It wasn't long after the primary-care focused Rio Grande Valley Health Alliance in McAllen, Texas, was formed in 2013 that it became apparent the accountable care organization's patients had trouble talking with physicians about their health during office visits.
Part of the problem was language related—most of the ACO's 7,500 patients in the southern Texas border town speak English as a second language. But a bigger challenge was the intimidation patients felt when they were meeting a doctor in the clinic was limiting their understanding of their health and how to improve or maintain it.
“We knew that our patients were sometimes willing to just say 'yes, I understand,' or they were reluctant to really show that they didn't understand certain aspects of their care,” said Victoria Farias, program administrator at Rio Grande Valley.
It was a problem with serious potential consequences. Many of the patients within the ACO are on Medicaid and considered to be high-risk, high-cost patients with high incidence of end-stage renal disease and diabetes.
The challenges Rio Grande Valley has encountered in educating its patients about their health is indicative of what many healthcare providers across the country are facing as the industry plays catch-up in recognizing the importance of having a health-literate patient population. Yet only an estimated 12% of individuals in the U.S. are considered to have a proficient level of literacy to effectively manage their health and prevent disease.
“Someone who has low health literacy usually has been demonstrated to have poorer health outcomes and their costs, because of higher utilization and later utilization of the healthcare system, is much higher,” said Pamela Cipriano, president of the American Nurses Association.
Health literacy, defined by HHS as having the “capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions,” is associated with lower rates of preventable hospitalizations and emergency department visits, better management of chronic conditions, and lower healthcare costs.
For years hospitals were not given an incentive financially to promote health literacy since doing so under the traditional fee-for-service reimbursement model would have resulted in less use of healthcare services and lower revenue. As more providers shift toward valued-based pay models, greater recognition is being given to the importance of promoting health literacy as a means of reducing and controlling costs.
“When hospitals were being paid to fix their mistakes, the lack of health literacy was a profit generator,” said Michael Abrams, managing partner at healthcare consulting firm Numerof & Associates. “Hospitals did not, by and large, own the issue.”
Estimates of the cost of low literacy indicate the problem is only growing. According to the National Institutes of Health, low health literacy cost the U.S. healthcare system between $106 billion and $238 billion in 2003, accounting for as much as 17% of all personal healthcare expenses. By 2015, the estimated cost of low health literacy was estimated at between $1.6 trillion and $3.6 trillion, according to researchers at George Washington University.
“If we ask 'is there a business case for health literacy?' there is,” Cipriano said. “That shouldn't be the compelling reason, but I believe it is one that really has been able to demonstrate value.”
Farias said the lack of effective dialogue has hindered efforts to educate patients on ways they could better manage their conditions, which led to more frequent visits to the doctor's office, more healthcare services being performed, and higher costs.