Emily Vardell, PhDMay 29, 2017

@evardell

Health Insurance Information Needs: How Librarians Can Help

health insurance literacy

“the extent to which consumers can make informed purchase and use decisions”

(Kim, Braun, & Williams, 2013, p. 3)

2

What is the problem?

Quantitative research studies have shown that individuals are often unable to select the most financially appropriate health insurance coverage.

Most studies have employed experiments and/or surveys, suggesting there may be a need to employ other methods to create a broader picture of the underlying factors.

3

Research Questions

How do people understand health insurance concepts?

How do individuals make their own health insurance decisions?

What are the factors that impact health insurance literacy and decision-making?

4

Participants

Participants were recruited through the pool of new employees who participate in benefits training from the Human Resources Department at a large university in the southeastern United States.

5

Study Design

• Demographic questionnaire

• Interviews

• Photographs of materials

• Health Insurance Literacy Measurement (HILM)*

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*Paez, K.A., Mallery, C.J., Noel, H., Pugliese, C., McSorely, V.E., Lucado, J.L., & Ganachari, D. (2014). Development of the Health Insurance Literacy Measure (HILM): Conceptualizing and Measuring Consumer Ability to Choose and Use Private Health Insurance.Journal of Health Communication, 19(Supplement 2), 225-239.

Model of the Health Insurance Decision-Making Process

7

Obtain Overview

• Orientation session (n=21)

• Review printed materials (n=24)

• Review information on state health plan website (n=16)

• Side-by-side plan comparison chart (n=9)

• Coverage scenarios (n=9)

• Chart of monthly premiums (n=6)

8

Orientation Session

• Present the information in a variety of formats to accommodate multiple learning styles

• Benefits officers should be aware of the bias they may be imparting

• "Psychologically reassuring" to have in-person sessions

9

Information Tactics

• Comparing plans side-by-side (n=30)

• Reviewing costs (n=30)

• Calculating costs (n=18)

• Ignoring/Eliminating information (n=16)

• Avoiding Overthinking (n=9)

• Should have done more (n=4)

• Not a logical choice (n=4)

10

Information Tactics

• Comparing plans side-by-side Continued use of online calculators

• Eliminate/ignore informationPreferences for smaller size set

Interactive health materials where users could hide irrelevant information

11

Personal Reflection

• Past experience with health insurance (n=27)

• Forecasting needs for the next year (n=26)

• Forecasting worst case scenario/unknown (n=15)

• Reflecting on health status (n=16)

• Age as a factor (n=14)

• Reflecting on past year’s use of coverage (n=9)

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Interpersonal Information Sources

13

Spouse/partner (n=13)

Colleague (n=12)

Parents (n=10)

Benefits officer (n=10)

Friends (n=8)

Other source (n=5)

• due to domain expertise, familiarity with available plans, and awareness of health care needs• through a variety of media, including in person, by phone, through text, and via social media

Health Insurance Literacy

“Well I've never actually told someone what I'm doing right now which is really good exercise and shows me that maybe I should have done that. I'm not totally naïve when it comes to trying to understand it. I guess I'm a little bit confused, what is the difference between a coinsurance maximum and an out of pocket maximum?” (P19)

14

HILM Scores

15

Outcomes

Provide better assistance with enrollment

16

ACA Navigators

Support process and provide access to quality health insurance informational materials

Human resources officers

Librarians and information professionals

Policy implications for funding information assistance

Save large employers money with savvier insurance purchasers

Possible Solutions

• Dictionary of insurance terminology

• Unbiased information sources

• One-on-one assistance

• Step-by-step enrollment instructions

• Ability to customize the information displayed in a comparison chart

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Possible Solutions

• Dictionary of insurance terminology

• Unbiased information sources

• One-on-one assistance

• Step-by-step enrollment instructions

• Ability to customize the information displayed in a comparison chart

18

Know Your Health Insurance (MerckEngage®)

http://www.merckengage.com/knowyourhealthinsurance

My Health, My Voice

All available in English and Spanish:

A Woman’s Step-by-Step Guide to Using Health Insurance

5 Steps to Using Your Health Insurance Wisely

The 4 Kinds of Costs You May Pay

What is a Well-Woman Visit?

My Health, My Voice: My Personal Health Journal

http://www.myhealthmyvoice.com/get-a-copy

Learn how to use your insurance card

From Coverage to Care (CMS)• English (PDF, 7.2MB)

• Arabic / ال عرب ية( PDF, 64KB)

• Chinese / 中文 (PDF, 145KB)

• Haitian Creole/Kreyòl Ayisyen (PDF, 58KB)

• Korean / 한국어 (PDF, 97KB)

• Russian / Русский (PDF, 63KB)

• Spanish / Español (PDF, 160KB)

• Vietnamese/TIẾNG VIỆT (PDF, 61KB)

http://www.cms.gov/About-CMS/Agency-Information/OMH/OMH-Coverage2Care.html

Acknowledgements

• Study participants

• Office of Human Resources

• Medical Library Association/ Thomson Reuters Doctoral Fellowship

22

Questions?

@evardell

emily.vardell@gmail.com

Extra Slides

24

Recruitment

Participant eligibility criteria:employment at the university in the southeastern United

Statesfluent in English

25Introduction Methods Findings Discussion

Collect Data – Demographic Questionnaire

• Gender

• Age

• Racial/ethnic identity

• Education level

• Marital status

• Family status

• Job title

26Introduction Methods Findings Discussion

Participants’ Characteristics (n=30)

• 80% of participants were female and 20% male.

• 46.67% of participants were between 27-35 years old, 20% 18-26 years old, 20% 36-45 years old, 10% 46-55 years old, and 3.33% 56-64 years old.

• 63.33 % of participants were White/Caucasian, 13.33% Black/African American, 13.33% Asian or Asian American, 6.67% Hispanic/Latino, and 3.33% American Indian.

• 43.33% of participants had a Master's degree, 36.67% had a Bachelor's degree, 13.33% had a Doctoral degree, and 6.67% had some college.

• 56.67% of participants were single, 36.67% were married, and 6.67% had a domestic partner.

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Collect Data – Interviews

Broad, Opening Questions (e.g., reflecting on choice(s))

Micro-Moment Time-Line Interview

Semi-Structured Interview Questions about the Decision-Making Process (e.g., preferred option desired characteristics)

Questions Design to Gauge Direct Change to Individual following the Affordable Care Act (e.g., changes in the last 5 years)

Questions about Health Insurance Materials (e.g., most helpful and least helpful information provided)

Wrap-Up (e.g., compare with other purchases)

28Introduction Methods Findings Discussion

Collect Data – Health Insurance Literacy Measurement (HILM)Choosing a Health Plan

Scale 1: ConfidenceHow confident are you that… Not at all

confidentSlightly

confidentModerately confident

Very confident

1. You understand health

insurance terms?

2. You know where to find the

information you need to choose

a health plan if you were not

offered insurance through an

employer?

3. You know how to estimate

what you have to pay for your

health care needs in the next

year, not including emergencies?

4. You know where to go for help

if you were having trouble

affording health insurance

outside an employer?

5. You know what questions to

ask so you can choose the best

health plan for you?

6. You would choose the health

plan that is best for you?

Choosing a Health Plan

Scale 2: Behavior

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When comparing health insurance plans, how likely are you to…

Not at all confident

Slightly confident

Moderately confident

Very confident

1. Understand how the plans differ? 2. Find out if you have to meet a deductible for health care services? A deductible is the amount of money you have to pay before your health insurance will pay anything for your health care. 3. Look to see which doctors and hospitals are covered in each plan? 4. Understand what you have to pay for prescription drugs? 5. Understand what you would have to pay for emergency department visits? 6. Understand what you would have to pay for specialist visits?

Introduction Methods Findings Discussion

Step 4. Analyze Data – Process

30

Micro-Moment Time-Lines

Coding Interviews

Analysis

• Hand coded individually• Codes = participants’ words

• Compared w/ info seeking & use models• Reviewed Integrated Framework

Mem

os

Introduction Methods Findings Discussion

• Identified strategies and sources

Trustworthiness/Reliability

• Constant-comparison method of content analysis

• Transcripts were coded individually by inductive reasoning, allowing themes to emerge

• After identifying more than 62 individual codes, identified connections between the codes to develop larger themes

• Wrote reflective memos

• Documented the research process in detail

31Introduction Methods Findings Discussion