aracely rosales - helping diverse consumers navigate health insurance exchanges
DESCRIPTION
Presented by Aracely Rosales on September 6, 2012 at the third annual Center for Health Literacy Conference: Plain Talk in Complex Times.TRANSCRIPT
Improving Health Communication One Word At a Time™
Aracely Rosales Chief Content Expert and Multilingual Director
Health Literacy Innovations
The Affordable Care Act – Are We Ready?
Session Goals:
Explore the link between the ACA, plain language, health literacy, and culture
List potential barriers consumers with limited literacy face when seeking health insurance coverage
Describe ways to adapt communication strategies to be culturally appropriate for your audience.
2
In March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act
The Patient Protection & Affordable Care Act
3
1. Protects people from insurance abuse
2. Makes health care more affordable
3. Gives better access to care
4. Strengthens Medicare
The Law Improves 4 Key Areas: 4
The ACA Goals
The goals include:
Expand Medicaid to more qualified low-income people
Expand insurance to 32 million Americans
Create Health Insurance Exchanges
• Consumers offered options/prices allowing comparison-shopping
5
The ACA Challenges
Some of goals include:
Expand Medicaid to more qualified low-income people
Expand insurance to 32 million Americans
• How to successfully bring health care to consumers new to the health care system?
Create Health Insurance Exchanges
• How to make these effective?
6
The ACA
Opportunity for Health Literacy Strategies!
Some of goals include:
Get more low-income people, who qualify, apply for Medicaid
Expand insurance to 32 million Americans
• How to successfully bring new health insures to a complicated system?
Provides Health Insurance Exchanges
• How will these be effective?
The answer: Health Literacy Strategies! Plain Language Techniques! Cross Cultural Communication Techniques
7
Making the Connection
Understand the connection between the ACA & low health literacy
8
What is health literacy?
The ACA definition of health literacy is consistent with Healthy People 2010:
“The degree to which individuals have the capacity to
obtain, process, and understand basic health information and services needed to make
appropriate health decisions.”
-- Healthy People 2010
9
In Plain English
An individual's ability to understand and act on health information.
10
Current Picture of US Health Literacy
Today, more than 75 million people have low health literacy.
11
Current Picture of US Health Literacy
In fact, according to the NAAL:
12
Future Picture of US Health Literacy Due to the ACA
Today’s 75 million Americans with low health literacy
+ 2014 - expansion of health care to 32 million Americans new
to health care through exchanges
-----------------------
= Hundreds of millions of new Americans with low health literacy who will try to access a complicated health care system
13
Current Picture of US Health Literacy
Individuals with low levels of health literacy are least equipped to benefit from the ACA “Rates of low literacy are disproportionately high among lower-income Americans eligible for publicly financed care through Medicare or Medicaid.” M. Kutner et al.
The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. U.S.
Department of Education, National Center for Education. Washington DC, 2006.
14
Understand the law’s focus on health literacy
The provisions fall into six health and health care topics in the legislation
1. Coverage expansion 2. Equity 3. Workforce 4. Patient information at appropriate reading levels 5. Public health and wellness 6. Quality improvement:
• innovation to create more effective and efficient models of care • chronic illnesses requiring extensive self-management
15
Clarifying the Provisions
ACA provisions acknowledges the need to:
Communicate health and health care information clearly
Promote prevention
Be patient-centered
Assure equity and cultural competence
Deliver high-quality care
Focus on health literacy (direct & indirect)
16
Health Literacy and its Impact on Coverage Expansion
More affordable coverage is available through the new Exchanges by 2014. Now consumers can -
Look for and compare private health plans. Get answers to questions about your health coverage options. Find out if they are eligible for health programs or tax credits that make coverage
more affordable. Enroll in a health plan that meets their needs.
Individuals can enroll in private or public health insurance coverage Small employers will have better choice of plans and insurers at a lower cost More than 32 million Americans new to health care enter the system:
States have the option to cover more people on Medicaid and expand coverage to lower income qualified people.
More individuals with pre-existing conditions will have coverage options Young adults can to stay on their parent’s plan until they turn 26 years old
17
Direct Provisions for Health Literacy
18
Direct Provisions for Health Literacy
19
Direct Mention of Health Literacy
Provisions touch on issues of: • Research dissemination • Shared decision-making • Medication labeling • Workforce development
All four suggest the need to communicate effectively with consumers, patients,
and communities to improve the access and quality of health care. None of these provisions create explicit health literacy programs, specify
implementation or regulatory supports, or expand further on the term “health literacy” beyond its mention.
However, all provisions are consistent with the themes of patient-centeredness and overall quality improvement that are found more broadly throughout the legislation.
20
Indirect Provisions for Health Literacy
21
The Challenge
New inexperienced health care consumers will have greater difficulty with:
Understanding eligibility guidelines for various insurance programs
Participating in the buy-in process of the exchange or high-risk pools
Providing supplemental identification and citizenship documentation needed for enrollment
Understanding which services are covered
Recognizing cost-sharing and premium responsibilities
Choosing a health care provider
22
Implementing ACA
None of these reforms will fully succeed without:
Improving efforts to make all information understandable-plain language
Targeted efforts to enroll under-resourced diverse populations
23
The Health Literacy Solutions for Success Already Required by ACA
Consumer Education and Assistance
ACA provision calls for:
Development and utilization of uniform explanations of coverage documents
• A mandate that could be strengthened with explicit linkages to:
Health literacy principles Plain language use and techniques
24
The Health Literacy Solutions for Success Already Required by ACA
Clear and Consistent Information to Consumers About Their Health Insurance Coverage
When? Deadline: September 23, 2012 Why? For Information when coverage – is renewed, changes, information on demand, when shopping for coverage How? Use the short, easy-to-understand Summary of Benefits and Coverage (SBC)
A list of definitions (called the “Uniform Glossary”) explaining terms such as “deductible” and “co-payment”
25
The Health Literacy Solutions for Success Already Required by ACA
EXAMPLE To design easy-to-understand forms:
Explain all policies using the same plain-English terms – defined in the glossary
Giving examples of specific coverage
26
The Health Literacy Solutions for Success Already Required by ACA
Use of Information Technology and Reducing Burden on Employers and Insurers: Establishment of internet portal to help individuals and businesses: Interact with the insurance exchange Understand eligibility guidelines for Medicaid/CHIP/Medicare/high-risk pools The final rule ensures that in the vast majority of cases, the SBC can be provided:
• Electronically • Post it on its website • Provide it by email • Electronic disclosure is expected to reduce costs • Consumer safeguards are designed to ensure actual receipt by individuals
http://cciio.cms.gov/resources/other/index.html#sbcug
27
Diversity Challenges
Starting in 2014, Medicaid could be serving 80 million Americans — or a quarter of the U.S. population — each year after 2014.
This “expansion population” will likely: • Be racially and ethnically diverse • Be predominantly childless adults • Have high levels of substance abuse and prior jail involvement • Require care management for complex physical and behavioral health
needs.
Addressing health literacy, language and culture could be a significant issue for this population
28
Diversity Cultural Competence Solutions for Success Already Required by ACA
Diversity and cultural competency. The Affordable Care Act expands initiatives to increase racial and ethnic diversity in the health care professions. It also strengthens cultural competency training for all health care providers. Health plans will be required to use language services and community outreach in underserved communities. Improving communications between providers and patients will help address health disparities particularly in Hispanic communities, which currently have high numbers of uninsured people.
To have information presented by the national and regional exchanges be: • Culturally appropriate
• Linguistically appropriate Translation of all materials
Interpretation services as needed
29
Requirements to make insurance and enrollment information consumer friendly for: Readable web and print materials Media such as phone, television, radio, social media, and in-person outreach
Use of community-based organizations Culturally specific media campaigns “Promotores,” lay health workers Individual insurance brokers
Diversity Cultural Competence Solutions for Success Already Required by ACA
30
Other Strategies for Successful ACA Implementation
Simplifying Medicaid enrollment information is not a new- Health Literacy Innovation’s -National Survey of Medicaid Health Literacy Standards:
90% -some type of health literacy standard.
67% -at least a sixth-grade reading level
22% -reading level to be even lower
96% -simple enrollment forms
82% -states offer one-on-one enrollment assistance
72 % provide onsite assistance, counseling and/or a toll-free helpline
Many racial and ethnic eligible for Medicaid or CHIP are not enrolled:
• 80% eligible uninsured African-American
• 70 % of eligible uninsured Latino children
31
Other Strategies for Successful ACA Implementation
The Centers for Medicare and Medicaid Services (CMS) has: Released readability guidelines for Medicaid print materials
to states Mandated certain contract requirements around
communication standards for Medicaid managed care plans.
However, these guidelines lack: Strong enforcement Uniform oversight from any particular federal or state agency
32
Other Strategies for Successful ACA Implementation for Diverse Audiences
ACA provisions, that could be helpful to make a case:
1. Eliminate and remove a common administrative burden and impediment to participation
2. Use a new, uniform method for determining income eligibility
3. Streamline citizenship documentation requirements
4. Set up an electronic enrollment processes
33
Other Strategies for Successful ACA Implementation for Diverse Audiences
34
Other Strategies for Successful ACA Implementation for Diverse Audiences
35
Other Strategies for Successful ACA Implementation for Diverse Audiences
36
Other Strategies for Successful ACA Implementation for Diverse Audiences
37
Other Strategies for Successful ACA Implementation for Diverse Audiences
The ACA offers consumer protection which allows them to:
Choose a health plan that best suits their needs, provided is in their preferred language
Appeal a plan’s denial of coverage for needed services, provided they get help to understand and act on it.
Select an available primary care provider of their choosing, provided they understand the guidelines, and have access to that information in their preferred language.
38
Implement National Initiatives
Implement National Initiatives
39
Implement Universal vs. Target Approach
Make the business case for: • Health literacy, plain language, cultural competence, language access
Educate:
• The public and health professional: Mandate requirements Target ACA exchanges to ensure they use clear health communication
techniques
Address vulnerable populations such as:
• People with special needs, • Diverse minorities (hard to reach). • Use appropriate channels of communication
40
Improve Health ACA exchanges information
Make sure information is: Clear and actionable In the language of the target client
but-also easy to read or in plain language Support informed consumer decision
making
41
Improve Health Professional Skills
Improve Health Professional Skills to improve provider/client communication:
Require professional trainings
Develop targeted training curriculums
Provide tools and Resources to produce and simplify information
Use the right technology and tools to help save time and resources
42
Promote health care systems innovations
Implementation of policies and best practices:
• Cultural competence standards and models
• Language access practices
• Health literate systems
43
Use Available Resources 44
The Patient Protection Affordable Care Act Resources
The Patient Protection Affordable Care Act Resources
The Patient Protection Affordable Care Act Resources
The Patient Protection Affordable Care Act Resources
Summary
ACA creates opportunities for health literacy in all of the key domains of health and health care:
1.The Coverage Expansion -32 millions Americans
Low income Americans need to understand their options and navigate the enrollment process.
2.Equity:
Paying attention to cultural differences, language, and, literacy.
3.Workforce:
There are provisions in ACA related to disparities, cultural competency, patient-centeredness and health literacy
45
Summary
4. Health Care Information:
Patient information must be at appropriate reading
5. Public Health and Wellness:
The preparation of consumer must be done with low literacy in mind
6. Quality Improvement:
Develop, test and spread best practices to improve quality and reduce costs
This presents many new opportunities for making the case for investments in health literacy, language and culture
46
References
AHRQ Report—Literacy and Health Outcomes (2004) www.ahrq.gov/clinic/epcsums/litsum.htm
AMA Foundation Health Literacy www.ama-assn.org/ama/pub/about-ama/our-people/affiliated-groups/ama-foundation/our-programs/public-health/health-literacy-program.shtml
Fox, S. & Fallows, D. (2003) Internet Health Resources. Washington, DC: Pew Internet & American Life Project www.pewinternet.org/Reports/2003/Internet-Health-Resources.aspx
Healthy People 2010, Health Communication, Objective 11-2 www.healthypeople.gov/Document/HTML/Volume1/11HealthCom.htm
Health Literacy Innovations Resources http://www.healthliteracyinnovations.com/resources/
47
References
NLM Bibliography—Understanding Health Literacy and Its Barriers (2004) www.nlm.nih.gov/pubs/cbm/healthliteracybarriers.html
The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy (2007) http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2006483
The Joint Commission Report: “What did the Doctor Say?:” Improving Health Literacy To Protect Patient Safety (2007) www.jointcommission.org/PublicPolicy/health_literacy.htm
Medical Library Association “Top 10” Most Useful Consumer Health Websites www.mlanet.org/resources/medspeak/topten.html
IOM Report (2004) – Health Literacy: A Prescription To End Confusion
www.iom.edu/report.asp?id=19723
IOM Report—Health Literacy: A Prescription To End Confusion (2004) www.iom.edu/CMS/3775/3827/19723.aspx
Health Literacy Implications of the Affordable Care Act Commissioned by: The Institute of Medicine, Authored by: Stephen A. Somers, PhD, Roopa Mahadevan, MA
48