH,  APHA-­‐CHPPD  •  Erin  Brigham,  MPH,  CareSource,  APHA-­‐CHPPD  •  Meghan  Bridgid  Moran,  PhD,  San  Diego  State  University,  School  of  Communica0ons    

•  Lisa  Peterson,  MPH,  CALPACT  at  UC  Berkeley  •  Stephanie  Bender,  MS,  Health  Educator  •  Aileen  Kantor,  Health  Literacy  Innova0ons  •  Nancy  Murphy,  MSHC,  Metropolitan  Group  

About  This  Series    •  The  Health  Communica/on  Ma1ers  series  will  help  par0cipants  in  all  

walks  of  public  health  to  apply  health  literacy  principles  to  their  everyday  communica0ons.      

 •  What  audiences  do  you  communicate  with—consumers,  health  

professionals,  disenfranchised  communi0es,  your  public  health  peers?  Whatever  your  role  in  public  health,  it’s  likely  that  you  need  to  communicate  effec0vely.  But  how  do  you  know  your  communica0on  is  effec0ve?    

 •  Only  about  10  percent  of  the  general  popula0on  is  considered  “health  

literate.”  That  leaves  the  vast  majority  of  us  with  barriers  to  understanding  the  health-­‐related  informa0on  we  read.  

 

Conclusion  

Thank  you!    

 

 

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