With the 25th anniversary of the American with Disabilities Act (ADA) this year, and the 30th anniversary of Section 508 of the Rehabilitation Act of 1986 next year, health insurers, particularly those that receive federal funding, are being scrutinized with regards to equal opportunity and digital information accessibility compliance. How does your company measure up?
Non-discriminatory and Accessibility Legislation
Section 504 of the Rehabilitation Act of 1973 and Title II of the ADA of 1990, grants equal protection under the law to the millions of people in the United States who have at least one disability. This legislation applies to entities that receive funds from federal, state, or privately owned establishments. For health insurance companies, this requires that users, including employees, have equal opportunity to participate in programs and benefit from company products and services. Insurers may need to provide processes or ancillary aids for users to request and receive braille or large print versions of materials, screen readers, audiotapes, competent interpreters, telecommunications devices for deaf persons (TDDs), video captions, and other methods of presenting information.
Section 508 requires federal agencies, and organizations who receive federal funds, to ensure that persons with disabilities have comparable access to electronic information technology. For health insurers, this means that websites, secure portals, mobile apps, education kiosks, and other digital technologies maintained, developed, or acquired, should be accessible to everyone. In particular, these guidelines affect companies who market, sell, and manage federally subsidized health plans, including Affordable Care Act (ACA) plans, Medicaid Expansion plans, and Medicare plans. Section 508 is heavily influenced by WCAG standards, which have been adopted over the past decade by many institutions as the de facto accessibility standard.
Put simply, Section 508 is one method of ensuring 504 compliance. Your company should develop digital solutions according to Section 508 (WCAG 2.0) for accessibility, and deliver to Section 504 for equal opportunity and non-discrimination.
Step1: Establish Enterprise Standards
The first step is often the most difficult. There are no formal government or third-party entities who offer non-discriminatory and accessibility certifications that can fully protect health insurers from legal challenges, negative press, or poor user experiences. Insurers must review and interpret the legislation themselves, and determine how to proceed (and how far to go) based on their own offerings and knowledge of their customers. Because the creation, adoption, and management of these standards is complex and never-ending, company-wide approval and support is essential. To that end, insurers often collaborate with knowledgeable vendors to help craft core technology and content standards, and at the same time, adopt best practices that can be implemented cost effectively and carried out by the organization.
- Create your own enterprise standards based on government legislation interpretations, WCAG guidelines, and knowledge of your products and consumers
- Adopt core non-discriminatory processes and accessibility standards for legal and compliance; enact implementation best practices for technology and support teams
- When possible, join forces with a knowledgeable vendor to provide guidance and ongoing monitoring
Step 2: Create and Execute Compliance Framework/Roadmap
While establishing enterprise standards might be the biggest challenge for health insurers, implementing those standards can also be expensive and time-consuming. It is important to evaluate every process, website, technology, and digital solution within the organization. Those that don’t measure up need to be changed or replaced, and assessing and prioritizing that work is a collaborative effort involving legal (risk to the insurer), technology (complexity to execute), and customer support (processes to fulfill).
During and after these changes, further governance is needed to manage adherence. This multi-level/disciplined governance board is charged not only with enforcement, but also with adapting standards as the healthcare and digital landscapes evolve. Both the federal government and WCAG are expected to update non-discrimination and accessibility guidelines later this year or in 2016. States are also beginning to include and impose specific accessibility requirements in their Managed Care Organization (MCO) contracts with insurers. Federal, state, and WCAG compliance legislative acts and revisions should be monitored by the board so internal standards can be managed accordingly.
Finally, the governance board should oversee enterprise training for both internal and external resources. Executive training helps raise equal opportunity awareness, and further understanding of the risks and benefits of becoming 504/508 compliant. Consider custom training for technology and support teams who create digital solutions or interact with customers day-to-day. Specific training will vary by department and may include modules on how to use web and assistive technology reporting tools, ancillary aid fulfillment processes, or how to code using WCAG best practices.
- Create an implementation roadmap that addresses user support processes and digital solutions; secure cross-functional approvals and budgets.
- Establish a governance board to administer adoption, adherence, and updated standards
- Develop training modules and education for all levels of the organization, including custom training for technology and support employees and vendors
Step 3: Measure and Report
The final step is perhaps the most important – gathering the information needed to determine adherence and to ensure quality. For accessibility, code and content conformity can be measured by quantitative Website Technology Tools (CSS validators, accessibility evaluation tools, color contrast analyzers) and Assistive Technology Tools (screen readers, speech to text translators, screen magnifiers, etc.). Non-discriminatory processes are better measured by qualitative methods, such as user acceptance testing conducted by disabled users and/or independent third parties. Both quantitative and qualitative reports are equally important: technology and support teams will use this information daily, as well as the Governance Board.
- Measure accessibility compliance using quantitative Website and Assistive Technology Tools
- Evaluate non-discriminatory compliance with usability testing across all channels
- Use findings to improve equal opportunity policies and practices and digital solution accessibility.
Health insurers need to make every effort to make their digital services and information equal and accessible to everyone. Enacting non-discriminatory and accessibility best practices can deliver benefits such as:
- Reaching new audiences to drive enrollment
- Increased brand awareness through positive press and social feedback
- Reduced costs with standardized tools and implementation processes
- Proactively engaging with the disabled community to minimize legal and compliance issues
In short, equal opportunity and access is not only the right thing to do, but increasingly, it is also the law.