Health Literacy 2014
Navigating Sometimes Tough Waters
Steven M. Berkowitz, MD
SMB Health Consulting,
Austin, TX
512-415-6095
steve@smbhealthconsulting.com
Health Literacy is:
The degree to which individuals have the capacity to obtain,
process, and understand health information to make
appropriate health decisions.
Health literacy is not simply the ability to read. It requires a complex group of
reading, listening, analytical, and decision-making skills, and the ability to apply
these skills to health situations. For example, it includes the ability to understand
instructions on prescription drug bottles, appointment slips, medical education
brochures, doctor's directions and consent forms, and the ability to negotiate
complex health care systems.
US Dept HHS, Healthy People 2010
How Literate are You?
National Literacy
Initiatives
You as a Participant
in Your Health Care
Individual Pt
Empowerment
Your Insurance
Knowledge
Your Health
Knowledge
Interactions
with Providers
The Role of
Social Media
How Literate are You?
National Literacy
Initiatives
You as a Participant
in Your Health Care
Individual Pt
Empowerment
Your Insurance
Knowledge
Your Health
Knowledge
Interactions
with Providers
The Role of
Social Media
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Provide everyone with access to accurate and
actionable health information
Deliver person-centered health information and
services
Support lifelong learning and skills to promote
good health
Institute of Medicine, 2013
1. Develop and disseminate health and safety information that is accurate, accessible,
and actionable
2. Promote changes in the health care system that improve health information,
communication, informed decision making, and access to health services
3. Incorporate accurate, standards-based, and developmentally appropriate health and
science information and curricula in child care and education through the
university level
4. Support and expand local efforts to provide adult education, English language
instruction, and culturally and linguistically appropriate health information
services in the community
5. Build partnerships, develop guidance, and change policies
6. Increase basic research and the development, implementation, and evaluation of
practices and interventions to improve health literacy
7. Increase the dissemination and use of evidence-based health literacy practices and
interventions
Institute of Medicine, 2013
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Organizations and individuals that develop and disseminate health and safety information:
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Health care providers
Public health officials
Health communicators and educators
Health care facilities
Government agencies
Commercial, academic, and nonprofit producers of health and safety information
Payers of health care services
◦ Health plans
◦ Government health care purchasers
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Print, audiovisual, and electronic/ social media
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Those responsible for food, drug, and medical device production and distribution
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Employers
Institute of Medicine, 2013
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Adults over the age of 65 years
Racial and ethnic groups other than White
Recent refugees and immigrants
People with less than a high school degree or GED
People with incomes at or below the poverty
Non-native speakers of English
Institute of Medicine, 2013
Patients with low health literacy have:
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Higher risk of hospitalization
Longer hospital stays
Less likely to comply with treatment
More likely to make errors with medication
More ill when they seek medical care
Total cost to US between $106 billion to $238 billion annually
Institute of Medicine, 2004
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Patient-physician communication
Drug labeling Medical instructions and medical compliance
Health information publications and other resources
Informed consent
Responding to medical and insurance forms
Giving patient history
Public health training
Assessments for allied professional programs, such as social
work and speech-language pathology
1. Has leadership that makes health literacy integral to its mission, structure, and operations.
2. Integrates health literacy into planning, evaluation measures, patient safety, and quality
improvement.
3. Prepares the workforce to be health literate and monitors progress.
4. Includes populations served in the design, implementation, and evaluation of health
information and services.
5. Meets the needs of populations with a range of health literacy skills while avoid-ing
stigmatization.
6. Uses health literacy strategies in interpersonal communications and confirms un-derstanding
at all points of contact.
7. Provides easy access to health information and services and navigation assistance.
8. Designs and distributes print, audiovisual, and social media content that is easy to understand
and act on.
9. Addresses health literacy in high-risk situations, including care transitions and
communications about medicines.
10. Communicates clearly what health plans cover and what individuals will have to pay for
services.
Brach, Institute of Medicine, 2012
How Literate are You?
National Literacy
Initiatives
You as a Participant
in Your Health Care
Individual Pt
Empowerment
Your Insurance
Knowledge
Your Health
Knowledge
Interactions
with Providers
The Role of
Social Media

The more knowledge I have about my own body and physical and
mental condition, the better I will do
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The more knowledge I have about the health care system, the
better and more efficiently I will be able to navigate it
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When I am ill is a poor time to get acquainted with the system
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Data transparency has shown a wide range of quality and prices
available in the market
How Literate are You?
National Literacy
Initiatives
You as a Participant
in Your Health Care
Individual Pt
Empowerment
Your Insurance
Knowledge
Your Health
Knowledge
Interactions
with Providers
The Role of
Social Media
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I know more about my body than anybody else
I am the most important member of my health care team
I am with me every day of my life
The time to start improving my health is now
The more I can learn about my own health and medical
conditions, the better prepared I am to succeed
If I am not motivated to lead a healthy lifestyle, I compromise
my whole health care team
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Increasing transparency of quality and price
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Higher deductible insurance
Value Based Purchasing
The increasingly informed consumer will make
health care decisions on the basis of VALUE
Value Based Purchasing
The increasingly informed consumer will make
health care decisions on the basis of VALUE
VALUE =
Outcomes + Satisfaction
Cost
Value Based Purchasing
The increasingly informed consumer will make
health care decisions on the basis of VALUE
VALUE =
Outcomes + Satisfaction
Cost
The CONSUMER ultimately determines which
of the above elements constitute VALUE
Data Transparency
That which is measured, tends to improve.
That which is measured publicly, tends to improve faster.
“What we concluded was that even when hospitals know their
performance is not good, that's not sufficient motivation for them to do
something. Making it public made a big difference in motivating them to
improve.”
Judith Hibbard, Health Affairs 2003
Total Health Care Spending
OECD, 2012
Total Premium and Percentage paid by Worker
Kaiser HRET, 2013
Percentage of Plans with $1,000 or $2,000 Deductible
Kaiser HRET, 2013
Average Single Premium Deductible
Kaiser HRET, 2013
Steve has a URI symptoms and feels bad!
Steve has great insurance but a $3,000 deductible
What does he do?
Treatment Options:
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Emergency Department
Urgent Care
PCP visit
Local Pharmacy
Self Treat.. rest, OTC meds...
Approximate*:
Out of Pocket
Wait
$ 300
2-3 hrs
150
1 hr
120
1 hr (if available)
80
30 min
10
? none
* The actual cost may not be known until the
evaluation is completed
Knowledge of how to get through the health care
system is more important than ever before….
Not just in terms of my own health, but also, my
own budget !!
Knowledge of how to get through the health care
system is more important than ever before….
Not just in terms of my own health, but also, my
own budget !!
No one is in a better position to do this than ME
How Literate are You?
National Literacy
Initiatives
You as a Participant
in Your Health Care
Individual Pt
Empowerment
Your Insurance
Knowledge
Your Health
Knowledge
Interactions
with Providers
The Role of
Social Media
So What’s New in Health Care Reform?
Same old wine in a brand new bottle?
1. What are my choices for health insurance?
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How old am I?
What state do I live in?
Can I get insurance through my job?
Can I get insurance through my spouse, parent/ guardian or school?
Am I a US citizen, US national, or legal US resident?
How much do I make a year, and how does it compare to the Federal
Poverty level?
 Have I or am I serving in the US armed services?
 Am I pregnant?
 Do I have End Stage Renal Disease or Lou Gehrig’s Disease?
Wu, Institute of Medicine, 2013
2. How do I get it?
 Medicaid: Apply at local social services office, health department,
Social Security office
 CHIP: call 1-877-KIDS-NOW or www.insurekidsnow.gov
 Medicare
 Medicare advantage
 Medigap
 Employer sponsored
 Health Insurance Exchange
 Tricare
 VA
 HIS
Wu, Institute of Medicine, 2013
3. How do I use it?
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What’s on my card?
What type of plan do I have? PPO, HMO, POS
Where can I get care? Hospital, ED, Urgent care, provider network
What do I do for prescription care?
Do I understand my SBC? Summary of Benefits and Coverage
Wu, Institute of Medicine, 2013
4. How much will it cost me?
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What are my covered services?
What is my co-pay?
What is my deductible?
What is my out of pocket maximum?
Wu, Institute of Medicine, 2013
How Literate are You?
National Literacy
Initiatives
You as a Participant
in Your Health Care
Individual Pt
Empowerment
Your Insurance
Knowledge
Your Health
Knowledge
Interactions
with Providers
The Role of
Social Media
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Family history
Age related prevention
Healthy Diet
Eliminating unhealthy lifestyle decisions
Exercise
My medical conditions
My medications and treatment
Long term effects of my medical conditions
How Literate are You?
National Literacy
Initiatives
You as a Participant
in Your Health Care
Individual Pt
Empowerment
Your Insurance
Knowledge
Your Health
Knowledge
Interactions
with Providers
The Role of
Social Media
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
What is my main problem?
What do I need to do?
Why is it important for me to do this?
How Literate are You?
National Literacy
Initiatives
You as a Participant
in Your Health Care
Individual Pt
Empowerment
Your Insurance
Knowledge
Your Health
Knowledge
Interactions
with Providers
The Role of
Social Media
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59% of US Adults have looked online for health information in past
year
80% of online inquiries start with search engine
50% of searches on behalf of someone else
16% tried to reach out to others who share condition
30% have consulted online reviews or rankings
35% of Americans have gone on line to figure out a medical
condition
Pew, Health On Line 2013
Of those 35% who went online:
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35% never pursued medical attention
41% medical professional confirmed the diagnosis
18% say the medical professional did not agree
1% medical professional was inconclusive
Pew, Health On Line 2013
Who Uses the Internet for Health Care?
Percentage of Adults who Looked Online to Diagnose
Pew, Health On Line 2013
Who Uses the Internet for Health Care?
Percentage of Adults who Looked At Rankings
Age
Pew, Health On Line 2013
Who Uses the Internet for Health Care?
Percentage of Adults who Looked At Rankings
Education
Pew, Health On Line 2013
Who Uses the Internet for Health Care?
Percentage of Adults who Looked At Rankings
Income
Pew, Health On Line 2013
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Who runs the website?
What is the purpose of the website?
What is the original source of the information?
How current is the information?
How does the website choose its links?
What information does the site collect on you?
Is the information in the chat sites accurate?
FDA, December 2005
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Can you easily see who sponsors the website?
Is the sponsor a Federal agency or a medical school
,or is it related to one of these?
Can you find the mission or goal of the sponsor of
the website?
Can you see who works for the organization and who
is the author? Is there contact information?
Can you tell when the information was written?
Is your privacy effected?
Does the website make claims that seem too good to
be true? Are quick, miraculous cures promised?
NIA, April 2007
How Literate are You?
National Literacy
Initiatives
You as a Participant
in Your Health Care
Individual Pt
Empowerment
Your Insurance
Knowledge
Your Health
Knowledge
Interactions
with Providers
The Role of
Social Media
To the world you may be just one person,
But to one person you may just be the world.
Unknown