Health Literacy Implications for Health Care Reform Workshop Summary (2011) / Chapter Skim
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4 Opportunities and Challenges for Those Implementing the ACA
4 Opportunities and Challenges for Those Implementing the ACA
Pages 33-48
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From page 33... ...
; the private health insurance industry; a voluntary quality accreditation organization; and health system pharmacists. CENTER FOR MEDICARE AND MEDICAID SERVICES Frank Funderburk Center for Medicare and Medicaid Services There are a number of provisions of the ACA that are particularly relevant to the CMS, including: • upporting informed consumer decision making; S • tandardizing prescription drug information and insurance plan S information; • mproving communications with diverse, low literacy patients; I • mproving beneficiary-provider communication; I • ncouraging use of new preventive care benefits; and E 33
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CMS has conducted extensive focus groups and individual interviews with a variety of audiences, as well as an experimental field test of direct marketing techniques, to see if the agency could achieve a measurable impact in the number of people in this target audience applying for the subsidy benefit. The data suggest that a carefully con structed CMS letter can increase the application rate for the low-income subsidy if it is written in plain language, provides very simple steps to follow, and includes the phone number of a local contact person.
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The Center for Medicare and Medicaid Innovation, funded under the ACA, is designed to help realize the vision of an ideal health care system through high quality, reduced avoidable costs, and patient- and community-centered care. The approach looks at the health care system as a whole, with the health care consumer as an active part of the system.
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Accountability for improving health literacy could also support more general health care system improvements. In conclusion, Funderburk said that improved health literacy can help build an accountable health care system; support better consumer decision-making; help reduce avoidable costs; produce better health outcomes; and improve the quality of life of CMS beneficiary populations and the people who care for them.
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A challenge for many of the member compa nies is that they are working to build and advance heath literacy programs at the same time that they are trying to implement health care reforms. While the ACA does not specify that all patient tools, programs, and approaches should be developed using principles of clear health communication, it offers enormous potential to develop tools that are clear, easy to use, and relevant, and for the industry to learn as it goes along.
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. Even though insurers are not the locus of information on prescription drugs, AHIP has an opportunity because many of its member companies use personal health records that include beneficiaries' prescription drug information.
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. The more people are participants in their own health care, the more likely they will be taking actions such as researching the qualifications of doctors, recognizing reliable health websites, using health resource books, finding comparative information about hospital quality, or comparing available health plans.
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The NCQA is looking at cross-cutting measures, and structural and process measures, as well as how best to collect the data, including reaching out to disad vantaged or vulnerable populations. Research Needs With the new Center for Medicare and Medicaid Innovation, the NCQA envisions opportunities to address issues around activating patients, providing them with simple information, and giving them the support they need to be involved in self-care decision making.
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prescription container labeling standards. As the key profession with expertise in medication therapy, pharmacists are integral to the collaborative-practice model that is at the core of medical homes.
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Only about 30 to 50 percent of patients with chronic conditions adhere to their prescribed medication therapies, and medication cost is an important cause of low adherence. Pharmacists can play an important role in managing therapies by reviewing the therapy that the patient is receiving; identifying cost-effective therapies and optimizing outcomes; resolving medicationrelated problems; optimizing complex regimens; designing and managing adherence programs; and finally, educating patients about the safe and effective use of their medications.
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3021 Center for Medicare and Medicaid Innovation o dvocate adoption of elements of MTM as part of development and testing A of new care models • Sec. 5305 Geriatric education and training • hronic disease testing and treatment, medication reconciliation, cognitive C impairment assessment, and wellness guidance for elderly • Meaningful use of electronic health records • Patient-centered care models such as medical home o harmacist collaboration for medication therapy services P SOURCE: McEvoy, 2010 Health literacy opportunities include effective communication through the prescription container label, comprehensible patient-centered supplemental materials, and clear counseling, education, and training.
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The ASHP Pharmacy Practice Model Initiative, for example, is focused on direct patient care as opposed to delivery of product. The Center for Health Transformation's 21st Century Intelligent Pharmacy Project is conducting similar pilot work looking at the transformation of pharmacy practice as a key component in providing affordable health care.
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People in the medical home model were very happy with their care and understood and appreciated the concept of coordinated care, while the other group was skeptical of the whole idea (although neither was familiar with the term medical home)
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Advice for Implementers A participant asked panelists what their advice would be to those that are now charged with implementing the ACA, in terms of inserting health literacy into program design now, as opposed to having to retrofit it later. Scholle noted that there is no requirement for the reading level of informational materials in the medical home standards, in part because of the burden it would place on small physician practices.
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47 OPPORTUNITIES AND CHALLENGES workforce strategy needs to encompass all health care providers and staff. Funderburk said that providers also need well-designed, simple, step-bystep information and systems so they are not wasting their limited time trying to figure out how to be in compliance.
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