Looking to make patient financial communications more friendly? Consider Aetna's three-pronged cultural approach.

In less than two years, an estimated 32 million newly insured Americans-some of whom have never had health coverage-are expected to start showing up at hospitals and physician offices, eager to get checkups, preventive care, and medical attention for long-ignored health problems.

The Affordable Care Act (ACA) will provide these people with access to coverage through individual and employer mandates, regional and state health insurance exchanges, and an expansion of Medicaid eligibility. However, the law will not educate these patients on how to navigate the complex healthcare system.

Healthcare finance leaders can take lessons from the health insurance industry, which has been focusing on improving patient health literacy for the past several years. Health literacy experts at Aetna believe that effective communication with patients cannot be accomplished solely by redesigning billing statements and form letters. It requires an organizationwide commitment to helping patients understand the information they need to make the best decisions about their health.

Hospital leaders may want to consider emulating Aetna's three-pronged approach to improving health literacy. The insurer has adopted the three key communication strategies recommended by the national trade association, America's Health Insurance Plans:

  • Creating a culture that values patient-friendly communications
  • Setting standards and monitoring written communications
  • Training staff members on using "plain language," "teach back," and other patient-friendly communication techniques

Mending the Disconnect

"Many individuals with low health literacy will face significant challenges understanding what coverage they are eligible for under the ACA, making informed choices about the best options for themselves and their families, and completing the enrollment process," states the Institute of Medicine in its recent report, Health Literacy Implications for Healthcare Reform: Workshop Summary

Serving this influx of new patients will make patient-friendly financial communications more important than ever. It comes down to fixing the disconnect between the healthcare industry and the patients it serves, says Brian Berkenstock, Aetna's director of content services for digital media strategy and communications. For example, many consumers do not use the term "provider" the same way healthcare insiders do.

"We found that people were confused. They were saying, 'Wait a minute, you're Aetna. Aren't you my health insurance provider?'" he says. "So that common industry terminology, which we use to mean 'doctors,' 'specialists,' and 'hospitals,' is lost on people who don't understand-and shouldn't have to understand-the words we use internally."

Aetna emphasizes that staff use "doctor," "healthcare professional," or "facility" instead of "provider" in written and oral communications, according to Berkenstock.

Aetna's intranet includes "jargon alerts" that advise staff not to use terms that the public may not understand. For example, the term "noncompliant" is considered jargon. "We are trying to weed that out," says Berkenstock. "Instead, use 'not following the treatment plan' or 'not taking the prescribed drugs.'"

Access tool: Jargon Alert Words 

Improving Health Literacy

Aetna has implemented the following three patient-friendly communications approaches.

Building a patient-friendly communications culture. In 2009, Aetna rolled out a multifaceted campaign to its 30,000 employees to build awareness of the consequences of poor health literacy. The campaign included articles about health literacy that were posted on Aetna's intranet, posters, a newsletter, and an online employee quiz.

Access tool: Sample Aetna Employee Health Literacy Quiz Question 

Aetna's internal campaign has now grown to include communication skills training, document assessments to weed out jargon and ensure readability, and constant reinforcement about the importance of communicating effectively with members.

"It has been an awareness-building project over the past several years, so all of our employees are aware of it now," says Vicki Lankarge, a communications marketing manager at Aetna.

Setting standards for written communications. An editorial review board is tasked to improve the simplicity and consistency of language used by Aetna employees. The board includes writers and editors, as well as staff members who work directly with consumers and can identify common communication issues.
Aetna developed a template for form letters to help people throughout the company communicate more effectively with consumers. "The folks who produce letters are experts about our products, but often don't have a formal writing background," says Berkenstock. "The template helps them know that this kind of information goes in this part of the letter, that kind of information goes here, and so forth."

The insurer also recently redesigned its explanation of benefits statement. A redesign team used the following guidelines to create an easy-to-read document for consumers:

  • Write to a fifth-grade reading level
  • Keep the language conversational and the tone positive
  • Deliver the most important information in an at-a-glance format
  • Provide a glossary of industry terms on the first page

Access tool: Sample Aetna Explanation of Benefits Statement 

Focus groups made up of health plan members are used to evaluate some of the written materials Aetna sends out each year. "We use their feedback to improve the written pieces for the following year," he says. "We ask members to tell us their meanings of certain words and phrases, such as copay. This helps us confirm if we got the message across."

Providing communication skills training. The use of plain language-defined by the Center for Plain Language as language you can find, understand, and use-has become part of the insurer's corporate culture. A section on plain language is included in Aetna's business conduct and integrity course that employees take each year.

Employees also have the opportunity to take additional training programs. For instance, Aetna offers a writer's training course for any employee who communicates with members.

Access tool: Basic Patient-Friendly Writing Principles 

In addition, employees who interact with members in person or by phone receive training on interviewing techniques that can help them gauge whether consumers comprehend the information that is provided. During this course, staff are taught to ask open-ended versus "yes" or "no" questions. For instance, the question, "Can you tell me what you will need to pay when you have a doctor's visit?" is likely to garner more information about a consumers' understanding than "Do you understand?"

Frontline staff members are also trained in teach-back techniques, a method used by providers to encourage patients and families to say back health instructions using their own words. "The nurses and customer service representatives try to use a conversational tone and plain language to help the caller," says Berkenstock. "It really goes a long way."

Finding Passionate and Dedicated Staff

Lankarge and Berkenstock have seen a cultural shift occur at Aetna. "Five years ago, no one mentioned 'plain language' in project meetings," says Lankarge. "Now, for any initiative that is going on, someone either invites one of the plain language specialists to participate in a meeting or plain language is included in our discussions in some way."

One key to creating a culture that values effective patient communications is identifying staff members who have the needed desire and skills and empowering them to take action. "It's finding the people who have the passion and the expertise in your organization to drive it forward, who are really committed to working on behalf of the consumer, and who are really committed to patient-friendly communication," says Lankarge.

Lola Butcher is a freelance writer and editor based in Missouri.

Interviewed for this article:

Vicki Lankarge is communications marketing manager, Aetna, Hartford, Conn.

Brian Berkenstock is director of content services for digital media strategy and communications, Aetna, Hartford, Conn. 

Publication Date: Wednesday, March 21, 2012