Health Literacy 2014 Navigating Sometimes Tough Waters

Health Literacy 2014Navigating Sometimes Tough Waters

Steven M. Berkowitz, MDSMB Health Consulting,

Austin, TX512-415-6095

[email protected]

Health Literacy is:

The degree to which individuals have the capacity to obtain, process, and understand health information to make appropriate health decisions.

Health literacy is not simply the ability to read. It requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations. For example, it includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor's directions and consent forms, and the ability to negotiate complex health care systems.

Health Literacy- A Definition

US Dept HHS, Healthy People 2010

Individual Pt Empowerment

Your Health Knowledge

Interactions with Providers

The Role of Social Media

How Literate are You?

National Literacy Initiatives

You as a Participant in Your Health Care

Your Insurance Knowledge

Provide everyone with access to accurate and actionable health information

Deliver person-centered health information and services

Support lifelong learning and skills to promote good health

National Action Plan to Improve Health Literacy

Institute of Medicine, 2013

1. Develop and disseminate health and safety information that is accurate, accessible, and actionable

2. Promote changes in the health care system that improve health information, communication, informed decision making, and access to health services

3. Incorporate accurate, standards-based, and developmentally appropriate health and science information and curricula in child care and education through the university level

4. Support and expand local efforts to provide adult education, English language instruction, and culturally and linguistically appropriate health information services in the community

5. Build partnerships, develop guidance, and change policies6. Increase basic research and the development, implementation, and evaluation of

practices and interventions to improve health literacy7. Increase the dissemination and use of evidence-based health literacy practices and

interventions

National Action Plan to Improve Health Literacy


Organizations and individuals that develop and disseminate health and safety information: ◦ Health care providers ◦ Public health officials ◦ Health communicators and educators ◦ Health care facilities ◦ Government agencies ◦ Commercial, academic, and nonprofit producers of health and safety information

Payers of health care services◦ Health plans◦ Government health care purchasers

Print, audiovisual, and electronic/ social media

Those responsible for food, drug, and medical device production and distribution

Employers

Key Organizations in the Models of Health Literacy


Adults over the age of 65 years Racial and ethnic groups other than White Recent refugees and immigrants People with less than a high school degree or GED People with incomes at or below the poverty Non-native speakers of English

Populations Most Likely to Experience Limited Health Literacy


Patients with low health literacy have:

◦ Higher risk of hospitalization◦ Longer hospital stays◦ Less likely to comply with treatment◦ More likely to make errors with medication◦ More ill when they seek medical care◦ Total cost to US between $106 billion to $238 billion annually

Consequences of Low Health Literacy


Patient-physician communication Drug labeling Medical instructions and medical compliance Health information publications and other resources Informed consent Responding to medical and insurance forms Giving patient history Public health training Assessments for allied professional programs, such as social

work and speech-language pathology

Opportunities for Increased Health Literacy

1. Has leadership that makes health literacy integral to its mission, structure, and operations. 2. Integrates health literacy into planning, evaluation measures, patient safety, and quality

improvement. 3. Prepares the workforce to be health literate and monitors progress. 4. Includes populations served in the design, implementation, and evaluation of health

information and services. 5. Meets the needs of populations with a range of health literacy skills while avoid-ing

stigmatization. 6. Uses health literacy strategies in interpersonal communications and confirms un-derstanding

at all points of contact. 7. Provides easy access to health information and services and navigation assistance. 8. Designs and distributes print, audiovisual, and social media content that is easy to understand

and act on. 9. Addresses health literacy in high-risk situations, including care transitions and

communications about medicines. 10. Communicates clearly what health plans cover and what individuals will have to pay for

services.

Ten Characteristics of Health Literate Organizations

Brach, Institute of Medicine, 2012

Changing Models of Care

The more knowledge I have about my own body and physical and mental condition, the better I will do

The more knowledge I have about the health care system, the better and more efficiently I will be able to navigate it

When I am ill is a poor time to get acquainted with the system

Data transparency has shown a wide range of quality and prices available in the market

Why is Health Literacy Important to Me?

I know more about my body than anybody else I am the most important member of my health care team I am with me every day of my life The time to start improving my health is now The more I can learn about my own health and medical

conditions, the better prepared I am to succeed If I am not motivated to lead a healthy lifestyle, I compromise

my whole health care team

Individual Patient Empowerment

Increasing transparency of quality and price

Higher deductible insurance

Individual Patient Empowerment

The increasingly informed consumer will make health care decisions on the basis of VALUE

Value Based Purchasing


VALUE = Outcomes + Satisfaction Cost



The CONSUMER ultimately determines which of the above elements constitute VALUE


VALUE = Outcomes + Satisfaction Cost

“What we concluded was that even when hospitals know their performance is not good, that's not sufficient motivation for them to do something. Making it public made a big difference in motivating them to improve.”

Judith Hibbard, Health Affairs 2003

Data Transparency

That which is measured, tends to improve.That which is measured publicly, tends to improve faster.

Total Health Care Spending

OECD, 2012

Kaiser HRET, 2013

Total Premium and Percentage paid by Worker

Kaiser HRET, 2013

Percentage of Plans with $1,000 or $2,000 Deductible

Kaiser HRET, 2013

Average Single Premium Deductible

Steve has a URI symptoms and feels bad!Steve has great insurance but a $3,000 deductible

What does he do?

Treatment Options: Approximate*: Out of Pocket Wait Emergency Department $ 300 2-3 hrs Urgent Care 150 1 hr PCP visit 120 1 hr (if available)

Local Pharmacy 80 30 min Self Treat.. rest, OTC meds... 10 ? none

Reflections on Price Transparency

* The actual cost may not be known until the evaluation is completed

Knowledge of how to get through the health care system is more important than ever before….

Not just in terms of my own health, but also, my own budget !!

Bottom Line:

Knowledge of how to get through the health care system is more important than ever before….

Not just in terms of my own health, but also, my own budget !!

Bottom Line:

No one is in a better position to do this than ME

So What’s New in Health Care Reform?Same old wine in a brand new bottle?

1. What are my choices for health insurance? How old am I? What state do I live in? Can I get insurance through my job? Can I get insurance through my spouse, parent/ guardian or school? Am I a US citizen, US national, or legal US resident? How much do I make a year, and how does it compare to the Federal

Poverty level? Have I or am I serving in the US armed services? Am I pregnant? Do I have End Stage Renal Disease or Lou Gehrig’s Disease?

Four Questions for Consumers and Providers About Health Insurance

Wu, Institute of Medicine, 2013

2. How do I get it? Medicaid: Apply at local social services office, health department,

Social Security office CHIP: call 1-877-KIDS-NOW or www.insurekidsnow.gov Medicare Medicare advantage Medigap Employer sponsored Health Insurance Exchange Tricare VA HIS



http://www.insurekidsnow.gov/

3. How do I use it? What’s on my card? What type of plan do I have? PPO, HMO, POS Where can I get care? Hospital, ED, Urgent care, provider network What do I do for prescription care? Do I understand my SBC? Summary of Benefits and Coverage



4. How much will it cost me? What are my covered services? What is my co-pay? What is my deductible? What is my out of pocket maximum?



Family history Age related prevention Healthy Diet Eliminating unhealthy lifestyle decisions Exercise My medical conditions My medications and treatment Long term effects of my medical conditions

What is my Personal Health Knowledge?

What is my main problem? What do I need to do? Why is it important for me to do this?

Health Care LiteracyAsk Me Three

Health Literacy and the Role of Social Media

59% of US Adults have looked online for health information in past year

80% of online inquiries start with search engine 50% of searches on behalf of someone else 16% tried to reach out to others who share condition 30% have consulted online reviews or rankings 35% of Americans have gone on line to figure out a medical

condition

Who Uses the Internet for Health Care?

Pew, Health On Line 2013

Of those 35% who went online:

35% never pursued medical attention 41% medical professional confirmed the diagnosis 18% say the medical professional did not agree 1% medical professional was inconclusive

Who Uses the Internet for Health Care?


Who Uses the Internet for Health Care?Percentage of Adults who Looked Online to Diagnose


Who Uses the Internet for Health Care?Percentage of Adults who Looked At Rankings

Age



Education



Income


Who runs the website? What is the purpose of the website? What is the original source of the information? How current is the information? How does the website choose its links? What information does the site collect on you? Is the information in the chat sites accurate?

How to Evaluate Information on the Internet

FDA, December 2005

Can you easily see who sponsors the website? Is the sponsor a Federal agency or a medical

school ,or is it related to one of these? Can you find the mission or goal of the sponsor of

the website? Can you see who works for the organization and who

is the author? Is there contact information? Can you tell when the information was written? Is your privacy effected? Does the website make claims that seem too good to

be true? Are quick, miraculous cures promised?

How to Evaluate Information on the InternetA Quick Checklist

NIA, April 2007

To the world you may be just one person,But to one person you may just be the world.

Unknown

Health Literacy 2014 Navigating Sometimes Tough Waters

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