Kate Goodrich, MD, chief medical officer of Humana, is leading a companywide initiative to improve members' health literacy.
Before Dr. Goodrich held high-level roles at CMS and later Humana, she was at the bedside as a hospitalist, and she saw firsthand how a lack of health literacy can affect patient outcomes.
Dr. Goodrich told Becker's about one case she encountered as a practicing physician where literacy had a huge effect on a patient's health — a woman who, despite a supportive family and community, was frequently admitted to the hospital for complications of diabetes.
It wasn't clear why the patient was having so many complications until a physician's assistant, who grew up in the same Washington, D.C., community as the patient, recognized she was unable to read the discharge instructions given to her.
"It feels silly now, looking back, but I hadn't even thought of that, at all. It turned out that with a little bit more discussion with the patient, facilitated by my PA, that this was a patient who really didn't understand our discharge instructions to her, which were given to her verbally and written," Dr. Goodrich said. "It was resulting in her coming back to the hospital because she did not understand how to take her insulin."
The story is a common one, Dr. Goodrich said, and one example of why Humana is educating all its employees on health literacy and cultural competency.
A 'universal precautions' approach
The first step to improving members' health literacy, Dr. Goodrich said, is educating employees so they can implement tools and processes to help members better understand their benefits and health.
This looks like using clear and understandable language in written materials and making sure members are receiving communications in the language they are most comfortable with.
"We want to be sure that what we're sharing with [members], whether it's written or spoken, is in their preferred language," Dr. Goodrich said. "Sometimes we don't necessarily recognize right off the bat that the member may speak some English, but it may actually be their second or third language."
Associates are also trained on techniques like "teach-back," where members are asked to restate instructions in their own words to ensure they understand information explained to them over the phone, Dr. Goodrich said.
Humana's largest member base is older adults enrolled in Medicare Advantage, but lower health literacy can be present among anyone, regardless of level of education. Research shows even individuals with advanced degrees can struggle to understand a diagnosis or explanation of benefits, Dr. Goodrich said.
"We have adopted a universal precautions approach," Dr. Goodrich said. "That's a term that has been used for medical diagnoses, but we want to use an approach that facilitates understanding by all of our members. We just make an assumption that we need to speak in plain language as much as possible, and really reduce or eliminate the jargon."
Humana is also piloting a health literacy training initiative at its CenterWell clinics in Florida, which provide primary care for older adults.
"That is a really critical place that we want to be sure that our CenterWell employees understand health literacy and are taking action to ensure that the patients that are right in front of them, that they're trying to care for, know what they need to do to best take care of themselves."
The intersection of health equity and literacy
Promoting health literacy works alongside promoting health equity, Dr. Goodrich said.
"While poor health literacy can affect any population, we know that at baseline there are disparities in care across the board in the United States. That's been well documented. There's a lot of work going on to try to address that. Addressing health literacy, using universal precautions, is a really important tool in our toolbox to try to narrow some of those gaps," Dr. Goodrich said.
Employees have had an "overwhelmingly positive" response to the new training, with some suggesting health literacy education should become an annual requirement, Dr. Goodrich said.
"I think once you realize this is a problem, and how that actually plays out, you want to do everything you can to fix it," Dr. Goodrich said.