Beyond Enrollment: Helping the Newly Insured be Part of the Solution

Kavita Patel, MD

Kavita Patel, MD

Dr. Kavita Patel was unable to attend the conference in person due to health problems, but joined the conference by Skype. She talked about problems with healthcare in the U.S. and how “one of the most common myths… is that the U.S. has the best healthcare in the world.” This may be true for some Americans, but compared to other countries, we are not getting good value for our healthcare dollars, she said. That’s why the Affordable Care Act (ACA) is so significant, but sometimes that gets lost in all the discussion about enrollment.

The ACA is bringing sweeping changes to all sectors of healthcare, impacting hospitals, makers of medical devices, health insurance companies, and employers. Although some aspects of the ACA have been delayed, like the employer mandate and applicant verification, many of these changes have already come to pass:

  • Expanded access to coverage by building on the existing healthcare system
  • More competitive and transparent healthcare markets
  • Reformed the health insurance market and hold insurers accountable
  • Simplified healthcare administration and reduction in waste, fraud, and abuse
  • Improved quality and delivery systems to lower costs
  • Focus on prevention and wellness

Dr. Patel talked about polling on the ACA. She noted that while many Americans don’t like “Obamacare,” some specific ACA provisions are very popular — such as getting rid of preexisting conditions and keeping 26-year-olds on their parents’ health insurance. “So there are some messaging problems,” she said.

She discussed how health literacy intersects with the ACA. She listed the Institute of Medicine’s attributes of a health literate organization and laid out a health literacy agenda. Dr. Patel illustrated how low health literacy is costly in both human and financial terms. “You can make a business case, a patient case, and a provider case for health literacy,” Dr. Patel said.

Dr. Patel listed questions every consumer and provider should ask about health insurance. They are based on a project called Let’s Ask 4: What are my choices for health insurance?, How do I get it?, How do I use it?, How much will it cost me? Dr. Patel closed with examples of health literate consumer guides.

Numeracy Requirements for Health Insurance Enrollment

Ellen Peters, PhD

Ellen Peters, PhD

Ellen Peters gave an introduction to numeracy. She also discussed how numeracy is relevant to the Affordable Care Act (ACA). Numbers instruct, inform, and give meaning to information about health plans, medicines, and treatments, Peters said.

But not all people can understand and use numbers effectively. Even highly educated people can be innumerate, she said. Less numerate people are more likely to be female, older, less educated, and poor. Plus, they are less likely to have health insurance, Peters said. Thus, the average numeracy skills in the ACA population will be lower than those of currently insured consumers. The newly insured will also have less knowledge and experience in healthcare settings, Peters said. “They may not know as well how to be a good patient — how to interact with doctors and nurses, how to record symptoms.”

Peters talked about numeracy skills that we learn in school. She also listed numeracy skills that we use to make decisions. We use these skills when we:

  • Seek information
  • Pay attention to numeric information
  • Ignore irrelevant information
  • Recall numeric information
  • Are sensitive to numeric information
  • Derive affective meaning from numeric information

Peters gave some examples of using numeracy. “Healthcare providers often underestimate how difficult these tasks are. And patients are often reluctant to admit that they don’t understand,” she said.

The way information is presented can reduce numeracy differences, Peters said. She offered strategies for providers to communicate with less numerate people:

  • Provide numeric information. “Numbers help whether you’re more numerate or less numerate,” she said.
  • Do the math for people.
  • Provide evaluative meaning, particularly when numeric information is unfamiliar. “If people don’t know how good or bad the number is, they’re not able to use the information,” Peters said. But take care when providing evaluative meaning, because it’s a big responsibility.
  • Draw attention to important information.
  • Set up appropriate systems to assist consumers and patients.

Yes It’s Clear… But Is It Effective? Why It’s Important to Get Input and Feedback from Your Intended Audience

Janet Ohene-Frempong, MS

Janet Ohene-Frempong, MS

Janet Ohene-Frempong emphasized that clarity and comprehension are necessary, but they may not be sufficient. If information lacks consumer appeal, readers may ignore it, reject it, and not use it. The only way to make sure materials are effective is to get input from the intended audience, she said. “It’s about how effectively we communicate, and how well people can navigate the information.”

In effective materials, she said, information:

  • Is easy to find
  • Looks easy to read
  • Is easy to read
  • Is easy to understand
  • Seems easy to relate to

To make information easy to relate to, she advised, check with the intended audience before you start a project. “Everybody’s got a story, if we’re willing to ask a good question and listen.”

Find out if the information is:

  • Personally relevant
  • Acceptable and non-offensive
  • Believable
  • Persuasive, convincing
  • Practical and easy to respond to

Listen to what people have to say about their beliefs, hopes and concerns. Then use the information you gather. Acknowledge and address their points of view in the information you provide, she said. “You want to get a sense of who you’re writing for, or producing a video for, and respond appropriately, with compassion,” she said.

Ohene-Frempong gave examples of how to make materials more effective and explained how to plan a writing project.  She also spoke about how much health literacy means to her and the deep impact it can have as “people’s health, and sometimes people’s lives, depend on it.”

Panel on Health Literacy in Public Health Practice: Examples from the Field

From left to right: Cynthia C. Peña, MPH, MSW, Steve Sparks, Bonnie Braun, PhD, Cynthia Baur, PhD (Moderator)

From left to right: Cynthia C. Peña, MPH, MSW, Steve Sparks, Bonnie Braun, PhD, Cynthia Baur, PhD (Moderator)

Panel members spoke about using health literacy in public health contexts. They talked about three successful education programs.

Cynthia Peña talked about a program called Sweet Success. It was developed by the California Diabetes and Pregnancy Program (CDAPP). The program’s goal was to train providers and patients in the area of gestational diabetes. It promoted the best ways to manage diabetes before, during, and after pregnancy, Peña said.

Steve Sparks talked about Health Literacy Wisconsin’s flu program. It was called Let’s Talk about the Flu. The program offered workshops in partnership with trusted organizations. It included a plain-language workbook, a flu prevention kit, and vouchers or access to free vaccines. “We were able to reach people who really needed that shot, and wouldn’t have done it without a little encouragement,” Sparks said.

Bonnie Braun talked about the Smart Choice Health Insurance program. The University of Maryland developed it. The developers made changes based on input from the intended audience. For example, they integrated definitions into text and used a spread layout, she said. Braun noted that buying insurance is confusing for everyone — not just for people with limited health literacy.