Accenture issues a report discussing the impact of health plan complexity and the interaction with lack of patient literacy. (Accenture Report) The firm has developed something it calls a Healthcare System Literacy Index. Consumers who have low scores don’t understand what a premium, deductible, copayment, coinsurance, out-of-pocket maximum or other commonly used health plan benefit terms are. They also tend not to understand the difference between in and out-of-network providers, that there may be different cost-sharing requirements for each or how to get a prior authorization when needed. According to an Accenture survey, 52% of consumers have low health literacy. They divide us this way; 33% have no experience with the health system, 19% are novices, that is, have a little experience, 32% are proficient at interacting with their health coverage and 16% are experts. Uhhh, I have some bad news for Accenture, that 16% who are expert, if it even is that percent, probably have very high health spending and account for a lot of national health costs, so since they already have good literacy, improving it isn’t going to do a thing for spending.
Now Accenture claims that 48% of those who fall in the low health literacy buckets have college or even graduate degrees. But that low literacy may just reflect that they are pretty healthy, so why would they care about coinsurance means. But more importantly, it just likely reflects that college today basically isn’t good at anything but preparing people to be social justice warriors, whatever that means. Accenture claims, and I think is likely true, that people with low health literacy cause health plans to incur more costs because they need more administrative support. Accenture also rightly points out that the solution may not be spending more on support, but to try to simplify plans. Hard to do that if you are an employer who believes that cost-sharing is an important way to ensure consumer engagement, so I doubt benefit design is going to get simpler. And we get the usual, boy, retailers have sure made interacting with their business easy, one-click shopping and all. Health care is not like anything else and you can’t one-click a colonoscopy or a specialty drug like you can deodorant. And you shouldn’t try to. Designing a course of treatment for a medical need is not simple and if the medical issue is at all complex, there is a fair amount of judgment involved. So helping patients understand their benefits and their medical care is important, but I don’t think you are going to save a lot of administrative expense improving patient literacy.