Plain Language Help for Insurance Coverage Documents?

Wouldn’t it be great if we could read and understand our health insurance coverage documents?  Then we might all be the informed consumers that the policy makers and health care advocates proclaim will save our country from spiraling health care costs.

Is this dream going to come true?   Do you believe the “gotcha” clauses will be eradicated?  My cynical side wonders….

Below is a reprint of the press release sent out by HHS today, just in case you missed it.    

FOR IMMEDIATE RELEASE                                                 Contact: HHS Press Office

February 8, 2012                                                                                           (202) 690-6343

 Health Reform to Require Insurers to Use Plain anguage in Describing Health Plan Benefits, Coverage

People in the market for health insurance will soon have clear, understandable and straightforward information on what health plans will cover, what limitations or conditions will apply, and what they will pay for services thanks to the Affordable Care Act – the health reform law – according to final regulations published today. 

The new rules, published jointly by the Departments of Health and Human Services, Labor and Treasury require health insurers to eliminate technical or confusing language from their marketing materials that sometimes make it difficult for consumers to understand exactly what they are buying. The new rules will also make it easier for people and employers to directly compare one plan to another.

 “Consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” said HHS Secretary Kathleen Sebelius. “This will give them a new edge in deciding which plan will best suit their needs and those of their families or employees.”

 Under the rule announced today, health insurers must provide consumers with clear, consistent and comparable summary information about their health plan benefits and coverage. The new forms, which will be available beginning, or soon after, September 23, will be a critical resource for the roughly 150 million Americans with private health insurance today.

 Specifically, these rules will ensure consumers have access to two key documents that will help them understand and evaluate their health insurance choices:

 ·       A short, easy-to-understand Summary of Benefits and Coverage ( or “SBC”); and

·       A uniform glossary of terms commonly used in health insurance coverage, such as “deductible” and “co-payment.”

All health plans and insurers will provide an SBC to shoppers and enrollees at important points in the enrollment process, such upon application and at renewal. In the past, health insurers would only provide selective details on a policy before it was purchased.

A key feature of the SBC is a new, standardized plan comparison tool called “coverage examples,” similar to the Nutrition Facts label required for packaged foods. The coverage examples will illustrate sample medical situations and describe how much coverage the plan would provide in an event such as having a baby (normal delivery) or managing Type II diabetes (routine maintenance, well-controlled) These examples will help consumers understand and compare what they would have to pay under each plan they are considering.

Today’s rules finalize the proposed rules issued in August 2011. Input was received from such stakeholders as the National Association of Insurance Commissioners (NAIC) and a working group composed of health insurance-related consumer advocacy organizations, health insurers, health care professionals, patient advocates including those representing people with limited English proficiency, and others. The final rules aim to ensure strong consumer information while minimizing paperwork and cost.

To view the template for the summary of benefits and coverage, visit:

To view the Final Rule, visit:

Other technical information is available at:

For more information on the rules announced today, visit:


Pioneer ACO Program groups announced

On December 19, 2011, the CMS Center for Medicare and Medicaid Innovation (CMMI) announced that 32 provider groups will be participating in the Pioneer ACO Program. The Pioneer Accountable Care Organizations (ACOs) will operate in 18 states and serve an estimated 860,000 Medicare beneficiaries; and CMS estimates that the provider groups’ coordination of care for beneficiaries could generate as much as $1.1 billion in Medicare savings over 5 years. More information about the select participants in the Pioneer ACO Program may be found here.

Time to Get App Happy

“Smartphone users spend more time on mobile apps than on the Internet.”

Whoa!  That phrase woke me up during the Mobile Apps workshop hosted by the Advertising Federation of Baton Rouge, featuring speaker David Jacobs, digital and creative strategist at the Tombras Group in Tennessee.

More wake-up calls:  Did you know that you can buy advertising on mobile apps?  I’m not talking about the Bejeweled Blitz game app, I’m thinking the CNN News app for Ipads or the Mobile Website version of ESPN.   Mobile ad revenues are already at $11 billion.  

If you are thinking that the Ipad market share doesn’t really matter — Oops!  The Ipad is now 15% of the Personal Computer market folks!  PC sales are down, tablet sales are up. 

By 2012, the pundits predict that more people will consume the Internet through mobile devices than through PCs. 

Pushaw the naysayers cry.  Well, then, why is Google trying to buy Morotola Mobility with a $12.5 Billion cash deal?  Mobile web traffic is 16% of all traffic. 

(If you want to check out mobile advertising, Motricity and other companies like it, claim they can reach your target demographic — right down to the zip code — and help you get into this new advertising channel quickly.)

And yes, the communications landscape just keeps a changing.  You can try to find the slides at the AAF-BR website where the slides are posted, but their site was down when I checked in.  David is on LinkedIn though.  Just tell him AAF-Baton Rouge sent you, and I’m sure he’d share the info.

StumbleUpon Links are Gold

That little squiggly blue and green StumbleUpon share button should be getting more attention from all of us now that Ragan Social Media has posted this article:

StumbleUpon Gets More Traffic Than Facebook or Twitter

I’ve been negligent in using this bookmarking site — but no more! 

Are you using StumbleUpon and getting great results?  Please share a success story with us.

Bookmark this New Health Communications Blog

Upstream is a health care communications blog from the graduate students at University of North Carolina at Chapel Hill.   In a world of very few health care comm blogs, I’m thrilled to see this addition.  It’s got a cool look as well, making the information easier to digest than the more  journalesque health care comm websites available.  

For my more visual PR friends, here is a screen shot.  It’s worth a click. 

The Power of Truth in PR

Healthcare PR is different, and you know it.  As a PR professional in this field, you aren’t just pushing out an event flyer or highlighting a new product to add to the company’s profit cycle.

The information you share with your publics can lengthen and improve their lives.   Or it can change their  minds about important policies.

For example, this blog post about the power of truth in healthcare from Thom Dahlborg on the Hospital Impact blog gives a glimpse into how a 5.4% increase in healthcare costs can truthfully be a good thing.  But the public won’t know that if the PR person in charge of the press release doesn’t reveal it.

It’s a thoughtful and important discussion that we must all have with ourselves.  How do you define truth in your PR materials?   How do you manage the riddle of what is really truth?

A Cotton Swab Probe Each Day Keeps the Germs Away

How to Prevent Infection after Surgery | FOX 11 News.

Patient Advocate Alicia Cole shared this story with the IHI Patient Advocacy group on Facebook.  One surgeon at Cedar-Sinai Medical Center in Los Angeles, Dr. Shirin Towfigh, is reporting a six fold drop in infection rates by probing post-surgical wounds each day with a cotton swab. 

The story didn’t include any opposing views, much scientific evidence or additional sources — but it could be the start of a robust medical conversation.  I wonder what triggered the physician to try this in the first place?  

Alicia’s story is buried deeper in the story — she developed a life-threatening infection in a hospital that she says didn’t place a high priority on cleanliness.    (Perhaps there is a connection here:  could cotton swab wound probing serve as a hand-washing reminder to providers?  Just a thought…)  

Do you know of any other doctors or hospitals testing this treatment?