Health insurance is one of the most complex products consumers will ever purchase. Starting October 1st, 2013, new health insurance marketplaces in many states will begin open enrollment for individuals, families and small businesses. Learn about what is being done to ensure consumers are fully informed and understand how to get the coverage they need.
Kathy Paez from the American Institutes of Research (AIR) will share the results from a national representative survey of consumer’s health insurance literacy. Coming at this historic juncture, AIR’s applied research offers insights in tailoring outreach and communication messages to consumers trying to understand health insurance in the new state and federal marketplaces.
Also presenting will be Jennifer Messenger Heilbronner from the Metropolitan Group. Jennifer will bring an insider’s view into strategies being used by Cover Oregon. As a new state insurance marketplace, her team is tasked with reaching a wide variety of audiences, addressing misperceptions and getting uninsured people in her state covered.
This resource was from the fourth session in the CALPACT sponsored Health Communication Matters Webinar Series, which will help participants in all walks of public health to apply health literacy principles to their everyday communications.
Please visit here to listen to the audio recording of the webinar:
https://cc.readytalk.com/play?id=551ax7
Visit these links for the other resources related to this webinar:
Health Literacy Undervalued by Public Health? A tool for public health professionals:
http://www.slideshare.net/SPHCalpact/calpact-training-health-literacy-undervalued-by-public-health-training-tool
Applying Health Literacy to Health Insurance - Resources
http://www.slideshare.net/SPHCalpact/applying-health-literacy-to-health-insurance-resources
Follow Us on Twitter: @CALPACT
Facebook: http://www.facebook.com/CALPACTUCB
Website: www.calpact.org
Questions?
Email sphcalpact@berkeley.edu
CALPACT Webinar: Applying Health Literacy to Health Insurance: How We Can Help Consumers
1. Welcome to the Webinar
Health
Communica/on
Ma1ers!
Applying
Health
Literacy
to
Health
Insurance:
How
We
Can
Help
Consumers
We
will
begin
shortly…
2. 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
3. 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
4. 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
5. 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
6. 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
7. 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
10. “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?
10
11. “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?
11
12. • 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?
12
14. 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
14
15. § 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
15
17. • 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?
17
18. • 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?
18
19. • Employer coverage or Self-purchasers
• Staff model enrollees or PPO enrollees
• Rare healthcare users or More frequent healthcare users
Whose more health insurance
literate?
19
20. • Employer coverage or Self-purchasers
• Staff model enrollees or PPO enrollees
• Rare healthcare users or More frequent healthcare users
Whose more health insurance
literate?
20
21. § 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
21
22. § Using health insurance:
Knowing how
Question: “You know most of the
things you need to know about using
health insurance.”
Global HIL Questions
22
4.5%
20.0%
58.6%
16.7%
Strongly agree
Agree
Disagree
Strongly
disagree
23. 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?
24. Overarching Theme:
Not knowing what you don’t know
24
Insurance Experience
Costly health
event
It’s a
hard
knock
life.
Health
Insurance
Literacy
Confidence
25. 25
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
26. 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?
28. a) Very confident
b) Moderately confident
c) Slightly confident
d) Not at all confident
How confident do you feel that you
understand insurance terms
28
29. 29
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?”
30. 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:
30
31. 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:
31
32. 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:
32
33. 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:
33
35. 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…(%)
36. 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
36
37. 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
37
63% were correct
38. 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
38
39. 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
39
19% were correct
40. • 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
40
45. 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.
50. 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?
51. 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
52. 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
53. LANGUAGE GUIDES
• Key messages developed by RWJF to help all
exchanges
• Healthcare.gov/glossary
• Community input
54. AUDIENCES
• Young and healthy
• Passive and skeptical
• Sick and worried
• Experienced and enthusiastic
• Isolated and independent
DEMOGRAPHIC, BEHAVIORIAL,
PSYCHOGRAPHIC
57. • Play/show Matt Sheehy, Lifesavas, education
ads
PAID MEDIA & CREATIVE
58. • Editorial boards
• Priority pitching
– Young and healthy
– Women/moms
– Small biz and entrepreneurs
– Multicultural communities
• Social Media
• Avoiding fraud
EARNED MEDIA
59. • Reaching traditionally underserved audiences
• Range of trusted organizations
§ Oregon State Library
§ OSU Extension
§ Multicultural organizations
• Events and paid sponsorships
GRASSROOTS
60. § 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.
Cover Oregon.com | 1-855-CoverOR (1-855-268-3767)
61. • Focused language and outreach in
underserved communities
– African American - Latino
– Asian and Pacific Islander - Russian/Slavic
– LGBTQ - Tribes
MULTICULTURAL OUTREACH
62. • 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
63. • 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
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
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!
Интернет-площадка, позволяющая найти
медицинскую страховку и финансовую
помощь для ее оплаты
Наличие медицинской страховки
защищает вас и вашу семью от
больших медицинских счетов и
помогает вам оставаться здоровым.
Медицинское
страхование
для вас и
вашей семьи
CO-C-00020 (7/13)
Получите помощь, заполнив бланк заявки
у общественного партнера или агента Cover
Oregon. Они могут объяснить разницу между
медицинскими страховыми планами и могут
помочь подать заявку через Cover Oregon.
Позвоните по телефону 1-855-CoverOR
(1-855-268-3767), расскажите сотруднику о своих
нуждах и узнайте, как подать заявку на получение
страхового медицинского полиса через Cover
Oregon. Сотрудник также может помочь вам найти
ближайшего к вам общественного партнера или
агента Cover Oregon.
Посетите сайт www.CoverOregon.com для того,
чтобы узнать больше о том, как Cover Oregon может
помочь вам и вашей семье. Узнайте с помощью
программы-калькулятора, размещенной на сайте, на
какую финансовую помощь вы можете рассчитывать.
Когда вы пользуетесь сайтом, тайна ваших личных
данных охраняется федеральным законодательством.
Предоставленная вами информация будет
рассматриваться строго конфиденциально.
Даже если у вас есть хроническое заболевание,
например, диабет или астма, или вам раньше было
отказано в медицинской страховке, вы сможете найти
свой вариант страхования с помощью Cover Oregon.
Возможно, у вас есть право на
помощь в оплате страхового полиса.
Как мне обратиться в Cover Oregon?
Вы можете получить бесплатную
помощь разными способами:
Cover Oregon обязана предоставлять
консультативную помощь на вашем
родном языке. Пожалуйста, узнайте,
как мы можем вам помочь.
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!
64. A
ques/on
for
Jennifer
Do you have an example
of how you adapted
materials for a specific
group and how that
worked?
65. • 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.com
Toll-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 Organization
Address line 1
Address line 2
555.555.5555
Email Address
website.com
LOGO
LOGO
CO-C-00020-RP-NA (7/13)
66. • 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
67. • Cover Oregon = plan? (skepticism)
• Tax credits and financial assistance?
• Connection to mandate/penalty
• Additional segmentation and specifics
§ Transgender
§ Women
WHAT’S STILL NEEDED
68. • “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
69. • 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
71. Thank
you
to
our
speakers!
Kathryn Paez, RN, Ph.D.
American Institutes for Research
Jennifer Messenger Heilbronner
Metropolitan Group
72. 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
73. 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
74. Resources
• RWJF
Medicaid
study
h_p://www.rwjf.org/content/dam/farm/reports/
surveys_and_polls/2012/rwjf73113
• Enroll
America
h_p://files.www.enrollamerica.org/best-‐prac0ces-‐
ins0tute/public-‐educa0on-‐resources/
EA_Final_Report.pdf
74
76. Thank
you
to
our
Sponsors!
Community Health Planning and Policy Development
Section, APHA
77. 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
78. 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.