1. The National Action Plan to Improve Health Literacy: A View from CMS Frank Funderburk 1 & Eileen Zerhusen 2 1 Director, Division of Research Strategic Research & Campaign Management Group, 2 Creative Services Group 10/20/2010 Presented at Seventh National Conference on Quality Health Care for Culturally Diverse Populations. Baltimore, MD1 Note: The statements expressed here are those of the authors and do not necessarily reflect the views or policies of CMS

2. Goals of the National Action Plan Help people understand their health care options and make better decisions. Give people trusted health and safety information that they can use to make better decisions and get the care they need when they need it. Use our materials to improve their quality of life. Make this information available where people live and work. Measure how well we are doing these things. Learn how to improve our approaches and materials. Share what we learn with others. 10/20/20102

3. Health Literacy Concepts Demonstrated Skill – Have they shown they can do it? Capacity – Could they do it, if trained? Motivation – Would they even try to do it? Shared Function – How do social and individual factors interact? Next steps – What should we do? Where should we intervene? 10/20/20103

4. Research to Develop Consumer- Based Communications Strategy Understand “consumer reality” ◦ Values ◦ Beliefs ◦ Needs ◦ Behavior ◦ Barriers ◦ Motivations ◦ Reactions to key concepts ◦ Literature review/Environmental scan (What is already out there? How can we learn from it?) 10/20/20104

5. Social Marketing Supports Health Literacy Goals Understand target audience – health literacy, culture, language, attitudes, perceptions Identify barriers Test materials and messages Develop campaigns Evaluate behavioral impact Refine and repeat process 10/20/20105

6. Some Vulnerable Populations Medicare ◦ Chronic Disease ◦ Seniors ◦ Disabled (Dual eligibles) ◦ Low-income Medicaid/CHIP ◦ Low-income family ◦ Low English proficiency 10/20/20106

7. Using Social Marketing to Improve Communications Low Income Subsidy Home Health Compare Discharge Planning Checklist Understanding Medicare Choices Motivational Assessment of Messages CHIP Enrollment Toolkit for Making Written Materials Clear & Effective 10/20/20107

8. Mixed Methods Research Strategy for Improving LIS Enrollment 10/20/20108

9. Initial Formative Research Approaches to formative research waves: ◦ Focus groups with audience segments (What to call it? What will motivate you to enroll? What are the barriers? What will be most [least] helpful?) ◦ In-depth interviews (How can we improve communication? Where do you go for information? Why did you go there?) ◦ Cognitive testing (Was that understood? Is this clearer? How would you say this?) Results/Recommendations ◦ Focus on building awareness of benefit ◦ Message outside of traditional communication windows/channels (not during open enrollment, photo-novella vs. written guides) ◦ Lack of perceived need/eligibility ◦ Expectation of continuous enrollment opportunity 10/20/20109

10. Decision-Making Style 10/20/201010

11. Understanding the Audience Understanding the Audience Psychographic Themes ◦ Strong family orientation ◦ Enjoy outdoor activities ◦ Want and appreciate “a good deal” Communication Themes ◦ Down to earth, altruistic “Stop & Smell the Roses” ◦ Pride, heritage, stability “Buy American” 10/20/201011

12. Experimental Field Study 10/20/201012

13. Key Findings – We Can Improve LIS Application Rate 10/20/201013

14. Home Health Compare Homepage Introduced 2003 10/20/201014

15. Home Health Compare Redesign 2010 10/20/201015

16. Discharge Planning Checklist 10/20/201016

17. Simple Step-by-Step Reminders 10/20/201017

18. Engaging Caregivers 10/20/201018

19. Simplifying Medicare Choices 10/20/201019

20. Improving Motivational Messaging 10/20/201020

21. Sharing Lessons Learned 10/20/201021

22. Next Steps Expand use of alternative communication channels/techniques (e.g., Edutainment) Expand to new audience segments Help staff and partners communicate more effectively Address paradoxical effects of generally effective health education Explore ways to measure population health literacy 10/20/201022

23. Consumer Empowerment Create a person-centered system of healthcare Consumer testing is key to health literacy assessment Target and tailor materials Segment on factors other than demographics Get and share the toolkit! ◦ Go to http://www.cms.gov, select Outreach & Education, and then select Outreach. Click on the toolkit to read or download it. 10/20/201023