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Welcome to the Webinar                  	  Communica*on	  Ma,ers:	          	  The	  Ongoing	  Challenge	  to	  Explain	  ...
Today you’ll be hearing          from. . .Nancy Murphy,   Linda Neuhauser,          Kathy Paez, RN, Metropolitan   DrPH, U...
Agenda	  	  1.  Review	  of	  session	  objec*ves	  2.  Introduc*on	  of	  today’s	  speakers	  3.  Overview	  of	  effec*v...
Objectives•  Understand	  health	  literacy	  principles	  and	  why	  they	  are	     important	  	  •  Know	  where	  to...
Health	  Literacy:	  Undervalued	  by	  Public	  Health?	  A	  tool	  for	  public	  health	  professionals.	  	  	  	  	 ...
Who is in our audience               Employer/Organiza=on	  50	  45	  40	  35	  30	  25	  20	  15	  10	   5	   0	  
Who is in our audience                                                 Occupa=on	                Teacher/Faculty	         ...
Who is in our audience        Geography	                                                West	  of	  MS	  River	           ...
Who is in our audience                         Familiarity	  with	  Health	  Literacy	  Principles	           Very	  famil...
What do you want to learn          about this topic?•  Be,er	  understanding	  of	  health	  literacy	  principles	  	  • ...
How to Participate•  Phone	  line	  is	  automa*cally	  	     on	  mute	  •  Send	  facilitator	  a	  ques*on	  or	     co...
Who is speaking today:Linda Neuhauser, DrPH       Linda Neuhauser, DrPH       Clinical Professor of Community       Health...
Who is speaking today:Kathryn Paez, RN, PhD       Kathryn Paez, RN, PhD       Principal Researcher, American       Institu...
Who is moderating our  discussion today:Nancy Murphy, MSHC      Nancy Murphy, MSHC      Executive Vice President,      Met...
Questions welcomed•  Submit	  a	  ques*on	  at	  any	  *me	  during	  this	  Webinar	  using	  the	     chat	  func*on	  O...
Before	  we	  launch	  into	  our	  presenta=ons,	            here	  is	  a	  ques=on	  for	  you:What	  percentage	  of	 ...
Introducing Linda Neuhauser          Linda Neuhauser, DrPH          Clinical Professor of Community          Health & Huma...
Health	  Literacy	  &	  Communica=on	  about	                 Health	  Care	  Reform	                                    	...
Ques=ons	                 19
Health	  Research	  for	  Ac=on	         Over	  20	  years	  of	  experience:	  	         • Assessing	  literacy	  levels	...
Communica*ng	  about	  Health	  Care	  Reform	  Over	  50%	  of	  consumers	  don’t	  understand	  it	  	  Many	  health	 ...
CA	  Consumer	  Assistance	  Survey	                  8/2012*	        •  Informa=on	  from	  77	  organiza=ons	        •  ...
Survey	  (cont.):	  Most	  Important	                 Topics   	    •  Medicaid	  changes	    •  Health	  Benefit	  Exchang...
A	  ques*on	  for	  Linda	          What	  is	  health	  literacy	  -­‐-­‐-­‐	  and	          why	  is	  it	  important	  ...
Health	  Literacy	         	  	         	           	  “The	  degree	  to	  which	  individuals	  have	  the	             ...
Health	  literacy	  is	  also…	         	  	         	            	  “The	  capacity	  of	  professionals	  and	  ins=tu=o...
What	  is	  it	  like?	                                      	  	  GNINAELC	  –	  Ot	  erussa	  hgih	  ecnamrofrep,	      ...
Na=onal	  Assessment	  of	  Adult	  Literacy,	  2003	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  Below	  Basic:	  No...
Health	  Literacy	  Skills	  by	  Level	  Below	  Basic:	  Circle	  the	  date	  of	  a	  medical	  appointment	  on	  a	 ...
Hispanic	  Health	  Literacy	  Levels	  Hispanic	  adults	  have	  lower	  average	  health	  literacy	    than	  adults	 ...
How	  well	  do	  people	  read	  and	  write?	                             31
US	  Reading	  Levels	  Compared	  to	     Health	  Informa=on	  Readability	  	  •	  The	  average	  American	  reads	  a...
Computer	  Literacy	  Requires	  More	                  Skills	                          	  •	  Ability	  to	  search	  •	...
Mismatched	  Communica=on	    Information is too complicated for   people’s health literacy abilities.                  34
Aler	  a	  clinical	  visit,	  pa=ents	  may…	  Forget	  or	  remember	  incorrectly	  over	  50%	       of	  what	  the	 ...
A	  ques=on	  for	  Linda	          What	  are	  the	  public	  health	          implica=ons	  of	  these	  healthy	      ...
Most	  of	  the	  US	  popula=on	  may	  be	  at	  risk	  for…	  	   •  Medical	  misunderstandings	       •  Mistakes	  t...
Es=mated	  Costs	  of	  	         Limited	  Health	  Literacy	  on	  the	  	                  Economy	                   $...
Na=onal	  HL	  Policy	  Evolu=on	                                                  	  AHRQ	  2001	  –	  top	  11	  pa*ent	...
A	  ques=on	  for	  Linda	          So given all of this, what        can we do to improve        Health Communication?
“Clear	  Health	  Communica=on”	  Tips	  	  •      Write	  informa=on	  at	  appropriate	  user	  level	  •      Put	  inf...
Measure	  the	  Readability	  of	                  Materials    	  •	  Many	  tests	  (mostly	  measure	  #	  words	  in	 ...
“Universal	  Design”                                                        	  Studies	  show	  that	  even	  people	  who...
Suitability	  Assessment	  of	  Materials	                     (SAM)                       	   	  22-­‐item	  assessment	 ...
What	  do	  YOU	  think?	  What	  do	  YOU	  find	  most	  difficult	  to	  explain	  about	     the	  ACA?	  a.  The	  *meta...
Some	  of	  Our	  Work	  to	  Improve	  Consumer	  Informa=on	  about	  Health	             Care	  &	  the	  ACA	  
Guides	  created	  by	  HRA	  and	  State	  of	  California	  
49
Health	  Research	  for	  Ac=on   	                  ACA	  Research	  Ac=vi=es    	  	  	  	  -­‐  Survey	  of	  CA	  orga...
CA	  Study:	  Assessment	  of	  ACA	  materials                                                   	     –  We	  tested	  1...
Health	  Research	  for	  Ac=on	      ACA	  Communica=on	  Development        	  	  •  Glossary	  of	  easy-­‐to-­‐underst...
Key	  takeaways               	     -­‐	  Health	  insurance	  informa*on	  requires	  a	  high	     level	  of	  health	 ...
Join	  the	  Conversa=on!                          	          Questions or comments for        Linda?        Please submit...
Discussion/Q&A	                       	  Ask Linda!Share with Linda!
It’s	  YOUR	  turn!Have	  you	  ever	  misunderstood	  your	  own	  health	  insurance	  rules	  and	  been	  surprised	  ...
Introducing	  Kathy	  Paez                           	            Kathy Paez, RN, PhD          American Institutes for Res...
Mee=ng	  the	  Challenge	  of	  Health	                         Insurance	  Literacy	  Aler	  the	  ACA	                  ...
By	  2014,	  20	  million	  Americans	  are	  expected	  to	  have	                       access	  to	  health	  insurance...
Literacy	  in	  the	  United	  States                                        	                  Percentage	  of	  adults	 ...
Health	  insurance	  is	  one	  of	  the	  most	  complex	        commodi=es	  sold	  to	  consumers	              	      ...
Consumers	  are	  required	  to	  navigate	  through	  layers	  of	  complicated	  jargon	  to	  effec=vely	  select	  and	...
What	  will	  I	  pay	  for	  a	  bunionectomy?	                                 	                               Copay?	  ...
A	  ques=on	  for	  Kathy	          What is health        INSURANCE literacy? How        is it different from health      ...
Health	  insurance	  literacy	                      defined	  “The	  degree	  to	  which	  individuals	  have	  the	  knowl...
Breaking	  down	  health	  insurance	  literacy	  into	  its	  parts                                                      ...
A question for Kathy      How health insurance      literate are consumers?
Overly confident that insurance                                   covers the cost of care	  “People	  have	  the	  tendenc...
Don’t	  understand	  insurance	                                       	      mi=gates	  financial	  risk	  “We’ve	  actuall...
Have	  difficulty	  assessing	  value	  •  Gravitate	  towards	  cheaper,	  high-­‐risk	  op*ons	     or	  more	  expensive	...
Have	  difficulty	  appropriately	  using	  insurance	                                                             	  •  Don...
What	  do	  YOU	  think?	  •  Where	  should	  consumers	  turn	  to	  find	  out	     details	  about	  their	  coverage?	...
Bridging	  the	  gap	  
Reducing	  the	  tremendous	  cogni=ve	  demand	  on	                         consumers   	       • Standardize	  	       ...
How	  the	  ACA	  will	  help	         ACA	  Reforms	              September	  23,	  2012	                   January	  1,	...
Coverage	  levels	  under	  the	  ACA	             “the	  metals”   	                            Metal	  Tier	     Actuari...
Standardized	  “essen=al	  benefits”	  required	  by	                        the	  ACA	  •  Ambulatory	  pa*ent	  services,...
Standardize	  summary	  of	  benefits	            and	  coverage  	  •  Mandated	  that	  all	  insurance	  plans	  use	  t...
Summary	  of	  benefits	  and	        coverage      	  
Summary	  of	  benefits	  and	        coverage      	  
Glossary	  of	  terms                      	                Deductible               The amount you owe for              h...
Glossary	  of	  terms                      	  
Tools	  to	  calculate	  consumer	  cost                                           	  
It’s	  YOUR	  turn 	  ACA	  and	  it’s	  implementa*on	  will	  make	  it	  easier	     for	  consumers	  to	  make	  good...
Reducing	  the	  tremendous	  cogni=ve	  demand	  on	                         consumers   	     • Standardize	  	     • Si...
Choice	  architecture	  Organizes	  and	  frames	  informa*on	  •  Filtering	  to	  limit	  what	  appears	  on	  the	  sc...
Filter,	  sort	  and	  compare	  
Compare	  side	  by	  side	  
Key	  takeaways               	     •  Selecting and using health   insurance is tremendously   complex!   •  We, as healt...
Join	  the	  Conversa=on!                          	          Questions or comments for        Kathy?        Please submit...
Discussion/Q&A	                       	  Ask Kathy!Share with Kathy!
Ques=ons	  for	  our	  speakers                                 	  Kathryn Paez, RN,   Linda Neuhauser,PhD, American      ...
Health	  Literacy:	  Undervalued	  by	  Public	  Health?	  A	  tool	  for	  public	  health	  professionals.	  	  	  	  	 ...
Next	  steps	  •  Today’s slides will be posted online, along with   an archived version of this webinar, for future   acc...
Thanks	  to	  our	  speakers!                               	   Kathryn Paez, RN,       Linda Neuhauser, PhD, American    ...
Resources                                   	  •	  CDC:	  Health	  Literacy       h,p://www.cdc.gov/healthliteracy/index.h...
Resources	  (cont.)                                           	  •  US	  Department	  of	  Health	  and	  Human	  Services...
Resources	  (cont.)                                       	  •  ACA	  Regula*ons	  and	  Guidance:	     h,p://www.dol.gov/...
99
Speaker	  Contact	  Informa*on	                                     	  Linda	  Neuhauser,	  DrPH,	  MPH	  lindan@berkeley....
Thank	  you	  to	  our	  Sponsors                                           	  	          Community Health        Planning...
Thank	  you	  to	  our	  planning	                   commiUee            	  •  Tammy	  Pilisuk,	  MPH,	  APHA-­‐CHPPD	  • ...
Conclusion	    Thank	  you!              	  
CALPACT Training: Health Communication Matters Webinar 092712
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CALPACT Training: Health Communication Matters Webinar 092712

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Welcome to the "Health Communication Matters! The Ongoing Challenge to Implement the Affordable Care Act" webinar sponsored by the California Pacific Public Health Training Center (CALPACT) at UC Berkeley's School of Public Health.

The most sweeping health policy change in decades – the Affordable Care Act, has created a myriad of challenges in how to convey a complex subject to the public, the media, policymakers, and other professionals. Experts in ACA-related health literacy and health insurance literacy initiatives walk us through ongoing areas of challenge after the passage of the ACA and health communication principles to deliver understandable and compelling content to diverse audiences.

Follow Us on Twitter: @CALPACT
Facebook: http://www.facebook.com/CALPACTUCB
Website: www.calpact.org

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Transcript of "CALPACT Training: Health Communication Matters Webinar 092712"

  1. 1. Welcome to the Webinar  Communica*on  Ma,ers:    The  Ongoing  Challenge  to  Explain  &  Implement   the  Affordable  Care  Act   We  will  begin  shortly…  
  2. 2. Today you’ll be hearing from. . .Nancy Murphy, Linda Neuhauser, Kathy Paez, RN, Metropolitan DrPH, University of PhD, American Group, California, Berkeley Institutes for Research Moderator
  3. 3. Agenda    1.  Review  of  session  objec*ves  2.  Introduc*on  of  today’s  speakers  3.  Overview  of  effec*ve  communica*on  in  the  public  health   context  –  why  does  it  ma,er?    4.  Ques*ons  &  Answers  5.  Mee*ng  the  Challenge  of  Health  Insurance  Literacy  aSer  the   ACA  6.  Ques*ons  &  Answers  7.  Specific  ac*ons  and  resources    8.  Next  steps  &  conclusion  
  4. 4. Objectives•  Understand  health  literacy  principles  and  why  they  are   important    •  Know  where  to  find  key  resources  and  guidelines  on  health   literacy  •  List  the  specific  components  of  health  insurance  literacy  •  List  specific  ways  to  apply  health  literacy  principles  to   improve  communica*on,  especially  about  health  insurance    •  Iden*fy  specific  ways  in  which  ACA  will  help  improve  health   insurance  literacy    
  5. 5. Health  Literacy:  Undervalued  by  Public  Health?  A  tool  for  public  health  professionals.                                                      Prepared  for  the  American  Public  Health  Associa*on  Community  Health  Planning  &  Policy  Development  Sec*on  Tammy  Pilisuk,  MPH        AUG  2011  
  6. 6. Who is in our audience Employer/Organiza=on  50  45  40  35  30  25  20  15  10   5   0  
  7. 7. Who is in our audience Occupa=on   Teacher/Faculty   Health  Policy   Med/Dental  Prac**oner  Health  Promo*on/Educa*on   Health  Administrator   Community  Health  Worker   0   10   20   30   40   50   60   70  
  8. 8. Who is in our audience Geography   West  of  MS  River   East  of  MS  River   40%  from  California  
  9. 9. Who is in our audience Familiarity  with  Health  Literacy  Principles   Very  familiar  Moderately  familiar   Somewhat  familiar   Limited  familiarity   Not  familiar   0   10   20   30   40   50   60   70   80  
  10. 10. What do you want to learn about this topic?•  Be,er  understanding  of  health  literacy  principles    •  Be,er  understanding  of  promo*ng  ACA  to  popula*ons  with   different  levels  of  heath  literacy  •  To  be  able  to  apply  some  of  the  core  health  literacy  principles   in  both  my  professional  and  personal  life    •  Be,er  ways  to  talk  about  health,  preven*on  and  the  ACA  •  More  about  ACA  implementa*on      •  How  to  be  a  stronger  advocate  for  the  ACA  in  community/ municipal  level  policy  discussions    •  Understanding  of  health  literacys  inclusion  in  ACA-­‐-­‐ expecta*ons  for  implementa*on,  measurement,  etc.    
  11. 11. How to Participate•  Phone  line  is  automa*cally     on  mute  •  Send  facilitator  a  ques*on  or   comment  using  Ready  Talk’s  chat   func*on  •  Click  “raise  hand”  bu,on  to  be  taken   off  mute  and  ask  a  ques*on  verbally    •  Slides  will  be  posted  online  following   webinar  –  link  will  be  shared  with  all   par*cipants
  12. 12. Who is speaking today:Linda Neuhauser, DrPH Linda Neuhauser, DrPH Clinical Professor of Community Health & Human Development, UC- Berkeley School of Public Health e: lindan@berkeley.edu w: www.healthresearchforaction.org
  13. 13. Who is speaking today:Kathryn Paez, RN, PhD Kathryn Paez, RN, PhD Principal Researcher, American Institutes for Research e: kpaez@air.org w: www.air.org
  14. 14. Who is moderating our discussion today:Nancy Murphy, MSHC Nancy Murphy, MSHC Executive Vice President, Metropolitan Group e: nmurphy@metgroup.com w: www.metgroup.com
  15. 15. Questions welcomed•  Submit  a  ques*on  at  any  *me  during  this  Webinar  using  the   chat  func*on  OR  clicking  the  “raise  hand”  bu,on  to  be  taken   off  mute.    •  We  will  consolidate  ques*ons  and  pose  them  to  the  speakers   throughout  the  Webinar  and  during  the  Q&A  session  at  the   end.    •  We  also  may  host  addi*onal  webinars  on  related  health   communica*on  topics  depending  on  the  results  of  the   evalua*on,  so  please  tell  us  if  you  want  more!    
  16. 16. Before  we  launch  into  our  presenta=ons,   here  is  a  ques=on  for  you:What  percentage  of  Americans  have  the  skills  to  understand  complex  health  informa*on,  such  as  insurance  choices?  a.  4%  b.  12%  c.  32%  d.  49%  
  17. 17. Introducing Linda Neuhauser Linda Neuhauser, DrPH Clinical Professor of Community Health & Human Development, UC- Berkeley School of Public Health
  18. 18. Health  Literacy  &  Communica=on  about   Health  Care  Reform     Linda  Neuhauser,  DrPH   Clinical  Professor   School  of  Public  Health,  UC  Berkeley    Health  Communica=on  MaUers!  The  Ongoing  Challenge   to  explain  and  Implement  the  ACA   Webinar:  September  27,  2012   18
  19. 19. Ques=ons   19
  20. 20. Health  Research  for  Ac=on   Over  20  years  of  experience:     • Assessing  literacy  levels  and  effec*veness  of     health  informa*on.   • Developing  and  distribu*ng  informa*on  for  large,   diverse,  and  mul*lingual  audiences  (over  15   languages,  plus  Braille,  MP3,  and  more).   • Conduc*ng  forma*ve  and  evalua*ve  research.   • Providing  trainings  to  improve  the  readability  and   usability  of  health  materials.     Recipients  of  na-onal  print,  Web,     health  literacy,  and  public  health  awards  
  21. 21. Communica*ng  about  Health  Care  Reform  Over  50%  of  consumers  don’t  understand  it    Many  health  care  providers  don’t  either  
  22. 22. CA  Consumer  Assistance  Survey   8/2012*   •  Informa=on  from  77  organiza=ons   •  74%  educa=ng  clients  about  ACA   •  72%  said  materials  are  “too   complex”  for  clients   •  Want  simple,  aUrac=ve  materials  in   many  languages;  accessible   •  Mul=-­‐media,  including  video  *Funded by: CA Office of the Patient Advocate and CA Dept ofManaged Health Care
  23. 23. Survey  (cont.):  Most  Important   Topics   •  Medicaid  changes   •  Health  Benefit  Exchange   •  Finding  insurance   •  Pa=ent  rights;  language  access   •  Medicare  changes   •  Preven=ve  care   •  Drug  coverage,  &  12  other  topics  
  24. 24. A  ques*on  for  Linda   What  is  health  literacy  -­‐-­‐-­‐  and   why  is  it  important  for  ACA-­‐ related  communica=on?  
  25. 25. Health  Literacy          “The  degree  to  which  individuals  have  the   capacity  to  obtain,  process,  understand,  and  act   on  basic  health  informa=on  and  services  needed   to  make  appropriate  health  decisions.”*        Components:    Reading,  listening,  speaking,  using   numbers,  mo*va*on,  health  ac*ons     *Institute of Medicine, 2004 25
  26. 26. Health  literacy  is  also…          “The  capacity  of  professionals  and  ins=tu=ons   to  communicate  effec=vely  so  that  community   members  can  make  informed  decisions  and  take   appropriate  ac=ons  to  protect  and  promote  their   health.”*     -Joanne G. Schwartzberg, MD, American Medical Association 26
  27. 27. What  is  it  like?      GNINAELC  –  Ot  erussa  hgih  ecnamrofrep,   yllacidoirep  naelc  eht  epat  sdaeh  dna  natspac   revenehw  uoy  eciton  na  noitalumucca  fo  tsud   dna  nworb-­‐red  edixo  selcitrap.  Esu  a  noUoc   baws  denetsiom  h=w  lyporposi  lohocla.  Eb   erus  on  lohocla  sehcuot  eht  rebbur  strap,  sa  =   sdnet  ot  yrd  dna  yllautneve  kcarc  eht  rebbur.   Esu  a  pmad  tholc  ro  egnops  ot  naelc  eht   tenibac.  A  dlim  paos,  ekil  gnihsawhsid   tnegreted,  lliw  pleh  evomer  esaerg  ro  lio.   27
  28. 28. Na=onal  Assessment  of  Adult  Literacy,  2003                                  Below  Basic:  No  more  than  the  most  simple  &  concrete  literacy  ac*vi*es  Basic:  Can  perform  simple  everyday  literacy  ac*vi*es  Intermediate:  Can  perform  moderately  challenging  literacy  ac*vi*es  Proficient:    Can  perform  complex  and  challenging  literacy   28
  29. 29. Health  Literacy  Skills  by  Level  Below  Basic:  Circle  the  date  of  a  medical  appointment  on  a  hospital      appointment  slip.      Basic:  Give  2  reasons  for  gepng  tested  for  a  specific  disease,  based      on  informa*on  in  a  clearly  wri,en  pamphlet.    Intermediate:  Determine  what  *me  to  take  a  prescrip*on  medicine,      based  on  informa*on  on  the  drug  label  rela*ng  *ming  of      medica*on  to  ea*ng.          Proficient:  Calculate  an  employee’s  share  of  health  insurance  costs      for  a  year,  using  a  table.               29
  30. 30. Hispanic  Health  Literacy  Levels  Hispanic  adults  have  lower  average  health  literacy   than  adults  in  any  other  racial/ethnic  groups.   30
  31. 31. How  well  do  people  read  and  write?   31
  32. 32. US  Reading  Levels  Compared  to   Health  Informa=on  Readability    •  The  average  American  reads  at  the          7th-­‐8th  grade  level-­‐-­‐3  to  4  grades        below  last  grade  completed                  •  20%  read  below  the  5th  grade  level    •  Most  health  informa*on  is  wri,en  at  the  10-­‐12th  grade  level    
  33. 33. Computer  Literacy  Requires  More   Skills    •  Ability  to  search  •  Ability  to  spell  •  Ability  to  navigate  pages  •  Ability  to  use  links  &  move  between  documents  •  Ability  to  use  interac*ve  features    Most  Internet  health  info  is  at  10-­‐12th  grade     33
  34. 34. Mismatched  Communica=on   Information is too complicated for people’s health literacy abilities. 34
  35. 35. Aler  a  clinical  visit,  pa=ents  may…  Forget  or  remember  incorrectly  over  50%   of  what  the  physician  said    
  36. 36. A  ques=on  for  Linda   What  are  the  public  health   implica=ons  of  these  healthy   literacy  challenges?  
  37. 37. Most  of  the  US  popula=on  may  be  at  risk  for…     •  Medical  misunderstandings   •  Mistakes  taking  medica=ons,  etc.   •  Excess  hospitaliza=ons  (2X)   •  Poor  health  outcomes  (1.5-­‐3X)   •  Unnecessary  deaths  
  38. 38. Es=mated  Costs  of     Limited  Health  Literacy  on  the     Economy   $106  -­‐  $238  Billion               This  represents  7%  -­‐  17%  of  all   personal  health  care  expenditures     Vernon  J.  et  al,  2007        38 38
  39. 39. Na=onal  HL  Policy  Evolu=on    AHRQ  2001  –  top  11  pa*ent  safety  prac*ces  IOM  Report  on  health  literacy,  2004  Healthy  People  2010:  Objec*ve  11  Joint  Commission:  pa*ent  communica*on  requirements  Surgeon  General’s  Workshop  on  Health  Literacy  -­‐  2006  Na*onal  Ac*on  Plan  to  Improve  Health  Literacy  -­‐  2010  U.S.  Plain  Language  Act  -­‐  2010    
  40. 40. A  ques=on  for  Linda   So given all of this, what can we do to improve Health Communication?
  41. 41. “Clear  Health  Communica=on”  Tips    •  Write  informa=on  at  appropriate  user  level  •  Put  info  in  small  “chunks”  •  Leave  1/3  to  1/2  page  as  “white  space”  •  Limit    info  to  1-­‐3  main  messages  •  Focus  on  behaviors  rather  than  facts  •  Use  photos  of  real  people    •  Make  informa=on  culturally  sensi=ve  Involve  users  as  co-­‐designers!    
  42. 42. Measure  the  Readability  of   Materials  •  Many  tests  (mostly  measure  #  words  in  a  sentence   and  #  syllables  per  word)  •  SMOG  •  Frye  •  Flesch  Reading  Ease  •  Flesch-­‐Kinkaid  (avoid!)  Aim  for  about  a  6th-­‐7th  grade  reading  level     43
  43. 43. “Universal  Design”  Studies  show  that  even  people  who  read  at  a   college  level  prefer  materials  wriUen  at  a  6th-­‐8th   grade  level,  and  understand  them  beUer.    Davis  TC,  Crouch  MA,  Willis  G.  et  al.  The  gap  between  pa*ent  reading  comprehension  and  the  readability   of  pa*ent  educa*on  materials.  J  Fam  Pract  1990;  31:  533-­‐8.             44
  44. 44. Suitability  Assessment  of  Materials   (SAM)    22-­‐item  assessment  tool:  Readability  and     • Organiza*on  of  content   • Formapng   • Cultural  relevance   45
  45. 45. What  do  YOU  think?  What  do  YOU  find  most  difficult  to  explain  about   the  ACA?  a.  The  *metable  for  implementa*on    b.  The  different  components  of  the  law  c.  How  the  Exchanges  will  work/cost  of  plans    d.  All  of  the  above    
  46. 46. Some  of  Our  Work  to  Improve  Consumer  Informa=on  about  Health   Care  &  the  ACA  
  47. 47. Guides  created  by  HRA  and  State  of  California  
  48. 48. 49
  49. 49. Health  Research  for  Ac=on   ACA  Research  Ac=vi=es        -­‐  Survey  of  CA  organiza=ons  providing  ACA   informa=on  to  consumers    -­‐  Assessment  of  available  ACA  resources  in   California    
  50. 50. CA  Study:  Assessment  of  ACA  materials   –  We  tested  10  ACA  fact  sheets  for  readability   with  3  tests   –  Results:  8  of  10  items  tested  at  12th    grade  to   college  reading    levels  (!!)   –  Organiza=ons  wanted  simple  customizable   fact  sheets  in  many  languages   –  Videos  on  using  consumer  assistants,  gerng   preven=ve  care,  and  reques=ng  an   interpreter,  calcula=ng  health  care  costs,  etc.   –  Easy-­‐to-­‐understand  glossary   –  PowerPoint  presenta=ons  for  providers   *Funded by: CA Office of the Patient Advocate and CA Dept of Managed Health Care
  51. 51. Health  Research  for  Ac=on   ACA  Communica=on  Development    •  Glossary  of  easy-­‐to-­‐understand  terms  •  Fact  Sheets  on  8  key  topics  in  3  languages  •  Videos  on  key  ACA  issues:  3  languages  •  Postcards  for  Medicaid  changes    •  Customizable  informa=on  templates  •  PowerPoint  presenta=ons  on  ACA  
  52. 52. Key  takeaways   -­‐  Health  insurance  informa*on  requires  a  high   level  of  health  literacy  skills.  Only  about  12%  of   American  adults  are  es=mated  to  have  that   level  of  skills.       -­‐ Available  ACA  informa*on  has  a  high  readability   level  (college)  and  is  too  hard  for  people  to   understand.  Such  informa=on  should  be  wriUen   at  a  6th-­‐8th  grade  level.     -­‐ Besides  wri,en  informa*on,  people  will  need   other  media,  such  as  videos,  and  also  people  to   help  them.         -­‐  There  many  good  principles    to  develop  easier   to  understand  materials,  both  for  print  and  the   web.    
  53. 53. Join  the  Conversa=on!   Questions or comments for Linda? Please submit questions by using the chat function OR clicking the “raise hand” button to be taken off mute We have our first question for Linda . . .
  54. 54. Discussion/Q&A    Ask Linda!Share with Linda!
  55. 55. It’s  YOUR  turn!Have  you  ever  misunderstood  your  own  health  insurance  rules  and  been  surprised  with  a  bill  or  a  coverage  denial?  a.  Yes  b.  No    
  56. 56. Introducing  Kathy  Paez   Kathy Paez, RN, PhD American Institutes for Research
  57. 57. Mee=ng  the  Challenge  of  Health   Insurance  Literacy  Aler  the  ACA   Kathryn  Paez,  R.N.,  Ph.D.  Copyright © 2012American Institutesfor Research.All rights reserved.
  58. 58. By  2014,  20  million  Americans  are  expected  to  have   access  to  health  insurance  .Source: The Congressional Budget Office, Letter to the Honorable Nancy Pelosi, Mar. 20, 2010,http://www.cbo.gov/doc.cfm?index=11379.
  59. 59. Literacy  in  the  United  States   Percentage  of  adults  in  each  literacy  level,  2003   Below  Basic   Basic   Intermediate   Proficient   Quan*ta*ve   22%   33%   33%   13%   Document   12%   22%   53%   13%   Prose   14%   29%   44%   13%   Source: National Center for Education Statistics, 2003 National Assessment of Adult Literacy
  60. 60. Health  insurance  is  one  of  the  most  complex   commodi=es  sold  to  consumers     Consumer  
  61. 61. Consumers  are  required  to  navigate  through  layers  of  complicated  jargon  to  effec=vely  select  and  use  health   insurance   Provider  Types   Health  Care  Services   U=liza=on  of  Services   Enrollment   Rx  Drug  Coverage   Plan  Type  &  Accounts   Cost  Sharing   ap 1 st Dolla Prev mC Coinsurance Care r Coverag e Max ime imu Medic ers en Prov Coverage t tive Consumer   Life Limit Copay id al Premium Plan Year Deductible Tiered Benefits d Den Guaranteed Bran Preexisting Midle ers i OOP Max Prov Paymal ofRenewal Condition ent In & Out of Network id vel Formulary Group ID Member ID Member Services Rehabilitation Services
  62. 62. What  will  I  pay  for  a  bunionectomy?     Copay?     $100 Deduc*ble?     $1000 How  much  met  already?     Out  of  Network?     $950 usual  charge=$4,500;  actual  charge=$5,450   Coinsurance?   $690 or 20%  before  or  aSer  copay  and  deduc*ble?   $900 Out-of-pocket = $2,740 or $2,950
  63. 63. A  ques=on  for  Kathy   What is health INSURANCE literacy? How is it different from health literacy?
  64. 64. Health  insurance  literacy   defined  “The  degree  to  which  individuals  have  the  knowledge,   ability,  and  confidence  to  find  and  evaluate   informa-on  about  health  plans,  select  the  best  plan   for  their  own  (or  their  family’s)  financial  and  health   circumstances,  and  use  the  plan  once  enrolled.”       Health  Insurance  Literacy  =  Selec=on  +  Use  Measuring Health Insurance Literacy: A Call to Action. A Report from the HealthInsurance Literacy Roundtable, February 2012http://www.consumersunion.org/pub/Health_Insurance_Literacy_Roundtable_rpt.pdf
  65. 65. Breaking  down  health  insurance  literacy  into  its  parts   Knowledge   Document  Literacy   e.g.,  Understand  insurance   terms  and  concepts   e.g.,  Understand  an  explana*on   of  benefits  statement     Self-­‐Efficacy   The  confidence  to  act     Informa*on-­‐Seeking   Cogni*ve  Skills   Skills   e.g.,  Project  use  and     out-­‐of-­‐pocket  cost     e.g.,  Find  in-­‐network  providers   on  plan  Web  site  
  66. 66. A question for Kathy How health insurance literate are consumers?
  67. 67. Overly confident that insurance covers the cost of care  “People  have  the  tendency  to  assume  that  because  you  have  a  par-cular  policy  from  a  par-cular  carrier,  you  have  good  insurance,  which  is  not  true.  You  can  have  Blue  Cross  Blue  Shield,  but  it  doesn’t  mean  that  it’s  a  good  policy.’’  
  68. 68. Don’t  understand  insurance     mi=gates  financial  risk  “We’ve  actually  encountered  a  fair  number  of  people  who  say,  ‘I’m  not  going  to  pay  $300  a  month  because  I’m  not  going  to  use  $300  a  month  of  anything.’  Some-mes  they  don’t  get  the  concept  that  if  you  don’t  need  it  now,  it’s  for  a  poten-al  future  health  problem  and  you  have  to  pay  in  advance.  You  don’t  sign  up  when  you  get  sick.”  
  69. 69. Have  difficulty  assessing  value  •  Gravitate  towards  cheaper,  high-­‐risk  op*ons   or  more  expensive  but  less  cost-­‐effec*ve   op*ons  
  70. 70. Have  difficulty  appropriately  using  insurance    •  Don’t  get  established  with  a  physician  •  Assume  physicians  will  refer  them  to     in-­‐network  providers  or  don’t  consider  network  at  all.  •  Have  trouble  applying  plan  rules:     “Is  a  referral  needed  or  not?”  •  Pay  out-­‐of-­‐pocket  costs  without  pursuing  insurance   nonpayment.  
  71. 71. What  do  YOU  think?  •  Where  should  consumers  turn  to  find  out   details  about  their  coverage?  a.  Health  care  provider  b.  Health  plan  or  Medicaid  office    c.  Employer  HR  department    d.  Health  care  advocacy  group  e.  I’m  not  sure    
  72. 72. Bridging  the  gap  
  73. 73. Reducing  the  tremendous  cogni=ve  demand  on   consumers   • Standardize     • Simplify  informa*on   • Harness  technology  
  74. 74. How  the  ACA  will  help   ACA  Reforms   September  23,  2012   January  1,  2014   Standardize  choice   •  No  life*me  limits   •  4  comparable  actuarial   •  100%  coverage  for  some   value  *ers     preven*ve  services   •  Coverage  of  “essen*al   benefits”   •  Plans  offered  in  health   insurance  exchanges  (HIX)   are  “qualified”   Simplify  consumer   Summary  of  benefits  and   informa*on   coverage  (SBC)  materials  with   •  Limit   coverage  examples   •  Standardize   •  Plain  language   Harness  technology   Plans  on  HIX  must  have  a   method  to  calculate  OOP  cost     Reforms apply to small group and individual plans in private market and sometimes large group plans.
  75. 75. Coverage  levels  under  the  ACA   “the  metals”   Metal  Tier   Actuarial  Value   More  Coverage   Pla*num   90%   Gold     80%   Silver     70%   Bronze   60%   Versus70 percent actuarial value: the plan pays 70percent on average for covered medical services;30 percent on average is paid for by beneficiaries.
  76. 76. Standardized  “essen=al  benefits”  required  by   the  ACA  •  Ambulatory  pa*ent  services,  such  as  doctor’s  visits  and  outpa*ent   services  •  Emergency  services  •  Hospitaliza*on  •  Maternity  and  newborn  care  •  Mental  health  and  substance  use  disorder  services    •  Prescrip*on  drugs    •  Rehabilita*ve  and  habilita*ve  services  and  devices  •  Laboratory  services  •  Preven*ve  and  wellness  services  and  chronic  disease  management  •  Pediatric  services,  including  oral  and  vision  care  
  77. 77. Standardize  summary  of  benefits   and  coverage  •  Mandated  that  all  insurance  plans  use  this  form   beginning  in  2012  •  Standardized  and  tested  format    •  Allows  comparison  of  coverage  op*ons  •  Includes  coverage  examples  •  Includes  glossary  of  terms   8  pages!!!  
  78. 78. Summary  of  benefits  and   coverage  
  79. 79. Summary  of  benefits  and   coverage  
  80. 80. Glossary  of  terms   Deductible The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1000, your plan won’t pay anything until you’ve met your $1000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.
  81. 81. Glossary  of  terms  
  82. 82. Tools  to  calculate  consumer  cost  
  83. 83. It’s  YOUR  turn  ACA  and  it’s  implementa*on  will  make  it  easier   for  consumers  to  make  good  decisions  about   health  insurance  a.  Agree  b.  Disagree  c.  Not  sure  
  84. 84. Reducing  the  tremendous  cogni=ve  demand  on   consumers   • Standardize     • Simplify  informa*on   • Harness  technology  
  85. 85. Choice  architecture  Organizes  and  frames  informa*on  •  Filtering  to  limit  what  appears  on  the  screen  •  Sor*ng  informa*on  •  Comparing  side  by  side  (quality,  cost)  
  86. 86. Filter,  sort  and  compare  
  87. 87. Compare  side  by  side  
  88. 88. Key  takeaways   •  Selecting and using health insurance is tremendously complex! •  We, as health care professionals, all need to become health insurance navigators and support the less health insurance literate. •  Attention is needed on navigating insurance once consumers get into the system.
  89. 89. Join  the  Conversa=on!   Questions or comments for Kathy? Please submit questions by using the chat function OR clicking the “raise hand” button to be taken off mute We have our first question for Kathy. . .
  90. 90. Discussion/Q&A    Ask Kathy!Share with Kathy!
  91. 91. Ques=ons  for  our  speakers  Kathryn Paez, RN, Linda Neuhauser,PhD, American DrPHInstitutes for University ofResearch California-Berkeley,
  92. 92. Health  Literacy:  Undervalued  by  Public  Health?  A  tool  for  public  health  professionals.                                                      Prepared  for  the  American  Public  Health  Associa*on  Community  Health  Planning  &  Policy  Development  Sec*on  Tammy  Pilisuk,  MPH        AUG  2011  
  93. 93. Next  steps  •  Today’s slides will be posted online, along with an archived version of this webinar, for future access•  An evaluation will be sent to you shortly ─ please let us know if you would like to follow-up on anything we touched on today•  Have additional questions? Contact our presenters or moderator.
  94. 94. Thanks  to  our  speakers!   Kathryn Paez, RN, Linda Neuhauser, PhD, American DrPH, University of Institutes for California-Berkeley Research
  95. 95. Resources  •  CDC:  Health  Literacy h,p://www.cdc.gov/healthliteracy/index.html  •    Literacy  Informa*on  and  Communica*on  System   (LINCS):    h,ps://community.lincs.ed.gov/  •  American  Medical  Associa*on’s  health  literacy  site:   h,p://www.ama-­‐assn.org/ama/pub/about-­‐ama/our-­‐ people/affiliated-­‐groups/ama-­‐founda*on/our-­‐ programs/public-­‐health/health-­‐literacy-­‐program.shtml       96
  96. 96. Resources  (cont.)  •  US  Department  of  Health  and  Human  Services     Web  Usability  Guidelines:  www.usability.gov       h,p://www.usability.gov/guidelines/index.html    •  Communica*ng  Risks  and  Benefits:  An  Evidence-­‐ Based  User’s  Guide:      h,p://www.fda.gov/AboutFDA/  ReportsManualsForms/Reports/ucm268078.htm    (see  especially  Chapter  9,  “Health  Literacy”  and    Chapter  14,    “Readability,  Comprehension,  and  Usability”)  
  97. 97. Resources  (cont.)  •  ACA  Regula*ons  and  Guidance:   h,p://www.dol.gov/ebsa/healthreform/ index.html#5  •  Web  Portal  for  the  public      www.healthcare.gov  •  Qualita*ve  research  reports  by  Consumers  Union   evalua*ng  health  insurance  tools  for  consumers   h,p://www.consumersunion.org/health.html     98
  98. 98. 99
  99. 99. Speaker  Contact  Informa*on    Linda  Neuhauser,  DrPH,  MPH  lindan@berkeley.edu  hUp://www.healthresearchforac=on.org    Kathy  Paez,  RN,  PhD  kpaez@air.org    hUp://www.air.org      
  100. 100. Thank  you  to  our  Sponsors     Community Health Planning and Policy Development Section, APHA
  101. 101. Thank  you  to  our  planning   commiUee  •  Tammy  Pilisuk,  MPH,  APHA-­‐CHPPD  •  Erin  Brigham,  MPH,  CareSource,  APHA-­‐CHPPD  •  Amanda  Crowe,  MA,  MPH,  Impact  Health   Communica*ons,  LLC  •  Meghan  Bridgid  Moran,  PhD,  San  Diego  State   University,  School  of  Communica*ons    •  Nancy  Murphy,  MSHC,  Metropolitan  Group  
  102. 102. Conclusion   Thank  you!  
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