No one understands what you’re trying to say.

Originally published by Circle

We need to radically move away from industry lingo.

When Esther Dyson learned she had early-stage esophageal cancer, she decided to create a concept doc for a video game about her experiences. Called ‘Second Opinion’, the ultimate goal of the game is to simply not die of cancer. To stay alive, you not only need to get treated, you need to figure out how to make an appointment, navigate insurance, and face off denials.

“Scheduling each step – a required medical consultation or test, for example – is a step in itself; so is calling the insurance company so they call the doctor, and calling the doctor’s office to ask her nurse to call the insurance company back. At each step, you usually get to choose from several options, including high-risk “obnoxious-intervention” measures (50 points each) that sometimes give you a positive response, but that might backfire – in a denied claim, for example – if people react badly.”

What makes the game really challenging is that you need to understand both the processes and the language of the health system. We all know what the words “denial” and “claim” mean, but when you put those words together in healthcare, they become really important. In this game, you need to understand what they mean and what to do about it. Now, Esther makes it clear, “it’s in the form of a spec rather than an actual game because no sane person would ever want to play it” (I am now questioning my sanity because I would definitely play this game.)

Want to or not, navigating healthcare industry language and processes is the “game” we all have to play when we need care. If you don’t understand what your health insurer, doctor, or pharmacist are telling you, you are playing without knowing the rules. This is what people face in real life, and unlike a video game, they don’t get multiple lives if they get it wrong.

Why is clear language important?

According to the American Medical Association, “literacy is the single best predictor of health status,” more so than “age, income, employment status, education, or race and ethnicity.” The single biggest predictor. With 54% of American adults reading below a 6th-grade level, we need to completely rethink both the processes and the language we use with people.

Since the 1980s, the consensus of the American Medical Association, National Institutes of Health, and the Centers for Disease Control and Prevention is that the information we put in front of individuals should be written at 6-th grade reading level. Do you know who is in 6th grade: 11-year-olds. Next time you are writing materials for patients and members, picture an 11-year-old and ask yourself: Would they understand this and know what to do with the information? I decided to test this out with the kids of a few colleagues and friends and had a few read the following paragraphs and explain back to me what they thought they meant:

Sample Language 12th vs. 6th Grade

12th Grade Reading Level

• From the Centers for Medicare and Medicaid

• From my health plan

  
  

Here is what the response of one rising 6th-grader was to these two paragraphs which are at 12th-grade reading level:

“I think they mean if you don’t participate you have to pay.” When we asked what ‘participate’ means he said “in the benefit plan?” We asked if he understood what that meant from the paragraph and he said “no” and he wasn’t sure if it was to “benefit the company or his family?”

(as an aside this is a good question)

When we rewrote these paragraphs we focused on two things: Language and the ability to solve the problem.

6th grade reading level:

• CMS rewrite:

• My health plan rewrite:

And here is the 11 year old’s understanding of what the second two paragraphs mean:

“If you see a doctor who is in your group you will pay less than if you see a doctor who isn’t part of your group. You will also be given a list of doctors and hospitals to work with so that you can decide who you want to visit.”

When we gave this same language to Esther Dyson, who went to Harvard at 16 and is no slouch, her response was that, “You may have been given a list of doctors or hospitals at some point…now up to you to find it, or ask for it!” This is such an important point, we think communication means someone asked a question and we answered. Effective communication in this sector means empowering people to be able to find the answer over and over again with as little friction as possible. Making materials easy to understand is half the battle. You need to also make it easier to find and action that information.

When I myself tried the same exercise, I understood what my health plan was telling me to do until I got to this sentence:

“Please look at your Certificate or Group Contract to find out if a particular service is covered under your Benefit Plan.”

Understanding the language in this sentence doesn’t go far enough. I took a good 30 minutes and looked for that certificate or group contract. I couldn’t find it anywhere. Not in my email, not on the site, not in my account on the site. Communication requires plain language and the tools to actually complete the task. Not just to say, “Please look at your Certificate.” with no link to the certificate. We need actionable, clear information if we want to reduce frustration.

So how are we doing? We have known that language matters since at least the 1980s. In March 2025 a study published by the Patient Education and Counseling journal reviewed healthcare language across the sector. It reveals that there was no improvement in the last 30 years in readability with most materials still at a 12th grade level in all healthcare sectors. (!!)

According to another recent study by Forrester, 90% of people want clearer information from their health insurer; the last 10% might have just given up. Language doesn’t just help to drive health outcomes, it affects trust. “Makes information easy to understand on their website” was ranked as the second driver of trust for US health insurers in 2024. Yet, in 2021, in the midst of an unprecedented public health emergency, a study by the AMA reviewed state websites’ information around COVID-19 and found that not one met the standard for readability. Not a one.

Hard-to-understand language creates an impenetrable wall between healthcare stakeholders and members and patients. They can’t understand what they are supposed to do to improve their health, access doctors, or use their insurance. They are telling us explicitly and through their health outcomes that language filled with jargon is eroding trust.

The good news, of all the problems in healthcare, this seems like one we could actually fix.

So if we know all of this, why do we continue to write this way?

Compliance fear

Noncompliance is a real fear; we need to deal with it on a regulatory level and in our organizations. In order to stay compliant, we build up walls of language that are hyper-specific. This is done in all areas of healthcare with all types of materials which are consumer facing. The average person doesn’t know the difference between “cost-sharing” and “co-pay” and it is my hot take that they shouldn’t have to. What they want to know is: am I going to pay more? Can I go to a doctor that I don’t find on my health plan’s website? If I am sick today, and need to see a doctor, but my doctor has no openings, what am I supposed to do? Do I go to the ER?

We know that it is scary to write clearly and directly. But CMS wants us to use clear language. They have written extensively about it. Let’s bring this issue to them with concrete examples.

Industry blindspots

It can be easy to forget what it was like before you knew all the healthcare language you know. We get so used to speaking in acronyms that we forget that people don’t live in this world day in and day out. It is not a moral failing, it is normal. And, like any industry we want to use the correct language, but unlike a lot of industries the cost of consumers not understanding us is really high. It is an easy trap we can all fall into.

It is too costly to change

Nothing gets done in healthcare without a financial motive to take action. The Center for Healthcare Strategies in 2024 wrote that we would save the U.S. healthcare system $106–236 billion a year if we met people’s level of healthcare literacy. I actually think we have no way of knowing how much we would save annually if people simply understood what we were saying to them. From reduced churn, improved adherence, better outcomes, fewer calls, the savings could be astronomical.

As some of you know, I also went through cancer treatment, and like Esther, I could write an agonizing game about my experience. It was a moment where I wasn’t talking about the game of health, but was playing it. It was very stressful and even harder to think clearly in those moments. So I was especially appreciative of the providers that understood that and spoke to me clearly and directly.

My surgeon called me after unexpectedly finding cancer. She did not beat around the bush. She didn’t hide behind jargon. She just came out and said, “You have cancer.” That level of clarity forced me to grapple immediately with the situation.

That level of clarity builds trust between health plans and members or doctors and providers. It can feel daunting, but almost all the leading associations and government agencies have produced guides on how to change language compliantly. I would say it is an easy change to make, except clearly if it was easy we all would do it. I do think it is necessary in this moment where trust in all parts of healthcare has been degrading and especially with health plans.

Clear language communicates to a patient or member that you see them. That you understand their challenge. If we started to communicate more clearly it will change the way we are perceived as an industry and it has the added benefit of reducing costs and improving health outcomes. It is worth it.

If you remember nothing else, James J. Kilpatrick sums up the best pathway to clarity in writing:

“Use familiar words—words that your readers will understand, and not words they will have to look up. No advice is more elementary, and no advice is more difficult to accept. When we feel an impulse to use a marvellously exotic word, let us lie down until the impulse goes away.”

Five Practical Takeaways for Payers and Providers

1. Above all, your members want to know what is covered. And does that mean fully or just partially? They want to be able to ask a question: Can I get Ozempic? And have a clear answer. Even if that answer is, you can get Ozempic with a prescription from your doctor, but we do not pay for it. You will have to pay for it out of pocket. To find ways to save on out of pocket medications, ask our chat.

2. I think it is fair to say that the average person doesn’t have a long attention span. If you think a 12 year old will give up on what you are writing, then it is too long and too complex. Aim for bullet points, short paragraphs, and where you can, interactive AI chatbots.

3. Put everything you write through some kind of readability checker. If it is above 8th grade, rewrite. Ernest Hemingway has a great quote about first drafts and their quality.

4. When the unfortunate occurs and you have to use an acronym, explain what it is. For example: “Your MOOP is $5000.” What’s a MOOP? It is the maximum amount you will pay out of pocket for the things that we cover. What does that mean? We don’t cover candy or dish towels. We do cover specific medications. So the maximum amount you will pay for things like the specific medications we cover.

5. Tap into the wealth of knowledge that is your call center reps. They hear all of the complaints, the frustration, the aggravation. Pay attention if your call center reps don’t understand how to easily help a member or if they read something and say, “Oh, no way people will understand that.” Listen to them.

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