The Importance of Literacy, Health Literacy, and Health Insurance Literacy in Enrollment KENTUCKY PRIMARY CARE ASSOCIATION SEPTEMBER 11, 2014
Overview kynect Update Literacy Health Literacy Health Insurance Literacy Strategies Resources Questions
kynect Update Special Enrollment Periods Changes to APTC amounts All changes made in next administratively feasible month On or before 15 th of the month -> following month After the 15 th of the month -> the month after the next month Requests should not be made to retroactively apply an increase in APTC. Differences reconciled at tax filing If no APTC was applied Use the request template to outline the details
kynect Update Special Enrollment Periods Effective Date Changes made only in following circumstances System generated ineffective date due to system error (template) Agent/kynector input error (template) Technical issue that prevented individual from applying (template) Resolved appeal
kynect Update Special Enrollment Periods Effective Date Changes not approved for An individual did not receive ID card in time to use insurance An individual had other coverage for the time they are requesting the change Kynectors/applicants can request a change that would not be approved by KHBE with the issuer
kynect Update Special Enrollment Periods Termination date changes Approved for: System error Agent/kynector input error Individual has died Will not approve: Customer requests for other reasons Can contact issuer to request change
kynect Update Problem Log Ongoing fixes with Immigrants and Refugees Notices sent out Deemed ineligible for Medicaid Incorrectly receiving Medicaid
kynect Update MCO Open Enrollment and MCO Changes 10/27/14 12/12/14 1-855-446-1245 Language line at 1-800-635-2570
kynect Update Medicaid recertification/renewal Received notice Renew through self-service portal, DCBS or on the notice
kynect Update QHP Notice as reminder to update information QHP recertification/renewal Passive renewal
kynect Update kynector Recertification Training Supplemental trainings available now Additional trainings required for recertification Not yet available
kynect Update Responsibility to Serve Those Seeking Assistance Applies to all assisters If unable to provide assistance, can make appropriate referral
The Importance of Literacy, Health Literacy, and Health Insurance Literacy in Enrollment
What Does it Mean to Have Low Literacy? Difficulty using written information Difficulty or inability to read, write, speak, and compute and solve problems Different levels 8 th grade reading level- difficulty reading and understanding more complex terms and ideas 6 th grade reading level- unable to read or understand some common words 4 th grade reading level- unable to read or understand many common terms Illiterate- unable to read or understand written communication Source: Health.gov Quick Guide to Literacy
Identifying People with Low Literacy Skills Challenge Developed coping strategies I can read Don t view that they have a problem 2/3 of those who admitted having a reading problem had never told their spouse 19% had never told anyone
Scope of the Issue 1 of 5 adults reads at a 5 th grade reading level or below. The average reading level is 8 th or 9 th grade SOURCE: National Patient Safety Foundation
Example Time to start sharing your information with us. Please make sure you answer every question. Remember to list all of the dependents in your household, even family members that do not need health coverage. Tell us about anyone who is on your tax return. Reading Grade Level 8.1
Example Application e-sign screen Reading Grade Level 10.0
Example Does anyone applying for health coverage on this application need help with activities of daily living (like bathing, dressing, etc.) or live in a medical facility or nursing home? Reading Grade Level 11.0
Example Does anyone in your household have any medical bills from the last three months that he/she needs help paying? By medical bills, we mean the amount you have to pay for: doctor or dentist visits hearing aids, eyeglasses, or other durable medical supplies medicines prescribed by a doctor hospital visits health insurance premiums, fees, copayments, deductibles, and other payments transportation to medical appointments Reading Grade Level 18.2
Identifying People with Low Literacy Skills Read one word at a time Difficulty with interpreting what was read Take things literally Concrete terms Difficulty understanding application of examples
Identifying People with Low Literacy Skills Avoid reading altogether Satisfy and suffice Stop reading as soon as they ve found the first plausible answer to what they are looking for, event if it is not the best answer or even the correct one Have difficulty recalling what they ve just read
Health Literacy The degree to which individuals have the capacity to obtain, process, communicate, and understand basic health information and services needed to make appropriate health decisions. Health Literacy is the ability to find, understand, and use complex information to make choices about health care. SOURCE: Affordable Care Act, 2010; Enroll America
Scope of the Issue 36% of U.S. adults have Below Basic / Basic Health Literacy 53% 12% 14% 22% Below Basic (14%) Basic (22%) Intermediate (53%) Proficient (12%) SOURCE: http://nces.ed.gov/pubs2006/2002483.pdf
Scope of the Issue Type of health insurance Medicare = 57% Below Basic or Basic Medicaid = 60% Below Basic or Basic No insurance = 53% Below Basic or Basic
Scope of the Issue More than half of the nearly 50 million uninsured Americans have either basic or below-basic health literacy. Difficulty understanding health information written at or below the fifth grade level 90 million people in the US have difficulty understanding and acting on health information The average reading level is 8 th or 9 th grade but medical materials are written above10 th grade level. SOURCE: Enroll America; National Patient Safety Foundation
You Need Health Literacy to: Fill out patient information and consent forms Follow treatment plans Read handouts, brochures, and news about health topics Figure out timing and dosage of medicines Follow cancer screening guidelines Use medical tools for personal care Figure out health insurance benefits Know where to go for appropriate care and much more
Example You have a 1 in 10 chance of having Disease A, and a 1 in 20 chance of having Disease B in the next 10 years. Which is the patient at highest risk for? People with low health literacy are more likely to say Disease B because 20 is greater than 10. SOURCE: http://www.healthed.com Health Literacy KY
Example Take 2 tablets by mouth twice daily. How should the patient take her medicine? Only 1 out of 3 patients with low literacy skills can correctly demonstrate how many pills to take. SOURCE: http://www.healthed.com Health Literacy KY
Why is Health Literacy Important? Many patients are dealing with multiple chronic diseases, doctors orders, tests medicine Health insurance coverage, Medicare or Medicaid benefits Complicated by low literacy and low health literacy
Why is Health Literacy Important? Patients with low health literacy: Use fewer preventative services Make more medication errors Make more visits to the ER Have more hospitalizations Have poorer health outcomes Have higher mortality rates AHRQ estimates the cost at $106 billion to $238 billion 17% of all U.S. personal health care expenditures SOURCE: Health Literacy Universal Precaution Toolkit, AHRQ 2006
Health Literacy Myths Myth: Years of schooling are a good measure of someone s health literacy level. Fact: Regardless of one s education level, when a health care provider uses unfamiliar medical language it is difficult to understand fully what is being said. Myth: Most providers can tell if someone has low health literacy. Fact: Many people with low health literacy are well spoken, look over written materials and say they understand, and hold white collar or health care jobs. Myth: Most adults can manage their own health. Fact: Almost 9 out of 10 adults lack the skills needed to manage their health and prevent diseases.
Health Insurance Literacy Enroll America Health insurance literacy measures the degree to which individuals have the knowledge, ability, and confidence to find and evaluate information about health plans, select the best plan for their financial and health circumstances, and use the plan once enrolled.
Literacy Financial Literacy Health Insurance Literacy Health Literacy
Literacy Financial Literacy Health Insurance Literacy Health Literacy kynect Enrollment
Enrollment creates a possibility for education and assistance!
General Tips Education works when it s From a trusted source Just-in-time Actionable information Consumer tested
General Tips Be aware of, understand, and follow your organization s literacy and health literacy policy Work with other staff/supervisors to create standard policies, processes and expectations
General Tips Assume that everyone has low literacy and health literacy Create a safe environment for everyone Warm greeting Creating space for what is important to the applicant Slow down and speak clearly Be specific and concrete Repeat important points in different ways Use images or guides whenever possible
General Tips Avoid asking Does that make sense? Okay? Is that clear? Do you understand? But do check for understanding Ex: Have them tell you how the plan will work rather than you telling them
General Tips Teach Back Technique to check for understanding Individual restates in their own words Repeat until they demonstrate understanding Do not present it as a test of their knowledge, but rather how well you explained the information. Health insurance is confusing and I want to make sure I did a good job. Avoid asking if they can tell you
Structure of the Enrollment Appointment Pre-assess potential health insurance literacy Have you had insurance before? Insurance is confusing, from 1-10 how comfortable are you with insurance related words? In the past, have you picked out your own insurance plan?
Structure of the Enrollment Appointment Use a conversational tone Focus on what they need to know or do Be an application tour guide This part of your application Chunk and check Make a few points Summarize Check for understanding Recap Introduce the next section Repeat Don t rush
Structure of the Enrollment Appointment Encourage Questions Those with low literacy and low health literacy are less likely to bring up questions unsolicited Show me how you would What questions do you have? instead of Do you have questions?
Written Communications Make materials easy to read Make them look easy to read Boil it down to what is important Be consistent with word choice APTC, payment assistance, CSR, special discounts
Written Communications Appropriate reading level simple page layout and the use of pictures/illustrations enhance the readability information Writing should be: Written in plain language or everyday words and not contain l jargon At or below the 6th grade equivalent reading level Written in an active voice Limited to 3-5 need to know information items In short sentences that have only one subject per sentence
Health Insurance Literacy Tips Be aware of consumer s preconceived notions PPOs are good! HMOs are bad! I ve had this BCBS PPO network before. XXX is always covered. Bronze is bad and Platinum is the best. XXX takes Coventry. I know that for sure. Cheaper plans will cost me more in the long run.
Resources Prepared Put together resource packets addressing Health literacy Navigating health system How to use insurance What to bring to an appointment Health Insurance Literacy Terms Get Covered Guides Job aids to breakdown with plan selection
Classes/One-on-one sessions You have people, think creatively about how you can get them the information they need.
Time is limited! Don t reinvent the wheel! Partner with other organizations who can help you teach consumers about health insurance Pull in others from your organization who can help Advocate for better tools and more consumerfriendly website design be a part of a feedback loop
New Resources Health Literacy Resources HRSA FAQs-> http://bphc.hrsa.gov/outreachandenrollment Resources on the blog Kypca.net -> Community Blog Health Assisters Guide to Tax Rules Eligibility for Immigrants Patient Letter template Applicant Account Creation Guide
Next Webinar: October 9 th, 2014 11 AM- 12PM Medicare Basics for Enrollment Assisters KPCA Annual Meeting October 20-21 Register Now!