October is Health Literacy Month, an observance focused on making health information easier for people to understand and use. For health insurance payers, however, health literacy reaches well beyond the wording in a member handbook.
It can also reveal how easy or difficult a health care provider network is to navigate.
The Institute for Healthcare Advancement explains in October is Health Literacy Month that the observance raises awareness about the importance of understandable health information. At the same time, Health Literacy in Healthy People 2030 expands the concept beyond an individual member’s abilities. It defines organizational health literacy as the degree to which organizations enable people to find, understand, and use information and services when making health decisions.
That distinction matters for provider network executives.
A payer can contract with the right number of providers and still create friction if members struggle to determine where to go for care. Health Literacy Month offers an opportunity to ask whether the network is not only adequate, but also understandable and usable.
The Provider Directory Is Part of the Member Experience
The provider directory is often a member’s first step toward using the health care network.
If the information is incomplete or difficult to interpret, the value of the underlying network can be diminished. A member may select a physician who is no longer accepting new patients. Another may have difficulty determining which providers can meet specific language or communication needs.
The Centers for Medicare & Medicaid Services recognized the importance of this information in its 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F). The rule requires Medicare Advantage organizations to include providers’ cultural and linguistic capabilities in their directories. CMS specifically noted that the requirement is intended to improve directory quality and usability for members, including people with limited English proficiency and those who use American Sign Language.
For provider network executives, this makes accurate network data more than an administrative requirement. It is part of turning contracted capacity into meaningful member access.
Provider network contracting should be supported by processes that keep locations, availability, and other important provider information current throughout the life of the agreement.
Health Literacy Can Reveal Hidden Network Friction
Healthy People 2030 notes that people can have difficulty accessing services when health care organizations do not adequately support organizational health literacy. It also recognizes that these problems can affect people who otherwise have strong personal health literacy skills.
For payers, repeated member confusion deserves a closer look.
A difficult provider search may indicate a data problem rather than a communication problem. Failed attempts to schedule care could point to provider capacity that exists in a directory but not in practice.
These experiences provide information that network executives can use.
When member feedback is examined alongside provider data and utilization patterns, network intelligence can help identify areas where the structure of the network may be creating unnecessary obstacles. TOG Network Solutions’ Network Intelligence services are designed to evaluate provider networks across dimensions that include access, availability, cost, contracting, and member experience.
The goal is to identify problems before they become persistent access issues.
Provider Communication Belongs in the Performance Conversation
Health literacy also extends into the examination room.
The Agency for Healthcare Research and Quality developed its CAHPS Health Literacy Item Sets to examine how well providers communicate health information to patients. AHRQ notes that providers can use member responses to identify factors affecting communication scores and improve their health literacy practices.
This does not mean every provider contract needs to become a checklist for patient communication. It does mean that recurring member experience patterns can offer valuable information about network performance.
If a particular provider organization consistently creates navigation or communication difficulties, payers have a reason to investigate. Those findings can inform provider performance discussions and future contracting decisions.
TOG’s Perspective: Measure Whether the Network Works for Members
A health care provider network is valuable only when members can successfully use it.
TOG’s network intelligence approach examines more than whether the appropriate providers have been contracted. It gives payers greater visibility into access and availability while connecting those findings to the broader performance of the network.
Three Priorities for Payer Executives
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Audit the member journey, not just provider counts.
Test how easily members can search for an appropriate provider and determine whether that provider can meet their needs. The experience should be evaluated from the member’s perspective rather than solely through an adequacy report.
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Make accurate provider information an ongoing priority.
Provider network contracting is only the beginning. Payers need reliable processes for maintaining information as physicians change locations, participation status, or availability.
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Connect member experience to network intelligence.
Complaints, call center activity, and utilization patterns can provide useful signals about where members are encountering difficulties. Bringing those findings into network analysis can help payers distinguish communication problems from underlying access issues.
Health literacy is not simply about making health care terminology easier to understand. For payers, it is also about making the health care provider network easier to use.
A network that looks adequate on paper can still fall short when members cannot navigate it successfully. By pairing provider network contracting with accurate data and proactive network intelligence, payers can create a clearer path from coverage to care.