"eHealth Literacy, Getting Started" was presented at the Center for Health Literacy Conference 2011: Plain Talk in Complex Times by Shannah Koss, MPP, President, Koss on Care LLC (Principal, MAXIMUS eHealth Literacy Collaborative). Description: Learn how to design and develop a consumer-oriented strategy and foundation for outreach, education, and engagement in the early stages of your state or community's health IT and reform programs. Find out about funding options. Share challenges and solutions for integrating eHealth literacy tools and resources into the emerging health IT infrastructure.

1. eHealth Literacy: Getting Started
Shannah Koss, President Koss on Care LLC 1
Principal, MAXIMUS eHealth Literacy Collaborative

2. AGENDA
 Introductions
 eHealth Literacy – Our Definition
 Health Information Technology (HIT)
foundations - The Health Information Technology
for Economic and Clinical Health (HITECH) &
the Affordable Care Act (ACA)
 What is happening in your state or community
 Consumer outreach, education and engagement
 When to start?
 How to start?
 Federal and state opportunities 2
 Emerging resources

3. EHEALTH LITERACY
 eHealth Literacy - the ability of
consumers, directly or with assistance,
to use computers and other
communication technologies to find, read
and understand health information to
make personal decisions.
 Why it is important
 Close to 50% of all US adults have problems
understanding many aspects of health care
 Older people, non-whites, immigrants and those
with low income have disproportionately low
literacy and are more likely to have chronic disease 3

4. RECOVERY ACT HIT INVESTMENTS
“ …HITECH Act, part of the Recovery Act,
designated funding to modernize the health care
system by promoting and expanding the adoption
of health information technology.”
 $22.6 Billion investment
 Advance rapid adoption and „meaningful‟ use, e.g.
, improve care, population health and engage
patients in their care through the use of HIT
 Electronic health record (EHR) incentives
 Investments in infrastructure (including health
information exchanges (HIEs), training and
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broadband access

5. HEALTH REFORM BASICS
 Affordable Care Act (ACA) established provisions
to expand insurance coverage, control health care
costs, and improve the quality of the health care
delivery system
 Many components of ACA and many HHS
initiatives launched pursuant to the legislation
build upon the emerging technology to improve
care
 Some components require additional HIT
infrastructure, in particular the Insurance
exchanges
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6. KEY DATES AND INITIATIVES
Recovery Act (2009)
Consumer/Patien
t and family
engagement is
Medicare & Medicaid EHR incentive programs
critical to success
Medicare meaningful use
HIEs prepare Robust meaningful
for supporting use
meaningful use Medicaid adoption, Medicaid
implementation and meaningful use and
incentives Beacon outcomes
2010 2011 2012 2013 2014
Expanded Medicaid New Medicaid
Accountable Care
coverage and option for a health Health insurance
Organizations pilots
coverage options home option exchange
implementation
CMS Establishes Health Insurance Exchange demos
Innovations Center
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Affordable Care Act (2010)

7. RECOVERY AND REFORM
EHEALTH LITERACY DRIVERS
Recovery/HITECH Reform
 Meaningful Use (MU)  Explicit health literacy
 Patient engagement  Expanded coverage
 Quality Metrics  Equity/reduced
 health status improvement disparities
 HIE participation  Workforce
 Patients and providers
 Patient information
 Beacon Communities
 Prevention & wellness
 Near term patient outcomes
 patient self-management  Quality improvement
 Particularly for duals
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Communication is the key to required informed choices

8. ENHANCE INFORMATION INFRASTRUCTURE
DEPENDENCE
 Recovery and Reform both rely on
enhance information systems to succeed
 Recovery ~22B+ investment will fail if:
 Providers do not adopt EHRs or
demonstrate meaningful use
 Patients do not engage
 Cost savings cannot be demonstrated
 Reform will fail (in any future form):
 If enrollment and improved quality don‟t
lower cost
 Without new models for duals and
chronically ill 8
All outcomes depend on better IT leverage

9. THERE IS AN INCREASE IN NATIONAL
CONSUMER OUTREACH, AWARENESS
AND EDUCATION CAMPAIGNS
 Care about your care – RWJ/AHRQ/ONC
 HealthIT.gov – ONC
 Developing Alzheimer‟s plan
 Million hearts initiative
 Healthcare.gov
 Medicare and Veterans Health blue button
 National eHealth Collaborative (NeHC)
Consumer Consortium for eHealth
 National Action Plan for Health Literacy
 Healthy People 2020
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10. WILL IT ALL COME TOGETHER?
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11. STATE AND LOCAL LANDSCAPES
VARY
HIT and HIE variation Reform variation
 EHR adoption highly  Political and legal
variable uncertainties
 HIE implementation
ranges from planning to  Many states are
various levels of embracing the
operational capabilities opportunities
 Wide range of governance  All states struggle with
and consumer input
models their health care
 Clear versus unclear expenditures
consumer focus  Funding opportunities
 Beacon communities with flow to states and non-
accelerated requirements profits
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12. WHAT IS HAPPENING IN YOUR
STATE OR COMMUNITY
 Provider EHR adoption
 HIE implementation or operations
 Existing or new reform
 Medical homes
 ACOs
 Medicaid expansion
 Prevention or dual eligible initiatives
 Partnership for patients
 Are consumers/patients engaged? When and how?
 Are consumer advocacy and community-based health
organizations involved?
 Will the investment support tools and resources to
foster patient engagement? 12

13. FIRST STEPS IN HIT PATIENT ENGAGEMENT
EDUCATION CONSENT
Health Information
Exchange Consent Form
I _______ consent to allowing
my electronic medical records
to be shared through the state
of…
Xxxxx xxxx xx xxx xxxx
I understand my rights to ....
_____________ ______
Name Date
CONNECTION YOUR RECORD
Increased patient engagement in 2013 depends on early education 13

14. FIRST STEPS IN HEALTH REFORM
 Insurance exchanges lag behind HIEs, but many
initial parts of reform are happening and require
patient engagement
 Some expanded eligibility is already happening
 Some quality initiatives are already underway
 Early adopters and innovators e.g., pioneer ACOs
 Consider which initiatives in your state would
perhaps be best served by early outreach and
education that will foster use of the technical
infrastructure to better serve consumers
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15. DISCUSSION
 In which HITECH or Reform programs or
projects are you most interested?
 What stage is the program or project in planning,
design development or implementation?
 Are consumers currently engaged in the
development stage of the program?
 How if at all are consumers being engaged?
 What are the main barriers or challenges to
advancing consumer outreach, education and
engagement throughout the process?
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16. GETTING STARTED – SELECT A
SAMPLE PROJECT
 Identify your target programs and initiatives
 What is the phase of development?
 Is, or was, there consumer representation in the
design phase?
 Are there opportunities for input?
 How will information be made available and
communicated?
 Who are the many stakeholders and
organizations that would support consumer
engagement?
 How are websites and online tools being used?
 What is or isn‟t working in your state? 16

17. NO SINGLE RIGHT APPROACH
 Emerging better practices
 Understand the dynamics in your state or region
and look for similar successful models
 Get involved
 Key players may want or at least be open to your
help
 Look for others that want to advance the
consumer facing component of the program
 ehealth literacy solutions leverage online
resource to support all appropriate channels of
communication 17

18. GOOD CONSUMER ORIENTED HIE
WEBSITES
 Focused messages, icons and tabs for consumers,
patients and families
 Introductory messaging that reaches all audiences
 Consumer specific FAQs
 Contextual information - not just about HIE,
incentive program or opting in or out
 Simplify the alphabet soup
 Multiple languages
 Graphics, video, mirror your diversity
 Helps set realistic expectations
 Targeted clinical information – linking to specific
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clinical initiatives

19. POTENTIAL FUNDING SOURCES
LEVERAGING UNPRECEDENTED $$$
 HIE, REC and Beacon Community funding
 Medicaid funding:
 90/10 EHR incentive $‟s for consumer education and outreach
 90/10 health home designation dollars
 75/25 Translation and interpretive services CHIP & Medicaid
 CMS innovations grants and demonstrations
 New care model development for Medicare, Medicaid or Duals
 Models include: Medical homes technology enable care coordination;
community based health teams w/patient self-management; fully
integrated care for duals; new patient safety partnership program
 Secretary can consider many additional factors focused on patient
engagement through technology (6 of 7 factors)
 Medicaid incentives for prevention of chronic disease program
 ACO investment
 Health home funding option and patient centered medical home
 Title V HRSA funding for cultural competency 19
 Non-profit initiatives – Robert Wood Johnson “Care about your
care”

20. CONCLUSION
 Growing focus, opportunities and resources
 Still need to help educate program staff on the
importance of consumer engagement
 Emphasis on outcomes and metrics will help
 Join the discussion: LinkedIn eHealth Literacy
Community
http://www.linkedin.com/groupsDirectory?trk=hb_side_g
rpsdir
 Contact information:
 MAXIMUS Center for Health Literacy
http://www.maximus.com/services/health/health-literacy
 Shannahkoss@maximus.com
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