How Can We Improve Health Literacy among Medicaid Populations?

Inadequate health literacy affects nearly 36% of the adult U.S. population and is found in disproportionately higher rates among Medicaid-eligible populations, according to the Center for Health Care Strategies.

In fact, one study estimates that more than 25% of uninsured, Medicare, and Medicaid populations may have low health literacy skills. This can negatively impact quality of life and health outcomes for members as well as drive up the cost of care.

Why Prioritize Health Literacy?

The U.S. government’s Healthy People 2030 initiative defines health literacy as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”

Patients with low health literacy often have difficulty understanding their prescriptions, participating in medical decisions, following medical recommendations, and attending follow-up appointments, according to research findings summarized in the journal BMC Health Services Research.

Patients with low health literacy are more likely to experience:

  • Increased risk of negative health outcomes, including mortality
  • Poorer self-care and preventive care habits
  • Over-utilization of emergency services
  • Lower satisfaction with their healthcare

Care managers play an important role in helping Medicaid members improve their health literacy. Below we look at how care management teams can tackle this critical challenge.

1. Identify Members with Low Health Literacy

To prioritize Medicaid members most in need of health education, care managers should be aware of specific factors associated with health illiteracy.

From a demographic perspective, lower health literacy is associated with older patients, those with limited education (although it’s important to note that highly educated patients can still be health illiterate), non-English speakers, and patients with chronic conditions, reports a study published in the journal Nurse Practitioner.

The following behaviors may signal the need to address health literacy, according to the Agency for Healthcare Research and Quality:

  • Frequently missed appointments
  • Incomplete registration forms
  • Non-compliance with medication
  • Inability to name medications or explain the purpose or dosing
  • Identifying pills by sight rather than reading the label
  • Inability to give coherent, sequential history
  • Asking fewer questions
  • Lack of follow-through on tests or referrals

2. Provide Individualized Health Education and Reinforcement

What does it look like to help a member learn to recognize heart failure symptoms? To motivate someone to follow through on preventive screenings? To coach a surgical patient on using ambulatory aids during recovery?

The right answer: It probably looks a little different for every individual. Learning style, language barriers, and cultural considerations all come into play.

Care managers can take these steps to provide effective tailored health education:

  • Spend time assessing a Medicaid member’s health literacy level
  • Offer education content in multiple media formats (e.g., print, digital files, video)
  • Deliver content in the member’s preferred modality (e.g., mobile-friendly link, emailed pdf)
  • Provide resources in the member’s language of fluency
  • Follow up to assess comprehension: ask for a return demonstration to ensure the learning formats and content delivery modalities are optimal for the member’s needs and provide additional coaching as needed

3. Address SDOH that Limit the Ability to Act on Health Education

An individual’s ability to use health information in addition to understanding it is an important component of health literacy for Medicaid members. Social determinants of health (SDOH) – non-clinical factors like economic circumstances and location of residence – can affect a patient’s ability to act on a care manager’s advice, or to follow through on provider instructions related to treatment.

For example, consider the following scenario:

James, a Medicaid recipient, has been identified as at risk for diabetes. His physician tells him he needs to incorporate daily exercise with the goal of losing 25 pounds. When his care manager follows up, James confides that a gym membership isn’t in the budget, and he doesn’t feel safe exercising outside on his neighborhood streets. The care manager sends videos of at-home cardio workouts and connects him to a nearby church with an exercise room available to local residents at designated times.

James’ case illustrates the need for care managers to ensure their patients both understand preventive and/or treatment instructions and are equipped to follow through on them.

Other facets that come into play could include connecting members with nutrition resources so they can stick to a diet plan, transportation services to help them keep appointments and obtain prescriptions, or mental health counseling to help deal with the stress of living with a chronic condition.

4. How Can Technology Support Health Literacy Efforts?

Population health management platforms like HELIOS enable healthcare organizations to make evidence-based health education content more accessible to everyone by centralizing data, streamlining workflows, and health content library integrations. For example, with HELIOS users can leverage content from Healthwise, WebMD, Krames and even add their own custom assets.

Below are a few tools in HELIOS that give care managers the tools and time to make a real difference in improving health literacy among Medicaid populations.

Workflow, trigger, task, and assignment automations. HELIOs’ strong data and automation capabilities help cut down time on manual tasks like repetitive documentation, searching disparate systems for critical information, or making several calls to track down specialists in a patient’s care. This allows care teams to focus on care and spend time on health education.

For example, care managers can devote more time to one-on-one interactions that help improve health literacy – gaining trust, uncovering individual barriers to health literacy, gaining insight into learning styles, assessing comprehension of materials, or following up to reinforce learning.

Automations that alert care managers to risk factors related to low health literacy. Missing steps in a post-procedure care plan or a lack of follow-through on preventive screenings may signal a member needing health literacy support. How? Well, a member may be missing the information they need to understand why these care steps are important. Properly educating members helps reaffirm provider instructions and encourages care plan adherence.

Health education content accessible within HELIOS. Convenience is key to members actually using health education resources. A printed handout on medication won’t be helpful if it’s crumpled up in a pocket at the bottom of the laundry basket – but when it’s accessible via a touch on a smartphone screen, chances are, it’ll result in better adherence. Blogs, videos, infographics – HELIOS’ integrations from health education partners allow you to choose the right piece and tailor it to learning styles and health concerns.

The ability to deliver tailored health education resources. HELIOs doesn’t just integrate health education content. It makes delivering it and discussing it simple. With HELIOSvisit, files and media can be exchanged instantly. This makes it easy to send along articles or quick video tutorials then talk about them via a virtual telehealth visit.

Closed-loop system to signal utilization of health education resources. What happens after a care manager clicks “send” and health education content is delivered? Mission accomplished, right? Not unless the patient actually uses the resource. Thankfully, HELIOS closes the loop by noting when a patient interacts with content. This can help care managers plan personalized, timely follow-ups or adjust strategies moving forwards.

Want to learn more about how VirtualHealth’s partnership with Healthwise can boost health literacy among Medicaid populations. Check out our recent webinar with Healthwise and Unite Us  .

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