Shannah Koss - eHealth Literacy, Getting Started
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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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