Lost in Translation

Why patient-friendly communication strategies are more important than ever.

Barbara Antuna, MD

Value-based care models have moved patient experience and engagement front and center. Forward-looking payers and providers, recognizing this reality, are responding by deploying the best tools and strategies for empowering patients in their care.

Patient communication sits at the heart of these developments as a foundational component to strengthening partnerships between all stakeholders—payers, providers, and patients. Providers must leverage communication tactics to improve patient understanding of diagnoses and conditions in all modes of communication, whether spoken, written, or electronic.

The critical nature of patient communication was recently underscored by CMS raising the stakes for payers. Following high-profile Medicare audits that resulted in combined financial penalties of more than $3.5 million for three of the nation’s largest insurers, a temporary suspension letter issued by CMS to one of them cited communication deficiencies as a key compliance shortcoming. The letter stated that denial letters for Part C organization determinations, Part D coverage determinations, and appeals did not include adequate rationales, contained incorrect or incomplete information specific to denials, or were written in a manner not easily understandable by beneficiaries.

Barbara  Antuna, MD

Barbara Antuna, MD

How audit activity and regulatory scrutiny will change under the Trump administration is uncertain. But regardless, use of consumer-friendly content is an absolute necessity if we are serious about engaging patients and improving their experience with health care. Too often, the language we use in health care is a kind of code that serves billing and other purposes. Jargon may be an efficient and precise way for insiders to communicate, but it is impossible for patients to understand.

Here are three suggestions for how providers and payers can begin to lower the barriers and improve communication with patients:

  • Decipher codified terminologies in patient communication. A patient with a chronic condition such as arthritis is not likely to view his care in terms of procedure and diagnostic codes. Most health plan bills use the ICD-10 code M19.90 for arthritis with a description that says “unspecified osteoarthritis, unspecified site.” A better strategy for external communications—such as explanation of benefits and bills—translates the ICD-10 terminology into the kind of language used on patient portals and in after-visit summaries.
  • Improve consumer search experiences. Search engine optimization, ads, and online education are used by many industry stakeholders to reach consumers seeking information and services for specific diagnoses. To avoid confusion, providers and payers should establish a consistent search experience that addresses the dynamic nature of communication, simplifying use of terms whenever possible. In other words, if a patient begins searching “trouble breathing,” they ultimately reach the correct structured terminology. Navigation among symptoms, diagnoses, and treatments should be fast, easy, and intuitive. Design must be optimized for the phone.
  • Take advantage of automation. Terminology management platforms, such as the Health Language platform offered by Wolters Kluwer, can integrate existing systems to add consumer-friendly descriptions alongside industry codes as well as improve consumer search experiences. A typical billing document might, for example, say “sprain of tibiofibular ligament of left ankle,” while an accompanying consumer-friendly description would simply read “ankle sprain.” With terminology platforms, the translation of data into language that patients understand can happen automatically.

Patients increasingly expect to be in the driver’s seat when it comes to their care. It’s a trend that most everyone in health care supports, because a more empowered and engaged patient usually means better outcomes and lower costs.

As payers prepare for value-based care and the potential for continued regulatory scrutiny, efforts to improve patient communication must become a priority.

Barbara Antuna is a medical informatics specialist with Wolters Kluwer Health Language Solutions.

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