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AIS's Health Business Daily
Featured Story May 30, 2008 Health Plans, PBMs Consider Strategies for Increasing Health Literacy of Their MembersReprinted from DRUG BENEFIT NEWS, biweekly news, data and business strategies for health plans, PBMs and pharmaceutical companies. By Neal Learner, Managing Editor, (nlearner@aispub.com) Nearly half all U.S. adults lack the "health literacy" skills necessary to understand and act on basic health information - a problem that costs pharmaceutical payers billions of dollars annually on misused medications and contributes to roughly 1.5 million adverse drug events every year, experts say. As a result, some health plans and pharmacy benefit managers (PBMs) contacted by DBN are taking steps to address the health literacy issues of their members in an attempt to improve therapeutic outcomes and the bottom line. While health literacy has been on the radar screen for some time now, several new national initiatives are underscoring the importance of the issue. For example, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in April launched a health literacy campaign that urges patients to take a more active role in their health care. The effort includes encouraging patients to know what medications they take and why they take them. And in late March, health care accreditation organization URAC for the first time included health literacy in its core standards for accreditation. The new standard, among other things, aims to ensure that health information is understandable to patients. Low Literacy Harms Rx Outcomes The implications of low health literacy on pharmaceutical outcomes and spending are especially significant, experts say. "The inability to read, understand and act upon medicine [and] medical information makes it less likely that patients will…follow their medicine instructions," says Ray Bullman, executive vice president of the National Council on Patient Information and Education (NCPIE). "This in turn is likely to lead to inappropriate, inaccurate and unsafe use of medications," he tells DBN. Studies bear this out. According to a July 2006 study by the National Academies' Institute of Medicine (IOM), medication errors harm at least 1.5 million people every year, and the extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year. An April 2004 IOM study found that 90 million adults have difficulty understanding and using health information, and that roughly 40 million read below the fifth-grade level. And a study published in the June 2006 American Journal of Health-System Pharmacy finds that the 40 million adults who read at the lowest literacy levels may have "profound difficulty understanding health information." Among other things, the American Journal study examined respondents' understanding of prescription drug warning labels. It found that with the message:
Plans, PBMs Are Addressing Health Literacy According to IOM, health literacy is defined as the degree to which individuals have the capacity to obtain, process and understand basic information and services needed to make appropriate decisions about their health. But much of the health care industry still produces materials written at a 10th grade level or higher, according to Health Literacy Innovations, LLC, which furnishes tools that review health care materials for literacy levels. Some health plans and PBMs are stepping in to address the issue. New York City-based Affinity Health Plan, for example, is in the process of revising its written materials to reflect a fourth- and sixth-grade reading level, using software developed by Health Literacy Innovations. Affinity also has partnered with the Literacy Assistance Center of New York City to build a curriculum for Affinity employees. Affinity members interact with the staff roughly a dozen times a year, says Carolyn Cocotas, director of the community health innovation at Affinity, which serves Medicaid patients. The training course, which will be rolled out by the end of the year, aims to help employees know when members' low health literacy levels might be a barrier to taking an appropriate health action, Cocotas explains. Online Resources Help Build Literacy "One of the major problems is that we as health care professionals develop instructions for people as if we're talking to ourselves," Cocotas says in an interview with DBN. "We are not taking a patient-centric view of what is actually required to communicate information." Other plans and PBMs also are tailoring their written materials with an eye on health literacy. Prescription Solutions, a PBM division of UnitedHealth Group, does this with an educational mailing it sends to seniors about drugs to be avoided in the elderly. "We are aware of the literacy aspect," Brian Solow, M.D., vice president and medical director of clinical services at Prescription Solutions, tells DBN. "These materials are pretty thoroughly researched, and we put them at a certain educational level to make sure the patients can understand them. We get feedback from the patients that let us know about the impact of the programs as well." Steven Rush, director of physician engagement at UnitedHealth, says the insurer is "in the process of developing an enterprise-wide health literacy initiative." This will include a series of programs for retirees to enhance health literacy related to Rx drug use and adherence. And UnitedHealth is interested in work to increase the understandability of drug labeling through design changes and use of icons, he tells DBN. Online resources also are helping address health literacy issues. DestinationRx, Inc., a drug price comparison Web site, says it has seen significant improvements in consumers' understanding of pharmaceutical options in recent years. In 2000, when DestinationRx introduced its therapeutic alternative tool, most people didn't even realize that there were multiple products available to treat a given condition, "let alone that there were price differences," says Toby Rogers, executive vice president of the company. "My informal poll of patients found about one out of 10 that understood this," he tells DBN. "Today, I'd say it's more in the range of eight or nine out every 10 people you ask." More Remains to Be Done Still, experts agree that more needs to be done. Aracely Rosales, chief content expert and multicultural director at Health Literacy Innovations, urges health plans to set policies that ensure the appropriate reading level of written materials going to members. "Sometimes, they need more help in managing their medications," she tells DBN. "A one-on-one [assistance program] would be ideal to provide some kind of follow-up or support." The pharmaceutical
industry also can make a significant contribution to health literacy
through Rx labeling reforms, says Cocotas, who is co-chair of the Health
Literacy Taskforce of trade group America's Health Insurance Plans (AHIP).
"Some people say, 'Oh, that's just dumbing stuff down, and everybody
doesn't need that,'" she says. "But, in fact, the research
shows that everybody benefits from clear and straightforward instructions." |
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