Our series of interviews with Jack Nelson (former Executive Vice President of Operations for CVS Caremark) concludes as we explore the role of plain language in healthcare communications. Jack’s current role sees him take care of PBM (Pharmacy Benefit Manager) Operations and its large, fast-paced call center operations. So he understands all too well what happens when organizations fail to communicate clearly. And the impact on member experience.
If you’d like to go back on the series, you can view our first article here and our second one here.
Plain language use in member experience
As with many industries, healthcare communications are clouded by a lack of clarity. It’s common to see:
- Overuse of jargon
- Complex concepts poorly explained
- Long sentences
- Too much passive voice
- Communications pitched way above the recommended 6th-grade level
The result of all this is a general lack of readability, and confused patients and members. We carried out some of our own research into Medicare communications and found a number of examples of this.
Example one: A top U.S. health insurer
One of the U.S. top health insurer’s communications includes the following sentence:
If you choose Original Medicare, you can purchase Medicare Supplemental Insurance plans – also called Medigap plans – to help you pay for care not covered by Parts A and B.
We scanned this sentence using the VT Insights Platform. The solution flagged that this sentence is way too long, at 31 words. It also has a 15.5-grade level. We were able to split the 31-word sentence into three sentences, and achieve a grade level of 7.6. Here’s the result:
You can purchase Medicare Supplemental Insurance plans with Original Medicare. These plans are also called Medigap. They will help you pay for care not covered by Parts A and B.
Example two: Medicare
We also found the following excerpt in a letter to an employer about their Medicare provision:
You are now required by CMS to take the following action:
Now that you have learned that your plan is “not creditable,” you have between September 15 and November 14, 2019 to communicate the status of your plan to all Part D-eligibles. This information is vitally important to your covered employees and retirees, as a delay in their enrolling into Medicare Part D will likely result in a higher premium.
CMS has developed a model notice that you may customize and use for this purpose. This notice can be found at <>.
While you are not obligated to use this letter, there are very specific government directions about what must be included in any communication to Medicare-eligibles regarding their current prescription drug coverage.
These paragraphs have 123 words in total, a readability score of 44, and a grade level of 12. It comprises of 6 sentences, 3 of which are too long. Spot the difference below.
We ran the extract through VT Insights, and made appropriate changes to the text:
CMS requires you to take the following action:
We outlined that your plan is “not creditable”. Now, you have to take action between September 15 and November 14, 2019. You need to communicate the status of your plan to all Part D-eligibles. This information is very important to your covered employees and retirees. A delay in their enrolling into Medicare Part D will likely result in a higher premium.
CMS developed a model letter that you may customize and use. Find it here: <>
You don’t have to use this letter. Be aware though that there are specific government directions. These cover what information you must include in communications to Medicare-eligibles regarding their current prescription drug coverage.
Now we have 117 words in total. The readability has improved to 56, while grade level reduced to 7.9. There are no long sentences.
Words also matter
And we also know that the vocabulary used within healthcare communications is complex. And concepts are complicated. So with such a “product”, you could assume that language will be hard to understand. “That’s a sell-out”, Jack says. He argues that companies need to take the time to simplify their communications. And when members understand these communications, they pick up the phone less often. And pressure on call center operations can ease up to 30%, according to Jack. It’s better for business, better for call center operations, and better for healthcare customer experience.
And it’s also the law. The Plain Writing Act of 2010 requires that federal agencies use clear government communication that the public can understand. In 2013, the Government made it an official requirement that the health industry uses plain language. The National Institutes for Health also supports this. They say that people need easily understandable health information regardless of age, background, or reading level. So that means that healthcare providers and insurers need to find alternatives for:
- Complex words
- Medical jargon
- Abbreviations
- Acronyms
The solutions are out there
And there are many resources available to help those creating healthcare communications. The PlainLanguage.gov website has pulled together a list of alternatives for complex words. For example:
“The patient is required to notify us” becomes “The patient needs to tell us.”
The second sentence uses active language, which is easier for our brains to process, as well as simpler vocabulary. It eases the member’s cognitive load.
The PlainLanguage.gov Thesaurus from the Centers for Disease Control and Prevention is another great resource. It offers plain language equivalents to medical terms and phrases. Examples include:
Administer – Give
Deficient – Lacking
Sanitary – Clean
Seasonal Influenza – Common Flu
Yet despite the availability of these tools, it’s clear that there’s still a problem. It sounds so simple – use plain language, and take time to make your communications easy to understand.
So what’s going wrong?
Jack told us that this all stems from an internal focus on speed rather than productivity. It often leads to people creating communications who have no training in it. He gave us a real-life example that he’s seen in action – claims letters. They are mostly written, not by marketing or service teams, but by the claims team. People who have no technical writing skills whatsoever. Jack explains:
“It’s not their fault, they’re asked to put together a letter without proper background. You end up with poorly constructed letters that are full of grammar, punctuation, formatting, and clarity issues.”
And the result is a member picking up a letter from her mailbox and becoming immediately confused. She calls her provider, adding to the stress and strain on call center operations and staff.
Jack explained that there’s a lack of empathy from senior managers. They don’t try to put themselves in the shoes of their members. Even as someone who works in the industry, Jack is often left confused by the communications from his healthcare insurer. So consider the impact on a senior person or someone who doesn’t speak English as their native language.
“There’s still a lack of understanding in terms of how the other side views healthcare. Who their audience is, and their level of understanding. It’s not that people aren’t smart, it’s that they’re not living healthcare operations every day of their lives.”
The opportunity is there for the taking
Our research found that 86.6% of insurers are not communicating effectively with their target audience. That’s a pretty poor state of affairs. But the good news is, there’s a big opportunity for the healthcare industry to get this right. According to Jack:
“There’s an awesome opportunity to make an impact in this area. It hasn’t been paid a lot of attention to. The industry would value a focus on clarification of information. The VT Insights Platform would be a massive help – it’s long overdue.”
Plain language is, perhaps, an unlikely hero. But Jack argues it is key to building trust with members. When members feel confident in their providers, they are less likely to leave. They are also more likely to drive new member acquisition through word of mouth. And, most importantly, if members feel reassured about their service, they’re less likely to flood the call center. The result is an opportunity for call centers to focus on those high-touch calls from customers who really need to talk to someone. And for call center operations training to pivot, and focus on delivering exceptional service to customers in need.
