plain language august 31 2016

Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutions

Zoe Stetson & Adele AngleAugust 31, 2016

Writing plain is everyone’s gain

Aetna Inc.Writing Plain is Everyone’s Gain

Your presenters

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Zoë Stetson, Communications Consultant & quality reviewer• 4 years with Aetna• Life before Aetna: Director of marketing and public relations at two

colleges, a long-term care facility and several non-profits; television producer and talk show host; freelance writer

Jim Dunn, Manager, Writers’ Center for Excellence• 3 years with Aetna as a copy quality reviewer. Now supervise 10

quality reviewers who look at all materials to be sent externally.• Life before Aetna: More than 25 years in health care

communications at Anthem, United Health and HealthNet


Before we start

• Be sure the Flesch-Kincaid Index is working in Microsoft Word

• Have class exercises open on your desktop

• Ask questions throughout

• Keep your phones muted

• Avoid multi-tasking

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Course objectives

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• Explain what plain language is and what it isn't

• Describe the value of using plain language for consumers, Aetna and yourself

• Go over the principles of plain language

• Use the Flesch-Kincaid tool to improve your writing

Aetna Inc.

So here’s the question …

Aetna Inc. 6Writing Plain is Everyone’s Gain

How do we change language like this: After this review, we determined that the proposed injection penicillin g benzathine, home infusion/specialty drug administration, home injectable therapy would not be covered under the member’s benefits plan, assuming all of the clinical information remains unchanged. Aetna does not consider intravenous antibiotic therapy medically necessary for Lyme disease when the medical records do not support that a definitive diagnosis of Lyme disease is established (positive serologic and/or cerebrospinal fluid (CSF) titer by indirect immunofluorescence assay (IFA), Prevue Borrelia burgdorferi antibody detection assay, or enzyme-linked immunosorbent assay (ELISA), which itself is validated by a positive Western Blot Test), and there is no documentation that any of the following criteria is met: Lyme arthritis which persists after failing to respond to a 4-week course of appropriate oral antibiotic therapy, moderate to severe cardiac involvement, Neurologic involvement of Lyme disease (neuroborreliosis), or Lyme disease in pregnant women who exhibit symptoms and signs of Stage II or Stage Ill Lyme disease.

READING GRADE LEVEL 40.6


Into language like this?

We cannot cover the treatment with antibiotics given through a vein. That’s because the laboratory results do not confirm that you have Lyme disease. Also, you do not have symptoms that would need this treatment.


Aetna Inc.

May we have a volunteer?


Michelle’s Law

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Under federal law, known as Michelle's Law, dependents who lose student status due to a disability (that is, serious illness or injury) may be eligible to continue coverage for up to one year from the first day of a medically necessary leave of absence or at such time coverage would otherwise terminate under plan or coverage terms, whichever occurs first.

Public Law 110–381 110th Congress An Act

https://www.cms.gov/HealthInsReformforConsume/Downloads/Michelles_Law.pdf


Michelle’s Law revised

10

A federal law called Michelle’s Law helps students who must take a leave of absence for medical reasons. The law lets them continue health coverage up to one year. To do this, the student must attend college before the leave starts. The student also needs a letter from his/her doctor. The letter must say why the leave is needed.


Plain language

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Communication that your audience understandsthe very first time they hear it or read it.

Baby talk, or “dumbing down”

Imprecise

Stripping out necessary technical or legal information

Is … Is NOT… Familiar words Short sentences Pronouns Bulleted lists Headlines/subheads No jargon Active voice


Why plain language is necessary – 3 trends

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1. Adults have different levels of reading skill.

2. Our attention span is lower than ever before.

3. People are now expected to make their own health insurance purchasing decisions.


Trend #1: Adults have different levels of reading skill

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Nearly 50 percent of adults in the U.S. read below the 6th grade level.

The average adult in the U.S. reads at the 7th grade level.

More than 80 percent below the 10th grade level.


Trend #2: Our attention span is shrinking

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Our attention is pulled in too many different directions at home … at work … everywhere.

The average American’s attention span is eight seconds. (Microsoft study, 2013)

And Psychology Today says that only 2 percent of us are effective multi-taskers ... but almost all of us try to.

multi-task


So here’s the situation we face today

• Your audience reads at a low grade level.

• They have short attention spans.

• We’re asking them to make their own health plan purchasing decisions.

• We expect them to learn a new vocabulary.

What is precertification? What is a tiered network? What is coinsurance? What is step therapy?

Aetna Inc.

So our communications needs to be

Plain

Direct

Simple


Why plain language is good for Aetna

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• Makes dealing with Aetna easier and less stressful

• Builds trust• Allows our

audience to understand what we’re saying

For our customers

ForAetna

Forus (employees)

• Makes for satisfied, loyal customers

• Helps to keep us competitive

• Reduces expensive calls to customer center

• Saves us from costly lawsuits (misinterpreted language)

• Makes me a more effective communicator

• Makes my job easier – fewer phone calls from a confused audience

• Complies with the Aetna Way


Plain language has been important at Aetna for a long time

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“Each letter you write should be short, direct, courteous and clear. Whoever receives it will form his impression of the Company from what you have written.”

Morgan Brainard, president and chairman from 1921 to 1957


Plain language uses

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• Familiar words• Short sentences• Pronouns --“you,” “we”• Bulleted lists• Headlines and subheads• No jargon• Active voice


Plain language

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Flesch-Kincaid index


Flesch-Kincaid indexDeveloped in 1975 by J. Peter Kincaid and his teamfor the United States Navy

does doesn’tIt can serve as an early warning system. It can tell you if your writing is too dense.

It doesn’t measure • Organization, logical order • Gender, class or cultural

bias• Poor design


The Flesh-Kincaid formula

.39 15.59( )total wordstotal sentences ( )total syllables

total words+ 11.8 -

Aetna Inc.

Taking Flesch-Kincaid for a test drive

Go to your exercises in the MS Word document.


Using the tool—Exercise A

1. Highlight what you want to test

2. Go to Spelling and Grammar check

3. You’ll get a prompt. “Word has finished checking the selected. Do you want to continue checking the remainder of the document.”

4. Click “NO”


Testing reading levelYour goal is:

• A grade level of 5.0 to 5.9 for employees, members• A grade level of 9.0 to 9.9 for doctors, brokers, plan sponsors

Exercise AUnder federal law, known as Michelle's Law, dependents who lose student status due to a disability (that is, serious illness or injury) may be eligible to continue coverage for up to one year from the first day of a medically necessary leave of absence or at such time coverage would otherwise terminate under plan or coverage terms, whichever occurs first. (Reading Level: )

A federal law called Michelle’s Law helps students who must take a leave of absence for medical reasons. The law lets them continue health coverage up to one year. To do this, a student must attend college before the leave starts. The student also needs a letter from his/her doctor. The letter must say why the leave is needed. (Reading Level: )

28.2

5.4


Remember1. Write a paragraph2. Check the reading level3. Revise 4. Test 5. Revise6. Test again

Aetna Inc.

The seven plain language principles

Now we’ll learn how to apply plain language to our own writing.


Plain language principles

1. Use familiar words


Scrape, cutNot cancer, harmlessSide effectHeart attackHigh cholesterol

SHORTER WORD

Let’s come up with familiar words for …

AbrasionBenignAdverse health effectMyocardial infarctionHypercholesterolemia(FROM AETNA’S DIFFICULT WORD LIST)

ORDINARY WORD


MoreUseGive or addAboutPrivate

SHORTER WORD

Examples of shorter words for these ordinary words

AdditionalUtilizeContributeApproximatelyConfidential(FROM AETNA’S DIFFICULT WORD LIST)

TIP

A long word with many syllables can raise your grade level.

ORDINARY WORD


Familiar words—Exercise B

First, test the sentence.Substitute plainer words for the ones in bold.Now test again by clicking spell check.

Research studies have demonstrated that eating additional whole grains may contribute to the reduction of cardiac disease, cancer and diabetes by lowering triglycerides, contributing to insulin control, assisting with weight management and slowing the gradual accumulation of plaque.


Exercise B before and after examples

Before: Research studies have demonstrated that eating additional whole grains may contribute to the reduction of cardiac disease, cancer and diabetes by lowering triglycerides, contributing to insulin control, assisting with weight management and slowing the gradual accumulation of plaque. (Grade 23.7)

After: Research shows that eating more whole grains may reduce the risk of heart disease, cancer and diabetes. It lowers triglycerides, helps control insulin, helps with weight control and slows the build-up of plaque. (Grade 8.3)



2. Use short sentences


Short sentences (and paragraphs)

sentences

paragraphsAim for 15 words or less

No more than five lines.Four lines is even better.


Short sentences

Original Michelle’s Law sentence: 56 wordsRevised Michelle’s Law sentence: Average length 10.8 words

• A federal law called Michelle’s Law helps students who must take a leave of absence for medical reasons. (18)

• The law lets them continue health coverage up to one year. (11)• To do this, a student must attend college before the leave starts. (12)• The student also needs a letter from his/her doctor. (10)• The letter must say why the leave is needed. (9)


How do I make my sentences shorter?

deletediet

divide


Delete ‘THAT’ constructions

Instead of this: Try this:

Our records indicate THAT your June premium is 30 days overdue.

This letter is to inform you THAT your prescription is covered.

It’s a well-known fact THAT a yearly physical is a good idea.

Your June premium is 30 days overdue.

Your prescription is covered.

A yearly physical is a good idea.


Put these phrases on a diet


Each and every month

Fair and just decision

Clear and simple case

Added bonus

Personal and confidential

Each month

Fair decision

Clear case

Bonus

Private


Divide long sentences into two or more

One sentence:

Because you have enrolled in the Aetna Student Health Insurance Plan, you are now protected by On Call International’s worldwide medical information and assistance services whenever you travel 100 or more miles away from your primary residence, or whenever you are traveling in a foreign country.




Two sentences:

Because you have enrolled in the Aetna Student Health Insurance Plan, you are now protected by On Call International’s worldwide medical information and assistance services. It’s there for you when you travel 100 or more miles away from your primary residence, or whenever you are traveling in a foreign country.




Three sentences:

Because you have enrolled in the Aetna Student Health Insurance Plan, you are now protected by On Call International’s worldwide medical information and assistance services. It’s there for you when you travel 100 or more miles away from your primary residence. You can also use it when you travel in a foreign country.



Hint: Look for sentences with and or or

You can usually split compound sentences – those with “and” and “or” into two or more sentences quite easily.


Your premium is 30 days overdue

and we must terminate your coverage.

You can get more information by

going to www.aetna.com or calling 1-877-555-1111.

Your premium is 30 days overdue. We must end your coverage.

You can get information at www.aetna.com. You can also call us at 1-877-555-1111.


Short sentences—Exercise C

First, test this sentence.Try breaking this sentence into two or more sentences.Can you substitute some shorter words?

Manipulation of your call volume is unacceptable and violates our departmental procedures for appropriate call handling and providing the level of service that our customers expect, and, as a result, if at any time in the future you place callers on hold for more than one minute without updating them on your efforts, display any other inappropriate behavior in the normal process of handling a call, or display any other form of misconduct, it could result in your immediate termination without further warning.


Exercise C before and after examples

Manipulation of your call volume is unacceptable and violates our departmental procedures for appropriate call handling and providing the level of service that our customers expect, and, as a result, if at any time in the future you place callers on hold for more than one minute without updating them on your efforts, display any other inappropriate behavior in the normal process of handling a call, or display any other form of misconduct, it could result in your immediate termination without further warning. READING GRADE LEVEL 37.6, no passive sentences

Please follow our rules when handling a customer’s call. They expect a high level of service. We may fire you immediately if you manipulate your call volume or handle a call the wrong away. Don’t put a person on hold for more than one minute without updating them on your efforts. Don’t show inappropriate behavior when handling a call or display any other form of misconduct. READING GRADE LEVEL 7.7, no passive sentences



3. Use pronouns – you, we, us


Pronouns are part of Aetna’s brand voice • Warms up the tone

of your writing• Sounds conversational,

not robotic

Example: My supervisor asked me to do a presentation on the product changes. I told him I wasn’t familiar with them but that Mary can do it. She knows all about the recent additions.


Example of using pronouns

“A decision on the above claim cannot be made at this time because not all of the requested information has been received.”

“We can’t make a decision on your claim. We did not receive the information we requested. Please send it to us.”

or


Using pronouns—Exercise D

Use pronouns to “warm up” this paragraph.

At the customer’s request, Aetna will send copies of all documents relating to the claim, free of charge. The customer can contact the 800 number on the member ID card, and a customer service representative will supply instructions on how to request copies of any documents used in the decision-making process.


Using pronouns—Exercise D

At your request, we’ll send copies of all documents relating to your claim, at no cost. You can call us at the 800 number on your member ID card. We’ll give you instructions on how to ask for copies of any documents we used in our decision-making process.



4. Use bulleted lists


Where can we break up this copy by using bullets?

DocFind, our newly redesigned online provider directory at www.aetna.com, provides information on all our participating providers including physicians, dentists, optometrists, hospitals, and pharmacies. DocFind is updated three times per week: Tuesday, Thursday and Saturday mornings, including during holiday periods. DocFind receives provider data updates from our Enterprise Provider Database (EPDB), our single source for all provider data.

READING

GRADE LEVEL 17


Bullet guidelines

• If you find three or more items in a row, pull them out of the paragraph and use them in a bulleted or numbered list

• Keep items short (remove details that don’t add value for the user)

• Don’t use too many bulleted lists in one piece – or too many bullets in one list (aim for no more than five)

Aetna style:• Primary bullets

─ Secondary


This is much easier to read with bullets

DocFind is our online provider directory. You can find it at www.aetna.com. It lists our participating providers, including:

• Doctors• Dentists• Optometrists• Hospitals• Pharmacies

We update this listing three times a week.

READING GRADE LEVEL: 5.3


Use parallel structure

Parallel construction helps readers quickly understand what they‘re reading. Unparallel construction is confusing. It forces readers to do a double-take and reread. Or worse, they may stop reading completely.

This structure uses all verbs and is in parallel construction.Other ways you can get help with your appeal:

• Call the Employee Benefits Security Administration at 1-866-444-3272.

• Go to www.aetna.com. Search on the word “ombudsman” or “consumer assistance.”

• Call us at the number on your member ID card.


Use parallel structure

If one bullet starts with a verb, they should all start with a verb. If the first bullet starts with a noun, the rest should all start with a noun. This is parallel construction.

It’s NOT this:Other ways you can get help with your appeal:

• By calling the Employee Benefits Security Administration at 1-866-444-3272

• You can go to www.aetna.com. Search on the word “ombudsman” or “consumer assistance.”

• Call us at the number on your member ID card.



5. Use headlines and subheads


How are email subject lines, headlines and subheads like highway road signs?

Road signs help us findour way as we speeddown the highway.

Subject lines, headlines andsubheads help us find our way while we speedthrough communicationsfrom Aetna.


What do headlines and subheads do?• They summarize your main messages.• They break up copy and make it easier to read.• They’re specific and meaningful.• They’re positive, not alarming.• They’re brief – typically, fewer than 10 words.

Remember: • Don’t use punctuation at the end of your headlines and subheads.• Only capitalize the first word.• Focus on why it matters to the READER, not to US.

Help us ensure we have accurate informationHelp us pay your claims faster – give us up-to-date infoUse our online InTouchCare diabetes resource guide Here’s help so you can more easily manage your diabetes


Which is easier to follow? Which is easier to read?



6. Avoid jargon


Jargon:the special language used by any group or profession. It's our common shorthand.


Example of taking out jargon

If you have any questions, please call me.

Should you have any questions or concerns regarding the above, please do not hesitate to contact the undersigned.

READING GRADE LEVEL 2.2READING

GRADE LEVEL 9.1

NO JARGONWITH JARGON



We may ask you to give us proof that you live in the state.

Proof of state residency may be mandated.


GRADE LEVEL 7.3




If you give us false information on purpose, we may change or cancel your policy.

Intentional misrepresentation may result in the policy being modified or terminated.


GRADE LEVEL 17.6



Do customers know what our jargon means?

We adjudicate claims.

We terminate members.

We incent good health practices.

We send information that’s pursuant to a law.


UseFinishSendCall, emailBring everyone up to speed

SHORTER WORD

Think of another word for…

LeverageFinalizeCascadeReach outLevel set

JARGON


What does this mean?!@@#$%

"I leveraged and re-cannibalized a slide deck that was cascaded to my team because I didn’t have the bandwidth to recreate the wheel."



Translating ?!@@#$%

“To save time, I used a slide deck from a coworker to help me get started.”



Use a simple explanation for these terms AD&LM: Aetna Disability & Leave Management (Say this instead: the area that manages Aetna's disability leaves)

STD: Short-Term Disability (not to be confused with sexually transmitted diseases)

PTO: Paid time off

ERISA: Employee Retirement Income Security Act (Say this instead: the law that requires an appeal process for covered benefits, among other things)

How did using acronyms start?In the late 1800s, businesses began abbreviating their company names in writing to fit into places where space was limited ─ on a barrel or crate, small-print newspapers and railroad cars.

For example, the National Biscuit Company became NABISCO.


Simple initial tips

1. Spell out the name, then put initials in parentheses:

EXAMPLE: National Insurance Association (NIA)

2. If you only use the term once, don’t use initials.

3. Always assume your reader will forget what an “initialism” means two paragraphs later. If your piece is long, spell out the acronym again, after first mention.



7. Use active voice


Active versus passive voiceActive voice describes a sentence where the subject performs an action. It tells what a person or thing does.

I’ll always remember my first promotion at Aetna.

Passive voice describes a sentence in which the subject is acted upon. It tells what is done to someone or something.

My first promotion at Aetna will always be remembered.

Active voice

Sounds more direct

Reader knows what’s going on right away

More genuine

Passive voice

Sounds robotic & business-like

Hides who or what is doing the action


The three-step active voice recipe

1. Find out who or what is doing something

2. Put this who or what in front of the verb

3. Use a verb that describes the action

Example:PASSIVE: The nonsmoking policy was explained in the letter.

ACTIVE: The letter explained the nonsmoking policy.


Passive sentences

Passive sentences hide who is doing the action.

Your claim was denied.

Who denied the claim: My doctor? The hospital? Aetna?


Active sentences

Active sentences say who is doing the action.

We denied your claim.

Oh, OK, you denied the claim. What should I do now?


Passive sentences

Passive sentences are indirect because they don’t start with who is doing the action.

The report was written by the manager.


Active sentences

Active sentences start with who is doing the action.

The manager wrote the report.


Put this passive sentence into active voice

Your job application will be reviewed by Human Resources.

(Using our recipe, who is reviewing?)

Human Resources will review your job application.

Aetna Inc.

The Flesch-Kincaid Hotline

How may I help you?


What other resources are there for writers at Aetna?

1. Aetna Editorial Style Guide (plus, the “Difficult word list”)

2. Writing templates (letterhead, PowerPoint, email)

3. “In Plain Language” newsletter – quarterly

4. Win with plain language – on Aetna Connect

5. Writer certification courses


Hotline

I am getting a high grade level score. What do I do now?• Test one paragraph at a time. Is one paragraph way

worse than the others?• Then work on that paragraph.


Hotline

I am stuck with the word “maternity.” I have to say it in this brochure. How can I get my score down?

Say it just once. Then try to use a pronoun in future references.

“You can read up on these topics by consulting your Beginning Right® Maternity Program booklet.

You haven’t received it yet? We can send it to you today!”


Hotline

I keep getting a score of zero. What am I doing wrong?

• Simple. Make sure your sentence has punctuation at the end.

• Your sentence(s) might be too short.

I removed some words. But my score went UP instead of down. What do I do?

• Keep working.


Hotline

I am stuck at a 6.2. I just can’t get this down any more. What do I do?

• Look at all the sentences that have the word “and” in them. See if you can split them into two sentences. “Or” works, too.

• Is there a word you MUST use? Test without it. (Just remember to add back in.)

• Is there phone number or URL? Test without it. (Just remember to add back in.)

• It’s OK. This might be the best you can do.


Hotline

Are we supposed to test with legal disclaimers?• No – never.

Am I supposed to include websites and phone numbers? • If your score is too high, take them out and test again.

Should I test other writing? • Yes. The more you practice and use the tool, the better

you’ll become.


Hotline

All this plain language stuff is great.

But frankly, to me, it doesn’t seem professional. Or business-like.

Thoughts?

Aetna Inc.

The Flesch-Kincaid Hotline

Do you have a question for the hotline?

Aetna Inc.

Thank you

plain language august 31 2016

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