By Cindy Brach, MPP, Senior Health Care Researcher, Agency for Healthcare Research and Quality (AHRQ) and Bernard Rosof, MD, MACP, Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
The U.S. Department of Health and Human Services (HHS) has developed a roadmap to drive the health care system to deliver better value. Shifting to a value-based payment system would hold providers accountable for helping their patients stay healthy and financially reward them for a job well done.
To be successful in this transformation, health systems will have to address health literacy. Health care has become so complicated that nearly everyone has some difficulty understanding health information and navigating the health care system. Furthermore, more than 1 in 3 adults have limited health literacy, which means that they have difficulty with basic health-related tasks.
In the roadmap, HHS identified 4 “Ps” — items that are key to delivering better value, and there’s a health literacy imperative for each item.
1. Patients as empowered consumers
All too often, people don’t learn how much health services cost until after they have received them. According to one survey, almost 20 percent of patients report simply forgoing care when they have questions about cost. Price transparency, an attribute of a health literate organization, requires telling patients what their out-of-pocket costs will be ahead of time. To make informed choices that provide high value, people also need information on quality that they can easily understand and use — as well as tools that will let them comparison shop to make choices based on both cost and quality. Patients need useful, understandable information about their health care options to be empowered consumers.
2. Providers as accountable patient navigators
Health care organizations, particularly primary care practices, are being asked to take greater responsibility for assuring that patients get the services they need, when they need them. The Charter on Professionalism for Health Care Organizations recognizes that organizations have an increasingly strong influence on the practices of health care professionals. In order to generate value, health systems — not just health professionals — must become health literate organizations. All levels of a health organization need to be accountable for helping patients navigate the health care system and access services that can improve health outcomes.
3. Payment for outcomes
Value-based payment systems reward hitting the “sweet spot” of balancing quality with costs. One way value-based payment systems do this is by basing a portion of health care payments on patients’ reports of the care they receive. A suite of surveys, called the Consumer Assessment of Healthcare Providers and Systems (CAHPS®), asks patients about their experience of care —like whether their health care providers explained things in a way that they could understand, listened carefully, treated them with courtesy and respect, and spent enough time with them.
Health care providers also get higher payments if their patients have better health outcomes. When providers are paid for better health outcomes and patient survey scores, there’s a financial incentive to use health literacy best practices and other strategies to improve provider-patient communication. Providers are therefore likely to be more effective in helping patients become critical partners in managing chronic conditions and maintaining good health.
4. Prevention of disease
The last “P” is for preventing disease and its exacerbation. Health education plays a vital role in prevention. Providers can help their patients make healthy choices by using clear communication strategies, selecting easy-to-understand educational materials, and using materials effectively. Providers can also encourage patients to use the myhealthfinder tool to learn which clinical preventive services they may need as recommended by the U.S. Preventive Services Task Force.
What you can do
To deliver better value, the health care system will have to make many changes — and becoming more health literate needs to be one of them. Here are some actions you can take to improve value though health literacy.
- Use the AHRQ Health Literacy Universal Precautions Toolkit — it teaches providers to assume everyone is at risk of misunderstanding.
- Look for health literacy training opportunities.
- Talk about costs with your patients. This can feel uncomfortable, so check out this evidence-based guidance for starting cost conversations.
- Adopt the Health Literate Care Model. Examples of using this model include making medical referrals easy, linking patients to community services, and using the teach-back method.
- Address language differences and consider culture, customs, and beliefs to provide high-quality care to diverse populations.
- Manage the health of the population that your practice serves by engaging patients who don’t present themselves at your office for preventive or on-going care.
- Use health literacy strategies like following up with patients, creating action plans, and helping patients remember how to take medicines correctly to improve population health.