Aracely Rosales - Helping diverse consumers navigate health insurance exchanges
The Affordable Care Act – Are We Ready? Aracely RosalesChief Content Expert and Multilingual Director Health Literacy Innovations Improving Health Communication One Word At a Time™
Session Goals:2 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.
The Patient Protection & Affordable Care Act3 In March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act
The Law Improves 4 Key Areas:4 1. Protects people from insurance abuse 2. Makes health care more affordable 3. Gives better access to care 4. Strengthens Medicare
The ACA Goals5 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
The ACA Challenges6Some 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?
The ACA Opportunity for Health Literacy Strategies!7 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
Making the Connection8 Understand the connection between the ACA & low health literacy
What is health literacy?9 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
In Plain English10 An individuals ability to understand and act on health information.
Current Picture of US Health Literacy11 Today, more than 75 million people have low health literacy.
Current Picture of US Health Literacy12 In fact, according to the NAAL:
Future Picture of US Health Literacy Due to the ACA13 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
Current Picture of US Health Literacy14 Individuals with low levels of health literacy are least equipped to benefit from the ACA “Rates oflow 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 .
Understand the law’s focus on health literacy15 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
Clarifying the Provisions16 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)
Health Literacy and its Impact on Coverage Expansion17 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
Direct Mention of Health Literacy20 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.
The Challenge22 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
Implementing ACA23 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
The Health Literacy Solutions for Success Already Required by ACA24 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
The Health Literacy Solutions for Success Already Required by ACA25 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”
The Health Literacy Solutions for Success Already Required by ACA26 EXAMPLE To design easy-to-understand forms: Explainall policies using the same plain-English terms – defined in the glossary Giving examples of specific coverage
The Health Literacy Solutions for Success Already Required by ACA27 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
Diversity Challenges28 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
Diversity Cultural Competence Solutions for Success Already Required by ACA29 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
Diversity Cultural Competence Solutions for Success Already Required by ACA30 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
Other Strategies for Successful ACA Implementation31 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
Other Strategies for Successful ACA Implementation32 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
Other Strategies for Successful ACA Implementation for Diverse Audiences33 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
Other Strategies for Successful ACA Implementation for Diverse Audiences34
Other Strategies for Successful ACA Implementation for Diverse Audiences35
Other Strategies for Successful ACA Implementation for Diverse Audiences36
Other Strategies for Successful ACA Implementation for Diverse Audiences37
Other Strategies for Successful ACA Implementation for Diverse Audiences38 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.
Implement National Initiatives39 Implement National Initiatives
Implement Universal vs. Target Approach40 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
Improve Health ACA exchanges information41 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
Improve Health Professional Skills42 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
Promote health care systems innovations43 Implementation of policies and best practices: • Cultural competence standards and models • Language access practices • Health literate systems
Use Available Resources44 The Patient Protection The Patient Protection The Patient Protection Affordable Care Act The Patient Protection Affordable Care Act Affordable Care Act Resources Affordable Care Act Resources Resources Resources
Summary45 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
Summary46 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
References47 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/
References48 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