Industry slow to improve patient health literacy
Skip to main content
MDHC_Logotype_white
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • This Week's News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • 'Little old West Virginia' sets pace on vaccine rollout
      Firefighter walking towards forest fire.
      Wildfires producing more harmful pollution
      Dr. Bruce Siegel
      By protecting the healthcare safety net, Biden can put us on the path to a stronger country
      4 cyberscams for hospitals to watch out for
    • 'Little old West Virginia' sets pace on vaccine rollout
      Dr. Bruce Siegel
      By protecting the healthcare safety net, Biden can put us on the path to a stronger country
      Joe Biden
      Revamp of the nation's vaccination effort may not be enough
      COVID-19 hastens hospitals' revenue cycle outsourcing moves
    • The Check Up: Trenda Ray
      The Check Up: Trenda Ray of the University of Arkansas for Medical Sciences
      Trenda Ray
      Q&A: Arkansas nursing leader looking for creative staffing solutions as COVID cases surge
      Cook Lydia 4x6_i.jpg
      Northeast Ohio health systems increase community benefit values in 2019
      Vaccine rollout hits snag as health workers balk at shots
    • CMS approves rule forcing insurers to ease prior authorization
      COVID-19 still a big uncertainty for insurers in 2021
      Health insurers' outlook boosted after Dems' Georgia win
      humana_i.jpg
      Humana supports Ohio not-for-profits with $500,000
    • 'Little old West Virginia' sets pace on vaccine rollout
      Joe Biden
      Revamp of the nation's vaccination effort may not be enough
      CMS will raise Medicare Advantage plan payments by 4.08% in 2022
    • Operation Warp Speed Dr. Moncef Slaoui, Pfizer Group President Angela Hwang, Moderna CEO Stephane Bancel, CVS Health Executive Vice President Karen Lynch and McKesson CEO Brian Tyler participate in a panel discussion on the COVID-19 vaccine.
      Hospitals, drug companies strive to stand out virtually at JPM
      Intermountain, Trinity, Memorial Hermann behind $300M private equity fund
      Operation Warp Speed to bump up McKesson's stock price
      Reporter's notebook: J.P. Morgan's 2021 health conference
    • A man in a room with servers.
      Momentum grows to outsource hospital tech functions in 2021
      5 things to know about Google's $2.1B Fitbit acquisition
      Providence bets on machine-learning, consolidating data centers
      Mental health treatment was most common telehealth service during COVID
    • Sticking to Mediterranean diet is good for the brain
      Chance of COVID-19 triage care looms over Arizona hospitals
      U.S. ramps up vaccinations to get doses to more Americans
      367146427.jpg
      Should businesses mandate that staff get the COVID vaccine?
    • Cone Health CEO, CFO to depart amid pending Sentara merger
      Tower Health's finance chief resigning after years of steep losses
      AHRQ director Gopal Khanna resigns in response to Capitol riot
      Brigham president stepping down after Moderna controversy
    • Midwest
    • Northeast
    • South
    • West
  • Insights
    • ACA 10 Years After
    • Best Practices
    • InDepth Special Reports
    • Innovations
    • The Affordable Care Act after 10 years
    • New care model helps primary-care practices treat obesity
      doctor with patient
      COVID-19 treatment protocol developed in the field helps patients recover
      Rachel Wyatt
      Project to curb pressure injuries in hospitals shows promise
      Yale New Haven's COVID-19 nurse-staffing model has long-term benefits
    • Dr. James Hildreth
      How medical education can help fight racism
      Modern Healthcare InDepth: Breaking the bias that impedes better healthcare
      Videos: Healthcare industry executives describe their encounters with racism
      Michellene Davis
      Healthcare leadership lacks the racial diversity needed to reduce health disparities
      Hospital divided into multiple pieces
      Health systems may be warming to offshoring, a mainstay practice for insurers
    • A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
      self service station
      COVID-19 pushes patient expectations toward self-service
      Targeting high-risk cancer patients with genetics
      A nurse holds up a phone with a message to a family member saying surgery has started.
      Texting, tablets help hospitals keep family updated on patient care
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Highmark Health inks six-year cloud, tech deal with Google
      Study: 1 in 5 patients report discrimination when getting healthcare
      HHS proposes changing HIPAA privacy rules
      Android health records app launches at 230 health systems
    • California hospitals prepare ethical protocol to prioritize lifesaving care
      Amazon, JPMorgan Chase, Berkshire Hathaway disband Haven
      Digital pathways poised to reshape healthcare continuum in 2021
      Healthcare was the hardest hit by supply shortages across all U.S. industries
    • A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
      New care model helps primary-care practices treat obesity
      How hospitals are building on COVID-19 telehealth momentum
      Researchers: Hospital price variation exacerbates health inequities
    • MedPAC votes to boost hospital payments, freeze or cut other providers
      Most Next Gen ACOs achieved bonuses in 2019
      Congress recalibrates Medicare Physician Fee Schedule after lobbying
      CMS approves rule to encourage value-based drug pricing
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
    • Health Systems Financials
      Executive Compensation
      Physician Compensation
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Wellstar CEO calls adapting for the pandemic her bold move
      Howard P. Kern
      Recognizing the value of telehealth in its infancy
      Dr. Stephen Markovich
      A bold move helped take him from family doctor to OhioHealth CEO
      Dr. Bruce Siegel
      Why taking a hospital not-for-profit was Dr. Bruce Siegel’s boldest move
    • Barry Ostrowsky
      Ending racism is a journey taken together; the starting point must be now
      Laura Lee Hall and Gary Puckrein
      Increased flu vaccination has never been more important for communities of color
      John Daniels Jr.
      Health equity: Making the journey from buzzword to reality
      Mark C. Clement and David Cook
      We all need to 'do something' to fight inequities and get healthcare right, for every patient, every time
    • Dr. Bruce Siegel
      By protecting the healthcare safety net, Biden can put us on the path to a stronger country
      Healing healthcare: some ideas for triage by the new Congress, administration
      Dr. Sachin H. Jain
      Medicare for All? The better route to universal coverage would be Medicare Advantage for All
      Connectivity: a social determinant of health that can exacerbate all the others
    • Letters: Eliminating bias in healthcare needs to be ‘deliberate and organic’
      Letters: Maybe dropping out of ACOs is a good thing for patients
      Letters: White House and Congress share blame for lack of national COVID strategy
      Letters: VA making strides to improve state veterans home inspections
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Award Programs
    • Nominate
    • Previous Award Programs
    • Other Award Programs
    • Best Places to Work in Healthcare Logo for Navigation
      Nominations Open - Best Places to Work in Healthcare
      Nominations Open - Health Care Hall of Fame
      Nominations Open - 50 Most Influential Clinical Executives
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Top 25 Minority Leaders
    • Top 25 Women Leaders
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • COVID-19 Event Tracker
    • Leadership Symposium
    • Healthcare Transformation Summit
    • Women Leaders in Healthcare Conference
    • Workplace of the Future Conference
    • Strategic Marketing Conference
    • Social Determinants of Health Symposium
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Minority Leaders Gala (2022)
    • Top 25 Women Leaders Gala
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
    • Carter Dredge
      Next Up Podcast: Ready, set, innovate! Innovation and disruption in healthcare
      Next Up Podcast: COVID-19, social determinants highlight health inequities — what next?
      Next Up Podcast: Saving Rural Health
      Ceci Connolly
      Next Up Podcast: How to navigate the murky post-election waters
    • An older man wearing a mask receiving a vaccine.
      Beyond the Byline: Verifying information on the chaotic COVID-19 vaccine rollout
      doctor burnout
      Beyond the Byline: How healthcare supply chain struggles contribute to employee burnout
      Beyond the Byline: Covering race and diversity in the healthcare industry
      Beyond the Byline: How telehealth utilization has impacted investor-owned company earnings
    • Leading intention promote diversity and inclusion
      Introducing Healthcare Insider Podcast
    • The Check Up: Trenda Ray
      The Check Up: Trenda Ray of the University of Arkansas for Medical Sciences
      The Check Up: Dr. Kenneth Davis
      The Check Up: Dr. Kenneth Davis of Mount Sinai Health System
      The Check Up: Dr. Thomas McGinn
      The Check Up: Dr. Thomas McGinn of CommonSpirit Health
      The Check Up: Mark Ganz
      The Check Up: Mark Ganz of Cambia Health Solutions
    • Video: Ivana Naeymi Rad of Intelligent Medical Objects
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Finance
November 03, 2018 01:00 AM

Industry slow to improve patient health literacy

Steven Ross Johnson
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print
    Dr. Hanh Nguyen, of Washington Permanente Medical Group, shares information with a patient at Rainier Medical Center in Seattle.

    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.

    Sonia Pineda, right, a nurse coordinator at Rio Grande Valley Health Alliance, discusses some care information.

    Rio Grande Valley decided to try a different approach toward educating its patients. Leaders hired four care coordinators to schedule home visits with the high-risk patients who make up 10% of the total population they serve but account for half of all healthcare costs.

    In the more relaxed setting of their home, Farias said patients began feeling more at ease and shared details with coordinators about difficulties they were having with taking their medications, care access, or problems they might have been having with a specialist.

    “Sometimes they really don't want to ask for help, and we're trying to break down those barriers and let them know it's OK to ask for help,” she said.

    But despite the growth in awareness and the efforts of a few providers, critics argue most hospitals have not made much progress in promoting health literacy among their patients, and some don't believe it's a financial slam-dunk to do so.

    “Honestly, there isn't a business case for a hospital to do it,” said Dr. Andrew Snyder, chief medical officer at healthcare consulting firm Evolent Health. “What I think hospitals consider to be helping with patient literacy is more along the lines of patient engagement, which for hospitals amounts to marketing.”

    Educating or marketing?

    Few would dispute that one of the goals of helping patients become more health literate is for them to become more engaged in their health, which leads them to make more informed medical decisions.

    But Snyder said hospitals oftentimes seek patient engagement for the purpose of keeping them loyal to their brand. He said many of the materials hospitals provide are often too confusing and hard for patients to find, requiring them to go to different sites to learn about their health conditions. He said a better system would be to take a more coordinated approach toward health literacy by creating a platform that provides patients with a single access point to find all the relevant information they need.

    “A simple place that brings together the patient's literacy format would vastly improve the use,” Snyder said.

    But easier access to education resources is only one of several challenges that continue to hinder providers from promoting better patient involvement in their healthcare. A number of hospitals are discovering that the effort to make patients more health-literate often depends on the relationship established with a physician. Yet many providers aren't sufficiently trained in strategies that will encourage patients to become more engaged for the purpose of becoming a shared partner in managing their care.

    Attempting to bridge the gap has been the focus of a project developed over the past year at UPMC to create a center for shared decision-making to address gaps in clinician training when it comes to engaging patients.

    The concept was adopted from a model first developed by Dartmouth College in 2014, according to Amy Ranier, senior director of patient experience at the University of Pittsburgh Medical Center, who said the purpose is to help providers learn how to reframe the patient-doctor conversation to focus on their quality-of-life issues.

    “The concept of the patient not just engaged in the options but also getting to say what's important to them in terms of their outcomes is novel,” Ranier said. “That's not how the health system runs.”

    Ranier said shared decision-making requires a high level of health literacy among patients, which in turn requires the hospital to do more in its education effort than simply distributing pamphlets.

    UPMC employs a screening tool to review all information to make sure that it is written in a way that is understandable before it is sent out to a patient.

    Much of the information is transmitted through the system's patient portal, MyUPMC. Dr. Glenn Updike, medical director for the portal, said the organization has seen an increase in the number of patients who reported reading their messages and reviewing their online after-visit summaries.

    Updike said such efforts can help patients better understand their health information, but acknowledged it was difficult to measure the efficacy of their work in terms of whether their initiatives were making patients more engaged, and whether that engagement led to better self-management and improved health outcomes.

    Measuring success

    Many healthcare providers that have just begun their health literacy promotion efforts don't know what, if any, impact they will ultimately have on their patients' health outcomes. But a number of stakeholders have seen their work produce results.

    Dr. Dennis Weaver, chief clinical officer at New York-based insurer Oscar Health, said the company has found success in achieving high levels of member engagement by offering members free access to Oscar's telemedicine service for the past several years.

    Each member upon enrolling into a health plan is assigned to a personalized concierge team that answers questions about their health insurance and helps schedule provider appointments.

    Weaver said 62% of Oscar members reached out on a monthly basis with questions about their health over the course of the third fiscal quarter of this year. Weaver said the high level of engagement the company sees through its technology provides an opportunity to educate patients through consultations with the concierge team.

    “We don't even call it healthcare literacy,” Weaver said. “We do things every day that are at a very consumer-focused level and we do it not really using the language of healthcare literacy but rather at their level.”

    Weaver said a key point is interacting with members on their terms, which means not overwhelming a patient with too much information while always being ready to answer questions.

    The more personalized approach toward the dissemination of health information is an approach Kaiser Permanente has begun to employ as part of the system's health literacy effort in recent years.

    Dr. Stephen Tarnoff, president and executive medical director of the Washington Permanente Medical Group, said leveraging information from the system's electronic health record has been key in helping patients make more informed decisions. He said clinicians engage in what he called a “robust shared decision-making” process with patients any time there is a question about the best course of action.

    Kaiser also uses several patient “decision aids” to assist patients in weighing their care options. They include brochures, DVDs and online interactive tools.

    A study on the efficacy of such tools by Kaiser Permanente in 2012 looked at whether they had an effect on the rates of surgeries performed and their outcomes. The study found the introduction of the decision aids led to a 26% decrease in total knee replacements and 38% fewer total hip replacements.

    “We find that we have a lot more satisfied patients with fewer complications,” Tarnoff said.

    Movement as a country toward improving health literacy has been slow. Numerof's Abrams said the lack of a centralized effort on the part of the federal government to address low health literacy is somewhat surprising given that HHS recognized it as a major problem back in 2010 when it released a National Action Plan.

    He said much of the effort to improve health literacy is still done by not-for-profit advocacy organizations, which he said were limited in their scope. He said hospitals in general have been late in addressing the issue of health literacy, until it became apparent the issue was driving up costs.

    But he noted there are signs of a cultural shift as more hospitals take on value-based risk for providing care and younger clinicians who are more open to the idea of educating patients step into the field.

    “This is a cultural thing, and cultures change slowly,” Abrams said. “It's a process that takes time.”

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Hospitals, drug companies strive to stand out virtually at JPM
    Hospitals, drug companies strive to stand out virtually at JPM
    Intermountain, Trinity, Memorial Hermann behind $300M private equity fund
    Intermountain, Trinity, Memorial Hermann behind $300M private equity fund
    Sponsored Content
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2021. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Insights
      • ACA 10 Years After
      • Best Practices
      • InDepth Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Top 25 Minority Leaders
        • Top 25 Women Leaders
      • Nominate
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Leadership Symposium
        • Healthcare Transformation Summit
        • Women Leaders in Healthcare Conference
        • Workplace of the Future Conference
        • Strategic Marketing Conference
        • Social Determinants of Health Symposium
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Minority Leaders Gala (2022)
        • Top 25 Women Leaders Gala
      • Webinars
      • COVID-19 Event Tracker
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing