Health insurance literacy programs. Are they important? To whom? And why?
To be clear, there is value in extending patient education beyond the clinical care continuum and into the financial subject.
A comprehensive patient educational program has two arms. The first arm is clinical – self-care activities, discharge instructions, nutrition, medication, etc. Significant focus is placed on the clinical patient educational program, and it is a clear priority to most providers, as it should be. However, the second arm, just as important, is educating patients on the financial aspect of their care, including health insurance options.
There is, not surprisingly, less emphasis here by providers today.
What does a patient health insurance literacy program actually look like? The financial patient education program should include several components, spelled out plainly:
- Coverage and out-of-pocket costs including prior balances
- Payment/financing options
- Potential linkage to eligibility programs such as Medicaid and disability, inclusive of the application and determination process
- Financial assistance
- Patient responsibility
- Alternative health insurance options such as transitioning from Medicaid to a health plan via the Marketplace
- If disabled through SSI, one option is Plan to Achieve Self-Support (PASS); if disabled through SSDI, two options are Trial Work Period (TWP) and Extended Period of Eligibility (EPE)
Financial patient education should be continuous and interactive
Throughout every encounter with the business office: admission counselors, financial counselors, billers, customer service representatives, and first-party and third-party vendors. One interactive aspect can be achieved by integrating the family and/or the individual responsible for the patient's continuing care.
Another interactive approach is engaging the patient directly throughout the educational process by asking questions, reiterating the patient's personal responsibility and engaging the patient’s interest by helping him understand that continued care is a significant benefit of financial resolution of his account.
Effective communication is the foundation of patient education
When it's done well, will lead to an improved patient experience that is equally influenced by clinicians and the business office. Collaboration between the clinicians and the business office in the patient educational program provides an interdisciplinary approach when resolving care issues and/or financial issues.
Using this approach, team meetings can focus on the patient from all aspects and work towards the financial goals of the organization. Remember, an effective educational program includes incorporating health insurance literacy in the first patient contact if a non-emergent situation and throughout every communication with the patient.
The true value of incorporating a patient health insurance literacy program is that it can impact the provider financially and can increase customer service metrics. And that is what makes it a win-win for both the patient and the provider.