Health Plan Efficiency
Previous research has shown that limited health literacy often leads to higher rates of hospitalization, greater use of emergency services, errors in treatment and medication, and other inefficiencies in the health care system. But how do these inefficiencies occur and can they be prevented?
HRA received funding from the California Office of the Patient Advocate (OPA) to explore the intersection between health literacy and health plan efficiency. We conducted a literature review, 31 key informant interviews, and 12 focus groups with 114 commercial and Medi-Cal HMO members.
Working with an advisory group to analyze the study findings, we identified five areas where health plan members with limited health literacy could use help navigating their health plans:
- Emergency department use
- Medication coverage and prescription drug formularies
- How to use health plan benefits
- Authorizations, denials, and grievances
- Using a provider directory
The Institute of Medicine defines health care system efficiency as avoiding waste, including waste of equipment, supplies, ideas, and energy. Inefficiencies in the health care system, such as the problem areas identified in this study, can result in increased costs, unnecessary use of human hours and labor, and poor treatments.
HRA is now partnering with OPA to develop interventions to address these issues.