Screening for Health Literacy, Social Determinants, and Discrimination in Health Plans
February 5, 2024 J. Nwando Olayiwola, MD, MPH, Candy Magaña, MPA
This study provides insight on the experiences of patients of a national health plan with 2 structural determinants of health—health care discrimination and health literacy—and how those interact with social determinants of health and patient demographics.
ABSTRACT
Objectives: Health inequities are frequently driven by social determinants of health (SDOH) and structural determinants of health. Our pilot sought to test the feasibility of screening for health literacy (HL) and perceived health care discrimination (PHD) through a live telephonic-facilitated survey experience with managed care patients.
Study Design: Cross-sectional study.
Methods: Newly enrolled Medicare Advantage patients were screened for self-reported PHD, HL, and multiple SDOH using validated screening tools. Response rates for both HL and PHD screens were analyzed. A χ2 test for association between response to PHD screen and patient race was conducted. A weighted logistic regression model was used to understand how HL is associated with SDOH and demographic factors (age, gender, race/ethnicity, and income).
Results: HL and PHD screening questions have different levels of feasibility. Administering the HL screen did not present a challenge, and patients felt comfortable responding to it. On the other hand, the PHD question had a lower response rate among patients, and some concierge advocates felt uncomfortable asking patients the question. Based on the self-reported HL data collected, low/limited HL is associated with patients who were Black, were low income, reported loneliness or isolation, or reported food insecurity. It is important to note that the study’s findings are limited by the small sample size and that study results do not imply causality.
Conclusions: It is feasible to collect self-reported HL data through a live telephonic format at the time of patient enrollment into a health plan. Health plans can leverage such screenings to better understand patient barriers for health equity–oriented interventions.
Am J Manag Care. 2024;30(2):In Press
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Takeaway Points
Learnings from this article can be useful to senior leaders and managers in managed care organizations looking to make an impact on health inequities. We provide early insight into the following:
- How screening for social and structural determinants of health can be integrated into health plan member intakes
- Application of validated tools to screen patients for the above determinants in managed care settings
- Barriers and considerations to screening patients for health literacy and discrimination, as this information will be more widely asked of health plans
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