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Project Details

Health Plan Efficiency

Photo for Health Plan Efficiency Project
Project Summary: 

What is the intersection between health literacy and health plan efficiency? Health Research for Action worked with the California Office of the Patient Advocate, California health plans, and an advisory group to explore this question. We conducted a literature review, 31 key informant interviews, and 12 focus groups with 114 commercial and Medi-Cal HMO members.

Main Findings: 

The project identified five areas where health plan members with limited health literacy could use help navigating their health plans:
• Emergency department use
• Medication coverage and prescription drug formularies
• How to use health plan benefits
• Authorizations, denials, and grievances
• Using a provider directory

Policy, Practice or Research Impacts: 

Previous research has shown that limited health literacy often leads to higher rates of hospitalization, greater use of emergency services, errors in treatment and medication, and other inefficiencies in the health care system. This project examined how these inefficiencies occur and how they can be prevented.

Contact Person: 
Beccah Rothschild
Contact Person's Email Address:
Health Research for Action, UC Berkeley
California Department of Managed Health Care, Office of the Patient Advocate