Health Literacy 2014 Navigating Sometimes Tough Waters

1. Health Literacy 2014 Navigating Sometimes Tough Waters Steven M. Berkowitz, MD SMB Health Consulting, Austin, TX 512-415-6095 steve@smbhealthconsulting.com

2. Health Literacy- A Definition 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. US Dept HHS, Healthy People 2010

3. How Literate are You? National Literacy Initiatives You as a Participant in Your Health Care Individual Pt Empowerment Your Insurance Knowledge Your Health Knowledge Interactions with Providers The Role of Social Media

4. How Literate are You? National Literacy Initiatives You as a Participant in Your Health Care Individual Pt Empowerment Your Insurance Knowledge Your Health Knowledge Interactions with Providers The Role of Social Media

5. National Action Plan to Improve Health Literacy • 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 Institute of Medicine, 2013

6. National Action Plan to Improve Health Literacy 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 policies 6. Increase basic research and the development, implementation, and evaluation of practices and interventions to improve health literacy 7. Increase the dissemination and use of evidence-based health literacy practices and interventions Institute of Medicine, 2013

7. Key Organizations in the Models of 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 Institute of Medicine, 2013

8. Populations Most Likely to Experience Limited 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 Institute of Medicine, 2013

9. Consequences of Low 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 Institute of Medicine, 2004

10. Opportunities for Increased 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

11. Ten Characteristics of Health Literate Organizations 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. Brach, Institute of Medicine, 2012

13. How Literate are You? National Literacy Initiatives You as a Participant in Your Health Care Individual Pt Empowerment Your Insurance Knowledge Your Health Knowledge Interactions with Providers The Role of Social Media

14. Changing Models of Care

15. Why is Health Literacy Important to Me? • 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

16. How Literate are You? National Literacy Initiatives You as a Participant in Your Health Care Individual Pt Empowerment Your Insurance Knowledge Your Health Knowledge Interactions with Providers The Role of Social Media

17. Individual Patient Empowerment • 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

18. Individual Patient Empowerment • Increasing transparency of quality and price • Higher deductible insurance

19. Value Based Purchasing The increasingly informed consumer will make health care decisions on the basis of VALUE

20. Value Based Purchasing The increasingly informed consumer will make health care decisions on the basis of VALUE VALUE= Outcomes + Satisfaction Cost

21. Value Based Purchasing The increasingly informed consumer will make health care decisions on the basis of VALUE VALUE= Outcomes + Satisfaction Cost The CONSUMER ultimately determines which of the above elements constitute VALUE

22. Data Transparency That which is measured, tends to improve. That which is measured publicly, tends to improvefaster. “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

23. Total Health Care Spending OECD, 2012

24. Total Premium and Percentage paid by Worker Kaiser HRET, 2013

25. Percentage of Plans with $1,000 or $2,000 Deductible Kaiser HRET, 2013

26. Average Single Premium Deductible Kaiser HRET, 2013

27. Reflections on Price Transparency 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 * The actual cost may not be known until the evaluation is completed

28. 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 !!

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

30. How Literate are You? National Literacy Initiatives You as a Participant in Your Health Care Individual Pt Empowerment Your Insurance Knowledge Your Health Knowledge Interactions with Providers The Role of Social Media

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

32. Four Questions for Consumers and Providers About Health Insurance 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? Wu, Institute of Medicine, 2013

33. Four Questions for Consumers and Providers About Health Insurance 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 Wu, Institute of Medicine, 2013

34. Four Questions for Consumers and Providers About Health Insurance 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 Wu, Institute of Medicine, 2013

35. Four Questions for Consumers and Providers About Health Insurance 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? Wu, Institute of Medicine, 2013

36. How Literate are You? National Literacy Initiatives You as a Participant in Your Health Care Individual Pt Empowerment Your Insurance Knowledge Your Health Knowledge Interactions with Providers The Role of Social Media

37. What is my Personal Health Knowledge? • 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

38. How Literate are You? National Literacy Initiatives You as a Participant in Your Health Care Individual Pt Empowerment Your Insurance Knowledge Your Health Knowledge Interactions with Providers The Role of Social Media

39. Health Care LiteracyAsk Me Three • What is my main problem? • What do I need to do? • Why is it important for me to do this?

41. How Literate are You? National Literacy Initiatives You as a Participant in Your Health Care Individual Pt Empowerment Your Insurance Knowledge Your Health Knowledge Interactions with Providers The Role of Social Media

42. Health Literacy and the Role of Social Media

43. Who Uses the Internet for Health Care? • 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 Pew, Health On Line 2013

44. Who Uses the Internet for Health Care? 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 Pew, Health On Line 2013

45. Who Uses the Internet for Health Care? • Percentage of Adults who Looked Online to Diagnose Pew, Health On Line 2013

46. Who Uses the Internet for Health Care? • Percentage of Adults who Looked At Rankings Age Pew, Health On Line 2013

47. Who Uses the Internet for Health Care? • Percentage of Adults who Looked At Rankings Education Pew, Health On Line 2013

48. Who Uses the Internet for Health Care? • Percentage of Adults who Looked At Rankings Income Pew, Health On Line 2013

49. How to Evaluate Information on the Internet • 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? FDA, December 2005

50. How to Evaluate Information on the InternetA Quick Checklist • 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? NIA, April 2007