eHealth Literacy: Getting Started Shannah Koss, President Koss on Care LLC

Principal, MAXIMUS eHealth Literacy Collaborative

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AGENDA

Introductions

eHealth Literacy – Our Definition

Health Information Technology (HIT)

foundations - The Health Information Technology

for Economic and Clinical Health (HITECH) &

the Affordable Care Act (ACA)

What is happening in your state or community

Consumer outreach, education and engagement

When to start?

How to start?

Federal and state opportunities

Emerging resources 2

EHEALTH LITERACY

eHealth Literacy - the ability of consumers, directly or with assistance, to use computers and other communication technologies to find, read and understand health information to make personal decisions.

Why it is important Close to 50% of all US adults have problems

understanding many aspects of health care

Older people, non-whites, immigrants and those with low income have disproportionately low literacy and are more likely to have chronic disease

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RECOVERY ACT HIT INVESTMENTS

“ …HITECH Act, part of the Recovery Act,

designated funding to modernize the health care

system by promoting and expanding the adoption

of health information technology.”

$22.6 Billion investment

Advance rapid adoption and „meaningful‟ use, e.g.

, improve care, population health and engage

patients in their care through the use of HIT

Electronic health record (EHR) incentives

Investments in infrastructure (including health

information exchanges (HIEs), training and

broadband access 4

HEALTH REFORM BASICS

Affordable Care Act (ACA) established provisions

to expand insurance coverage, control health care

costs, and improve the quality of the health care

delivery system

Many components of ACA and many HHS

initiatives launched pursuant to the legislation

build upon the emerging technology to improve

care

Some components require additional HIT

infrastructure, in particular the Insurance

exchanges 5

KEY DATES AND INITIATIVES

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Expanded Medicaid Expanded Medicaid

coverage and

coverage options

Recovery Act (2009)

Medicare & Medicaid EHR incentive programs Medicare & Medicaid EHR incentive programs

HIEs prepare HIEs prepare

for supporting

meaningful use

Medicare meaningful use Medicare meaningful use

Medicaid adoption,

implementation and

Medicaid adoption,

implementation and

incentives

CMS Establishes CMS Establishes

Innovations Center

New Medicaid

option for a health

New Medicaid

option for a health

home option

Accountable Care

Accountable Care

Organizations pilots

meaningful use and

Medicaid

meaningful use and

Beacon outcomes

Health Insurance Exchange demos Health Insurance Exchange demos

Health insurance Health insurance

exchange

implementation

Consumer/Patien

t and family

engagement is

critical to success

2011 2012 2014 2013 2010

Affordable Care Act (2010)

Robust meaningful

use

RECOVERY AND REFORM

EHEALTH LITERACY DRIVERS

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Meaningful Use (MU)

Patient engagement

Quality Metrics

health status improvement

HIE participation

Patients and providers

Beacon Communities

Near term patient outcomes

patient self-management

Explicit health literacy

Expanded coverage

Equity/reduced

disparities

Workforce

Patient information

Prevention & wellness

Quality improvement

Particularly for duals

Recovery/HITECH Reform

Communication is the key to required informed choices

ENHANCE INFORMATION INFRASTRUCTURE

DEPENDENCE

Recovery and Reform both rely on enhance information systems to succeed

Recovery ~22B+ investment will fail if: Providers do not adopt EHRs or

demonstrate meaningful use

Patients do not engage

Cost savings cannot be demonstrated

Reform will fail (in any future form): If enrollment and improved quality don‟t

lower cost

Without new models for duals and chronically ill 8

All outcomes depend on better IT leverage

THERE IS AN INCREASE IN NATIONAL

CONSUMER OUTREACH, AWARENESS

AND EDUCATION CAMPAIGNS

Care about your care – RWJ/AHRQ/ONC

HealthIT.gov – ONC

Developing Alzheimer‟s plan

Million hearts initiative

Healthcare.gov

Medicare and Veterans Health blue button

National eHealth Collaborative (NeHC)

Consumer Consortium for eHealth

National Action Plan for Health Literacy

Healthy People 2020 9

WILL IT ALL COME TOGETHER?

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STATE AND LOCAL LANDSCAPES

VARY

EHR adoption highly variable

HIE implementation ranges from planning to various levels of operational capabilities

Wide range of governance and consumer input models

Clear versus unclear consumer focus

Beacon communities with accelerated requirements

Political and legal uncertainties

Many states are embracing the opportunities

All states struggle with their health care expenditures

Funding opportunities flow to states and non-profits

HIT and HIE variation Reform variation

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WHAT IS HAPPENING IN YOUR

STATE OR COMMUNITY

Provider EHR adoption

HIE implementation or operations

Existing or new reform

Medical homes

ACOs

Medicaid expansion

Prevention or dual eligible initiatives

Partnership for patients

Are consumers/patients engaged? When and how?

Are consumer advocacy and community-based health organizations involved?

Will the investment support tools and resources to foster patient engagement?

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FIRST STEPS IN HIT PATIENT ENGAGEMENT

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Health Information

Exchange Consent Form

I _______ consent to allowing

my electronic medical records

to be shared through the state

of…

Xxxxx xxxx xx xxx xxxx

I understand my rights to ....

_____________ ______

Name Date

EDUCATION CONSENT

CONNECTION YOUR RECORD

Increased patient engagement in 2013 depends on early education

FIRST STEPS IN HEALTH REFORM

Insurance exchanges lag behind HIEs, but many

initial parts of reform are happening and require

patient engagement

Some expanded eligibility is already happening

Some quality initiatives are already underway

Early adopters and innovators e.g., pioneer ACOs

Consider which initiatives in your state would

perhaps be best served by early outreach and

education that will foster use of the technical

infrastructure to better serve consumers

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DISCUSSION

In which HITECH or Reform programs or

projects are you most interested?

What stage is the program or project in planning,

design development or implementation?

Are consumers currently engaged in the

development stage of the program?

How if at all are consumers being engaged?

What are the main barriers or challenges to

advancing consumer outreach, education and

engagement throughout the process?

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GETTING STARTED – SELECT A

SAMPLE PROJECT

Identify your target programs and initiatives

What is the phase of development?

Is, or was, there consumer representation in the design phase?

Are there opportunities for input?

How will information be made available and communicated?

Who are the many stakeholders and organizations that would support consumer engagement?

How are websites and online tools being used?

What is or isn‟t working in your state? 16

NO SINGLE RIGHT APPROACH

Emerging better practices

Understand the dynamics in your state or region

and look for similar successful models

Get involved

Key players may want or at least be open to your

help

Look for others that want to advance the

consumer facing component of the program

ehealth literacy solutions leverage online

resource to support all appropriate channels of

communication

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GOOD CONSUMER ORIENTED HIE

WEBSITES

Focused messages, icons and tabs for consumers,

patients and families

Introductory messaging that reaches all audiences

Consumer specific FAQs

Contextual information - not just about HIE,

incentive program or opting in or out

Simplify the alphabet soup

Multiple languages

Graphics, video, mirror your diversity

Helps set realistic expectations

Targeted clinical information – linking to specific

clinical initiatives

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POTENTIAL FUNDING SOURCES

LEVERAGING UNPRECEDENTED $$$

HIE, REC and Beacon Community funding

Medicaid funding:

90/10 EHR incentive $‟s for consumer education and outreach

90/10 health home designation dollars

75/25 Translation and interpretive services CHIP & Medicaid

CMS innovations grants and demonstrations

New care model development for Medicare, Medicaid or Duals

Models include: Medical homes technology enable care coordination;

community based health teams w/patient self-management; fully

integrated care for duals; new patient safety partnership program

Secretary can consider many additional factors focused on patient

engagement through technology (6 of 7 factors)

Medicaid incentives for prevention of chronic disease program

ACO investment

Health home funding option and patient centered medical home

Title V HRSA funding for cultural competency

Non-profit initiatives – Robert Wood Johnson “Care about your

care”

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CONCLUSION

Growing focus, opportunities and resources

Still need to help educate program staff on the importance of consumer engagement

Emphasis on outcomes and metrics will help

Join the discussion: LinkedIn eHealth Literacy Community http://www.linkedin.com/groupsDirectory?trk=hb_side_grpsdir

Contact information:

MAXIMUS Center for Health Literacy http://www.maximus.com/services/health/health-literacy

Shannahkoss@maximus.com

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