Louisiana Statewide Health Literacy Initiative Terry Davis, PhD State Senator, Lydia Jackson Understanding What Works in Improving Health Literacy Across a State _ IOM and UCLA School of Business November 30, 2010
Why Involve the State? With healthcare reform -- States will be enrolling more people in Medicaid and more eligible people will fail to enroll. There will be fewer state employees to help people understand information and navigate the system. More information and services will be computer-based. To date, 96% of states have simplified enrollment forms, 86% offer one-onone assistance. Despite these efforts 80% African American and 70% Hispanic eligible children are not enrolled. States must use practical strategies to make health information and services more user-friendly.
Healthcare Reform & Plain Language Act Create Need to Focus on Health Literacy Affordable Care Act -all states must enroll individuals < 65 up to 133% poverty level (29,000 family of 4) Plain Language Act government documents must be written clearly By 2014 Medicaid will cover ¼ US (80M) (2007-58M, $300B) In 2010 LA enrollment 15% of poverty ($3,300 family of 4), LaCHIP 250% An additional 384,000 Medicaid enrollees expected (50-75% drop in uninsured). 2010 Center for Healthcare Strategies, IOM White Paper on HealthLiteracy Implications of Affordable Care Act; 2010 Kaiser Commission on Medicaid and the Uninsured; 2010 Public Affairs Research Council of Louisiana
The Louisiana Story (2002-2010) Evolving vision and strategy
What Was the 2002 Strategy? Where did we start? How did we reach and persuade elected officials? What was the ask? How did we get state-wide buy-in? How did we fund it?
The Big Problems Ranked as unhealthiest state in nation High levels of uninsured, low performing health delivery system Highest health-care cost with worst outcomes 1 in 3 children live in poverty 48% of 9 th graders will not graduate in 4 years 28% of adults in NALS level 1 (ranked 49th)
Health Care For All 10 state public hospitals run by LSUHSC
Find a Legislative Champion Identify legislators interested in both education and health (who have health and education record) Champion must be able to conceptually link health and literacy/education Champion must be skilled in connecting existing health and education officials
Louisiana Legislative Champion Senator Lydia Jackson Louisiana Senate Chair Committee on Women & Children Vice-Chair Finance Committee Committees: Judiciary, Budget Government Affairs, Local & Municipal Affairs Eagle Award for healthcare Fleur de Lis Award for healthcare leadership Louisiana House of Representatives Committees on Health & Welfare, Ways & Means, Joint Capital Outlay
LA -1 st in Health Literacy Legislation Act# 1226: Create an Interagency Task Force on Health Literacy Study the health literacy of LA residents Identify groups at risk for low health literacy Identify barriers to accessing services & communicating with providers Make recommendations to: Improve health literacy Promote providers use of plain language Simplify forms and procedures Develop easy to understand health info Develop health literacy curricula Examine impact on quality & cost
Member Agencies 31 members representing 23 health & education organizations Developmental Disabilities Council AAP State Medical Society Public Health Institute Governor s Office DHH Literacy Dept of Ed Dept of Ag Alliance of ACS NMA Greater NO Managed Healthcare Assn. ITFHL AHEC Assoc. of Nurse Practitioners LA Medicaid Schools of Public Health, Medicine, Nursing, Pharmacy
Needs Assessment Survey of health and education organizations and state agencies about their health literacy problems and activities: Revealed little or no interagency coordination regarding health literacy activities Identified specific problems & strengths Led to the development of a proposal
Health Literacy Problems 2005 Citizens struggle with Medicaid instructions too long, not encouraging, forms not logical Many citizens lack the knowledge & skill to adequately manage chronic disease or use preventive services Louisiana schools of medicine, nursing, pharmacy, and public health do not have a health literacy curricula. Health education is required in schools grades K-9, but doesn t prepare students with basic health knowledge and skills. Adults literacy classes want more health education.
Health Literacy Task Force Proposal Develop train-the-trainer workshops & electronic modules to train 7,000 health-care professionals, staff, and educators to: Communicate more effectively with patients (particularly those with low health literacy). Develop user-friendly materials (pamphlets, intake forms, letters, payment materials). Post curriculum & materials on website. Track participation. Evaluate efficacy of training and outcome of project.
Bringing the Proposal to Life Proposed funding: $300,000/yr for 3 years Phase I: Train all FQHC providers and staff Legislative committees & Secretaries of Health & Labor approved the project (no funds attached). Novel funding strategy: Department of Labor Incumbent Worker Funds. Funding problems identified: Labor funding does not provide for development, pilot testing, project evaluation or train-the-trainer format. Funding is reimbursement per employee who completes training sessions.
Katrina and Rita Commerce in our major city was virtually eliminated 45% of sales tax revenue lost 81,000 business impacted 109,000 students in N.O. displaced 280,0009 people lost jobs - 14% of work force 360,000 people homeless Only 2 hospitals open in N.O.
2010 Rebirth Possibilities Outcome of lunch with Sen. Jackson to plan for IOM/UCLA meeting Healthcare reform increases demand for user-friendly communication at a time when supply of communicators is declining. Information more likely to be computer based. What would user-friendly system look like? Goal integrate within existing delivery system NOT to build new silo. Could we devise a strategy that would be low cost?
Recommendations for Health Literacy Advocates Find a legislative champion. Connect with key health and education officials. Develop plan to make state health information and services easier to understand and act on. Integrate plan into existing delivery system. Partner to make case that improving health literacy is good public policy reduces cost and improves quality. Strategize a realistic funding proposal for a legislature with a shrinking budget.