"Comprehensive Coverage, Consumer Consciousness, Cultural Competency: 'C'ing' the Road Ahead" by Christina Severin

Gov. Deval Patrick’s administration did indeed “move mountains” with its recent successful negotiation of lower rates for Commonwealth Choice. In addition to being another big step for health care reform, it also illustrates the pressing need for frequent, timely, comprehensive communication to Massachusetts residents about programs available to them under health care reform.

As executive director of Network Health, a health plan that provides access to high-quality health care to low- and moderate-income Massachusetts residents, I am well aware of the challenges of conveying the many details of health insurance to a multilingual, diverse audience. It is critical for our members to receive simple, clear materials and information in a variety of languages to ensure that they can comprehend and participate in programs they’re eligible for.
Network Health’s success in serving our low- and moderate-income members stems from an ability to communicate in ways that resonate with their needs and beliefs, avoiding dense “insider” language. We’ve found that effective communication with our members takes a number of different tactics, including a multilingual, multicultural staff; in-house interpreter services; materials printed in at least seven languages; and a wealth of community-based partnerships with diverse organizations.
Even without major health care reform, health insurance is a complex topic, so some basic confusion is not unexpected. For example, one of our Network Health Forward™ (Commonwealth Care) members recently called us, thinking he now needed to switch to a Commonwealth Choice plan. This demonstrates that people are already understandably confused about the difference between Commonwealth Choice and Commonwealth Care. While both aim to provide access to a certain standard level of comprehensive health insurance, there are key differences, including 1) income levels required for eligibility, 2) costs to members and how those costs are determined, and 3) availability to groups vs. individuals.
Providing fodder for confusion are the similarity of the programs’ names; the significance of the July 1, 2007, date, although for different reasons (the date for the individual mandate and the date Choice plans must be available); and the complex eligibility rules and enrollment processes surrounding both. Another factor has been the necessary speed with which both programs were created, and some of the ensuing inevitable shifts in rules that resulted.
As Jim Roosevelt of Tufts Health Plan wrote earlier this week, “reform has been attempted many times in the past but has been crippled by the weight of its complexity.” Successful health care reform implementation requires aggressive, ongoing public education and dialogue to ensure that we all hear about and understand its benefits, costs, and nuances. A key question we’re asking ourselves and that I’d like to throw out for discussion is, what approaches can key players — including the Connector, the health plans, providers, and community groups — use to effectively communicate about the intricacies of our health care reform?
Over 55,000 members have been enrolled into the subsidized Commonwealth Care program. Much of this enrollment has been driven by moving pre-qualified members from the “free care pool” into the Commonwealth Care program. This was a smart and efficient way to jump-start enrollment, and gets thousands of individuals comprehensive coverage. Now, our challenge is to reach the “outreach population” (those who weren’t automatically transferred from the free care pool), to thoughtfully educate them about their options, and to get — and keep — them covered.
As we move forward, we need to examine how we can streamline some of the existing complexities of this system we have all built, while simultaneously addressing the issues of quality and affordability.

Christina Severin is executive director of Network Health, a health plan with more than 100,000 low- and moderate-income members with state-subsidized health insurance across Massachusetts.