V ERBAL R EMEDIES LITERACY HEALTH LITERACY HEALTH INSURANCE LITERACY Best communication practices for in-person assisters in OE3 Don Rubin

V ERBAL R EMEDIES Your naicisyhp has dednemmocer that you have a ypocsonoloc. Ypocsonoloc is a test for noloc recnac. It sevlovni gnitresni a elbixelf gniweiv epocs into your mutcer. You must drink a laiceps diuqil the thgin erofeb the noitanimaxe to naelc out your noloc. Can you read this?

Platinum Plan Gold Plan Silver Plan Bronze Plan Catastrophic Plan Benchmark Plan Qualified health plan In-network provider Advance premium tax credit Maximum out of pocket expense Life qualifying event Household PPO POS HMO Co-pay Co-insurance Deductible Can you read this?

V ERBAL R EMEDIES Comprehension of Medicare Patients with Low Literacy Percent Correct Identify next appointment 73% Take medicine every 6 hours 52% Take medicine on empty stomach 46% Interpret blood sugar value 32% Upper GI instructions (4th grade) 24% Medicaid Rights (10th grade) 0% GGa Gazmararian et al., 1999

V ERBAL R EMEDIES 43% of uninsured didn’t know about government subsidies for insurance

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1 of 6 adult Georgians reads at K-6 level 16% of adult Georgians lack a HS diploma 1 of 7 unemployed Georgians has not finished high school 75% of incarcerated persons lack a HS diploma. 1 in 10 Georgians is an immigrant and does not speak English as their native language. Adult Literacy in Georgia

V ERBAL R EMEDIES Integrate Health Literacy into Adult Basic Education and ESoL

What is Health Literacy? The Patient Protection and Affordable Care Act of 2010, Title V, defines health literacy as… … the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. V ERBAL R EMEDIES

Why is Health Literacy Important? Persons with limited health literacy: Experience more preventable hospital admissions. Too often end up in the ER for conditions that could be treated at home or in the doctor’s office Are less likely to adhere to treatment. Commit more medication errors Do a poor job of self-management of chronic conditions Less likely to obtain health insurance

Health Literacy can mitigate health disparities Race predicts variance in HIV medication nonadherence (AOR=2.4) When a measure of health literacy is added to the set of predictors, race becomes non-signficant [Osborne, Paashe- Orlow & Davis, 2007] Similar result among elderly for self- rated health (Bennett et al, 2009)

What is Health Insurance Literacy? Ability to find and evaluate information about health plans Ability to select the best plan for their (family) financial and health situation Knowledge about using insurance once enrolled to obtain needed preventive and therapeutic care. V ERBAL R EMEDIES

Why is Health Insurance Literacy Important? Consumers stay in the same plan year after year, ignore better choices (Gruber). 88% cannot calculate health insurance costs using a table based on income and family size (Kutner et al.). Consumers struggle with cost-sharing terms, e.g., coinsurance, allowed amount, annual benefit (Quincy). Poor health insurance literacy leads to… – Reluctance to enroll – Selecting plan that does not meet needs or is unaffordable – Failing to utilize benefits V ERBAL R EMEDIES

Can we make it any easier?

What’s in the Health Insurance Literacy Toolkit? Packaging & staging information for usability SOCO – Single Over-riding Communication Objective Engaging Consumers/Dialogue – inviting Consumer questions Plain language Analogies & Metaphors Examples Stories Visuals

V ERBAL R EMEDIES Draw this! You got insurance from the Marketplace. So you must send in a tax return next year. You have to attach a special form called 1095A with your taxes. The 1095A form tells about your insurance cost. The Marketplace will give you the information you need for your 1095A. The information from the Marketplace will come on another form called 8962

V ERBAL R EMEDIES Plain language & redesign exercise -- Can you make this notice more health literate?

Enrollment is not the finish line: Help clients access healthcare services Budget for monthly premiums Choose a primary care provider Set aside money for out-of-pocket costs Schedule preventive services Getting past the front desk Learn how to see a doctor Shop again to e-enroll

V ERBAL R EMEDIES Don Rubin