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Health Insurance LiteracyThe Basics

March 6, 2018

Moderator: Evelyn Mantilla, Grossman HeinzPresenter: Victor G. Villagra, MD, FACP

Associate Director, UCONN Health Disparities Institute

Health Insurance LiteracyThe basics

March 6, 2018AHCT Webinar

Victor G. Villagra, MD, FACPAssociate Director

UCONN Health Disparities Institute

Webinar Objectives• Define health insurance literacy (HIL)• Understand the benefits or consequences of

low/high HIL• Introduce suggestions for member/client HIL

education to reduce potential health or financial harms

• Address questions regarding selection and use of health insurance

The Challenge of Selecting and Using Health Insurance

Complexity of Insurance Products• A typical “consumer-friendly” subscriber

agreement (SA) is over 100 pages long.• A typical Bronze PPO plan in CT had a Flesch-

Kinkaid Reading Ease score of 30.7 corresponding to a 16.5 grade level (10-12 is roughly high school)

Patient’s literacy

System Complexity

Access to Healthcare

Potential health harm• Untimely care• Foregone carePotential financial harm• Economic insecurity• Judicial action • Personal bankruptcyDissatisfaction with the system• Inconvenience• Aggravation

Navigation support

8

What is Health Insurance Literacy?

Health insurance literacy measures the degree to which individuals have the knowledge, ability, and confidence to find and evaluate information about health plans, select the best plan for their financial and health circumstances, and use the plan once

enrolled.

Source: Measuring Health Insurance Literacy: A Call to Action, Consumers Union and partners, February 2012

9

Is HIL the same as Health Literacy?

Financial Literacy

Health InsuranceLiteracy

Health Literacy

“A confession: I am a health economist, and I cannot rationally select a health plan.”

He has an educational background in physics and engineering. After receiving his PhD in statistical and applied mathematics he spent four years at a research and consulting firm conducting policy evaluations for federal health agencies.

Health Insurance Made Simple

• Enroll in a plan• Pay premiums(if

required)• Follow the rules

Insurance coverage

Delivery System

• Safe• Timely• Effective• Equitable• Respectful• Affordable

Optimal health outcomes

• Safe• Timely• Effective• Equitable• Respectful• Affordable

Delivery System

Access to Healthcare:Challenges for the newly insured

Insurance coverage

• Enroll in a plan• Pay premiums(if

required)• Follow the rules

Optimal health outcomes

• Safe• Timely• Effective• Equitable• Respectful• Affordable

Delivery System

Access to Healthcare:Challenges for the newly insured

Insurance coverage

• Enroll in a plan• Pay premiums(if

required)• Follow the rules

Optimal health outcomes

Access to Healthcare:Challenges for the newly insured

Insurance System

When do I pay a “co-pay”?

What is a “premium”?

What is the “provider network”?

What is “the formulary”

When do I stop paying

“deductibles”?

My hospital was “in-network” but the

anesthesiologist was “out-of-network”

• Enroll in a plan• Pay premiums(if

required)• Follow the rules

Optimal health outcomes

• Safe• Timely• Effective• Equitable• Respectful• Affordable

Delivery System

Access to Healthcare:Challenges for the newly insured

Insurance coverage

No/limited access to specialists

Mounting medical

debt

Unaffordable Rxs.

Complex self-care tasks.

Help!

Denied payment for service rendered

• Enroll in a plan• Pay premiums(if

required)• Follow the rules

CT HIL Survey Results

Selected Survey Results

Meaning of “Premium”in everyday lifeNoun

1. A prize, bonus, or award given as an inducement2. A gift, or sum additional to price, wages, interest, or the like.3. Insurance. the amount paid or to be paid by the policyholder for

coverage under the contract, usually in periodic installments.4. Economics. the excess value of one form of money over another of

the same nominal value.Adjective5. Of exceptional quality or greater value than others of its kind; superior:

a wine made of premium grapes.Idiom6. “Housing in that area is at a premium.”

Survey Results

Survey Results

Survey ResultsQuestion # 10: “Suppose that under your health insurance policy, hospital expenses are subject to a $1,000 deductible and a $250 per day copay. You get sick and are hospitalized for 4 days, and the bill comes to $6000. How much of that hospital billwill you have to pay yourself?”

$0

$1,000

$2,000

$4,000

$6,000

What Needs to Be Done• Know what is the HIL level in CT • Test the best way to teach HIL to consumers in

ways that are culturally and linguistically appropriate

• Policy change that will require basic HIL education starting in high-school

• Policy change to simplify health insurance • Community Based Organizations: Continuously

educate patients about HI language and concepts

Consumer Protection and Patient Support Public Policies

• Against surprise medical bills– No “out-of-network” providers in in-patient service of

“in-network” facilities• Elimination of complex cost-sharing schemas

• Deductibles• Co-insurance

• Public funding for HIL education• Public funding for Community Health Workers in

impoverished communities• Legal assistance for defendants in medical debt

claims court

Consumer Resources• Have patient HIL resources in the office, on your web site

– Pamphlets, Videos https://www.youtube.com/watch?v=yhBTnPeY3ks

– www.goodRx.com– www.HealthcareBluebook.com– www.OHA.ct

Toll-Free: 1-866-HMO-4446 (1-866-466-4446)healthcare.advocate@ct.gov

• Transparency in medical billing: Beware of ”summary bills”, be prepared to ask for an itemized hospital bill (can be very long and confusing) and ask for help scrutinizing them…before you pay.

Treximet, 9 tablets $882.48 Approved in 2008 for the treatment of migraine headache, Guess what? Treximet is just naproxen (Aleve): $2.55 (14 tablets, generic) and sumatriptan (Imitrex) :$14.54 (9 tablets, generic) To make your own Treximet equivalent you can take 500 mg of naproxen and 1.5 tablets of generic cheap 50 mg Sumatriptan. Does swallowing one Treximet pill work better than taking a naproxen and a sumatriptan at the same time? There is no proof that it does—and why would it really?

Acamya: Clindamycin 1% + benzoyl peroxide : $546 for 50 gram tubeYou can fill a prescription for a tube of clindamycin 1% at as low as $4 –$10 through some generic discount programs, and a 30 gram tube of benzoyl peroxide 2.5% at as low as $15.

Source: https://www.goodrx.com/blog/youre-paying-much-10-expensive-combination-drugs/

HIL To Beat High Drug Prices: Generic vs. Brand NameThe case of combination drugs

Disclaimer: We are not making medical recommendations.Consult your provider before making any changes to your medication regimen.

For Providers• Collaborate with insurance companies to– Simplify and expedite the prior authorization process– Leverage resources such as disease and/or case

management services• Offer patients all the preventive services appropriate

for age/sex covered under the ACA with no OOP costs• Educate hospital/clinic staff about health insurance to

help patients avoid pitfalls (e.g.: screening vs. diagnostic colonoscopy)

• Identify patients with accumulating debt and offer alternative payment options before you send out a collection agency

Medical related Small Claims Court Cases in CT: 2011- 2015

Pre ACA Post ACA

Benefits to Practicing Providers• Enhances patient trust

– Can a patient who has been taken to court by their provider or hospital trust them?

• Avoids potential conflict of agency– Balance practice financial stability and patients best interest

• Enhances practice financial performance– Reduced magnitude and longevity of “account receivables”

• Continuity and quality of care– Patient taken to court may be “lost to follow-up”

The Solutions to Selecting and Using Health Insurance

• Fewer, betterHI choices

• Improved labelling• Plan selection by

medical need

• Public funding for consumer HIL education

• More, better HIL education by carriers

• Public funding for training of CHW, others on HIL and navigation support

Reduction in health care disparities and economic inequality

Opportunities to Partner with Access Health CT

What is a Community Partner?• Partners share information about access

to health coverage with communities all over Connecticut

• AHCT provides resources and invites dialogue with our partners

• Our community partners include:Community Health CentersCommunity OrganizationsDepartment of LaborEducational institutionsElected OfficialsHealthcare Providers

Health DepartmentsHospitalsLibrariesFaith Organizationsand many others!

Community Partners

Partner EngagementWays that we can be helpful to you:

• AHCT staff can speak at events, informational, or training sessions

• The AHCT Outreach Team can table at your events or events in your community

• AHCT hosts educational webinars for our partners throughout the year

• The AHCT Community Website, Learn.AccessHealthCT.com/Community, offers information about events, links to our newsletter, printable education materials, and contact information for various AHCT departments

• Providing materials to distribute to your community

Partner Engagement (continued)

Some ways that you can help us spread the word are:

• Place an AHCT poster somewhere visible to your members and the public

• Display AHCT open enrollment brochures for your community• Send an email to your membership during key points of Open

Enrollment (we can help with content)• Link to AHCT from your website• Share AHCT social media posts

Engaging With Your Community• Speaking engagements (EN/SP)• Local/state events, fairs, festivals,

etc. • Educational webinars for partners• Informational materials• Research and surveys• Planning sessions

Want us in your community?Email Outreach@AccessHealthCT.com or fill out the form on our Community Partner website

Resources

• Community website:Learn.AccessHealthCT.com/Community Locate general information and educational materials

• Search for in-person help: Support.AccessHealthCT.com

• Monthly Community NewsletterSign up today!

• Educational Webinars

Become a Community Partner!To reach the AHCT Outreach Team:

• Call 860-327-5517

• Email Outreach@AccessHealthCT.com

• Visit our website Learn.AccessHealthCT.com/Community

• Follow us @AccessHealthCT

#AHCT #GetCoveredCT

Questions?

Thank you!