Having spent more than 25 years working with payers and providers to improve how members engage with their care, I’ve seen a dramatic shift in how patients access health information.

It’s easy to recall how, not all that long ago, people relied almost entirely on conversations with physicians to access information. Today though, before a patient ever enters an exam room, they’ve likely searched their symptoms online, read patient forums on social media, or asked an AI chatbot for advice.

However, despite this explosion of digital tools and content driving greater access, 9 in 10 adults still struggle with health literacy.

As I look at the healthcare landscape, health literacy matters more than ever—not because medicine lacks clear answers, but because better access to health information does not automatically translate to better understanding. Patient outcomes still depend on how well individuals understand treatment options and trade-offs, so they can align health decisions with their personal goals.

For health plans, improving health literacy at scale requires empowering members to gain clarity on treatment risks, alternatives, and realistic expectations earlier in the decision-making process. Forward-thinking plans are leveraging member-focused shared decision support as an upstream health literacy intervention to control costs and complications, and change how they approach utilization management (UM).

While traditional UM focuses on controlling decisions after they’re made—through processes like prior authorization and clinical reviews—strategic shared decision support tools enable members to proactively make more appropriate care decisions, reducing burdensome downstream UM processes.

Health literacy breaks down during critical care moments
The health literacy gap tends to surface in several ways across the care journey. In practice, when making a medical or surgical decision, patients often struggle to understand realistic recovery timelines, potential setbacks, and alternative options. Post-treatment complications are also often tied to a poor understanding of risks.

Patients are inundated with increasing amounts of health information, and we must help them build practical skills to better navigate important care decisions. Health plans are uniquely positioned to facilitate and scale structured support across populations so members can effectively query, interpret, and apply information to each health situation.

Consider the following scenarios where the importance of health literacy is particularly evident:

• Unexpected medical events: Health problems that can onset suddenly—like a hernia or appendicitis—force high-stakes decisions fast. Stronger health literacy provides members and their caregivers with the foundation to understand treatment options, risks, and next steps. This allows patients to weigh trade-offs and make real-time decisions with confidence.
• Long-term health journeys: Chronic conditions such as cardiovascular disease leave members with time to plan, but many still reach key decision points unprepared. Stronger health literacy helps them understand what’s likely ahead to work with care teams more effectively, prepare earlier, and consider alternatives to anticipated surgeries. These steps help patients make informed choices before predictable milestones become crises.
• Preference-sensitive decisions: When multiple treatments may be clinically appropriate, such as with a back injury or gallstones, the “right” choice depends on a member’s personal goals and risk factors. Stronger health literacy helps members compare options, understand likely outcomes, and choose treatments that align with their priorities—reducing regret and avoidable utilization driven by misaligned expectations.

The common thread across all three scenarios is the need for improved shared decision-making. Members deserve the tools and skills to collaborate with providers to understand all treatment options, clarify goals, and determine the most appropriate course of care.

3 ways shared decision support improves health literacy upstream
Investing in shared decision support tools that help members navigate their care builds trust, reduces unnecessary utilization, and improves outcomes.

When offered to members, these programs help strengthen health literacy by:

1. Reducing patient-provider knowledge imbalances
   When patients don’t understand what’s happening or what to expect, care can become reactive and expensive. This includes second opinions, delayed decisions, and ER visits when uncertainty spikes.Conversely, stronger health literacy—built through shared decision-making tools— helps patients better collaborate with their clinicians.

   For instance, member-focused shared decision support tools enable an individual deciding between knee injury treatment options  to learn about their options, expected recovery timelines, and key risks of each before discussing next steps with their doctor. They can arrive at the point of care with targeted questions and a foundational understanding to guide their interaction.

   The result is more balanced conversations between patients and providers, and clearer, more confident care decisions that can help reduce unnecessary utilization while improving satisfaction.

2. Aligning member expectations with realistic outcomes
   Healthcare systems often address immediate symptoms without helping members understand the longer-term trajectory of their condition, or what treatment options may realistically achieve.

   Improved health literacy helps members understand trade-offs before they commit to a major decision. For example, consider again the member with a knee injury. If, alongside talking to their doctor, the individual can access shared decision support tools that help outline and weigh treatment risks and benefits against their personal goals, they can enter the decision-making process with clear preferences and priorities (e.g., pain relief, limited time off work, or avoiding follow-up procedures).

   This way, the member and their provider can set realistic expectations together and make deliberate decisions based on both short-term improvements and long-term health goals. A checkpoint like this can help reduce decision regret while supporting more appropriate utilization patterns.

3. Integrating legacy and emerging health information sources
   Technology has significant potential to improve how people manage health and wellness. Soon, AI-enabled tools may pull from medical history, known health literacy levels, and documented personal preferences to help individuals interpret instructions, prepare questions, and stay aligned with treatment plans.

   But today, patients are still stuck in a transitional phase—part photocopied discharge paperwork, part AI-generated advice—with little integration between the two.

   For example, in the case of our knee injury patient, the individual may sort through information on different surgical options and rehabilitation plans from their provider, as well as online chatbot guidance and patient stories posted in online forums at the same time. This information overload—or even discrepancies across these various sources— can delay care and affect outcomes and costs.

   Shared decision-making tools provide a practical solution. Health plans can use them to curate trusted information and embed guidance directly into care journeys. Translating clinical information into plain-language next steps helps members prepare for conversations with providers  to ensure they get their questions answered and make decisions with clarity.

Health plans must proactively build health literacy
When people understand healthcare information and how decisions connect to their personal goals and risk factors, they can navigate care with greater confidence and less friction.

Conversations become more balanced. Decisions become more deliberate. Over time, clinical care trends toward more appropriate utilization. Unnecessary costs begin to decline.

That’s what practical health literacy is: helping members participate meaningfully in their own care, as early as possible.

Health plans have both the incentive and the infrastructure to support this endeavor. By sponsoring pragmatic tools, embracing technology responsibly, and reinforcing structured shared decision-making, industry leaders can introduce upstream improvements that prime downstream care journeys to work better for members and providers.