The National Action Plan to Improve Health Literacy: A View from CMS Frank Funderburk 1 & Eileen Zerhusen 2 1 Director, Division of Research Strategic

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  • The National Action Plan to Improve Health Literacy: A View from CMSFrank Funderburk1 & Eileen Zerhusen21Director, Division of ResearchStrategic Research & Campaign Management Group, 2Creative Services Group10/20/2010Presented at Seventh National Conference on Quality Health Care for Culturally Diverse Populations. Baltimore, MD*Note: The statements expressed here are those of the authors and do not necessarily reflect the views or policies of CMS

    Presented at Seventh National Conference on Quality Health Care for Culturally Diverse Populations. Baltimore, MD

  • Goals of the National Action PlanHelp people understand their health care options and make better decisions.Give people trusted health and safety information that they can use to make better decisions and get the care they need when they need it.Use our materials to improve their quality of life. Make this information available where people live and work. Measure how well we are doing these things.Learn how to improve our approaches and materials.Share what we learn with others.


  • Health Literacy ConceptsDemonstrated Skill Have they shown they can do it? Capacity Could they do it, if trained?Motivation Would they even try to do it?Shared Function How do social and individual factors interact?Next steps What should we do? Where should we intervene?10/20/2010*

  • Research to Develop Consumer-Based Communications StrategyUnderstand consumer realityValues Beliefs NeedsBehaviorBarriersMotivationsReactions to key conceptsLiterature review/Environmental scan (What is already out there? How can we learn from it?)


  • Social Marketing Supports Health Literacy GoalsUnderstand target audience health literacy, culture, language, attitudes, perceptionsIdentify barriers Test materials and messagesDevelop campaignsEvaluate behavioral impact Refine and repeat process10/20/2010*

  • Some Vulnerable PopulationsMedicareChronic DiseaseSeniorsDisabled (Dual eligibles)Low-incomeMedicaid/CHIPLow-income familyLow English proficiency


  • Using Social Marketing to Improve CommunicationsLow Income SubsidyHome Health CompareDischarge Planning ChecklistUnderstanding Medicare ChoicesMotivational Assessment of MessagesCHIP EnrollmentToolkit for Making Written Materials Clear & Effective10/20/2010*

  • Mixed Methods Research Strategy for Improving LIS Enrollment10/20/2010*

  • Initial Formative ResearchApproaches to formative research waves:Focus groups with audience segments (What to call it? What will motivate you to enroll? What are the barriers? What will be most [least] helpful?)In-depth interviews (How can we improve communication? Where do you go for information? Why did you go there?)Cognitive testing (Was that understood? Is this clearer? How would you say this?)Results/RecommendationsFocus on building awareness of benefitMessage outside of traditional communication windows/channels (not during open enrollment, photo-novella vs. written guides)Lack of perceived need/eligibilityExpectation of continuous enrollment opportunity10/20/2010*

  • Decision-Making Style10/20/2010*

  • Understanding the AudiencePsychographic ThemesStrong family orientationEnjoy outdoor activitiesWant and appreciate a good dealCommunication ThemesDown to earth, altruistic Stop & Smell the RosesPride, heritage, stability Buy American


  • Experimental Field Study10/20/2010*

  • Key Findings We Can Improve LIS Application Rate10/20/2010*

  • Home Health Compare Homepage Introduced 200310/20/2010*

  • Home Health Compare Redesign 201010/20/2010*

  • Discharge Planning Checklist10/20/2010*

  • Simple Step-by-Step Reminders10/20/2010*

  • Engaging Caregivers10/20/2010*

  • Simplifying Medicare Choices10/20/2010*

  • Improving Motivational Messaging10/20/2010*

  • Sharing Lessons Learned10/20/2010*

  • Next StepsExpand use of alternative communication channels/techniques (e.g., Edutainment)Expand to new audience segmentsHelp staff and partners communicate more effectivelyAddress paradoxical effects of generally effective health educationExplore ways to measure population health literacy


  • Consumer Empowerment Create a person-centered system of healthcareConsumer testing is key to health literacy assessmentTarget and tailor materialsSegment on factors other than demographicsGet and share the toolkit!Go to, select Outreach & Education, and then select Outreach. Click on the toolkit to read or download it.


    *6th grade reading level. (Of course, health literacy is more than just attention to reading level.) These goals are very consistent with CMS strategic goals, especially those related to delivering high valued health care, confident and informed consumers, and building collaborative partnerships. The emphasis on person-centered care is a central theme as well *Social marketing is centered on understanding the target audience -- *Chronic disease accounts for a disproportionate share of healthcare costs etc.**Also found photo-novellas could often communicate more clearly than written materials for many could be a function of low health literacy or channel preference.*People who were eligible for but not enrolled in the LIS Program had a less active healthcare decision making style. They need more than just information about the program; motivational and decision-making skill issues need to be addressed.

    *Characteristics of target audience surprised many people. Its important to not just rely on our assumptions about the audience -- *Odds Ratios show that even after controlling for prior awareness of the benefit, demographics, and decision-making style, application rates were significantly boosted by the CMS letter more than 11 times the rate under the active control community outreach alone. Calls and personal contact boosted rates a bit more, but were much more costly. Results were validated using SSA data.*This looks like a government web site bland, text heavy, not written in plain language, not much white space, not easy to get to or find information that you need.*Now it has been improved via extensive consumer testing (beneficiaries, caregivers, health professionals). Its more interesting and understandable; people can identify with people in photos, go right to the search or learn more. Combines rational and emotional appeals, better design, more useful. *Originally designed to help patients/beneficiaries and their caregivers get engaged in the discharge process. Has places for notes, so important details arent as likely to be lost during the process (often rushed, patients are still sick, caregivers are worried and distracted not the best time to learn new concepts or tasks). Tested with patients, caregivers, practitioners (docs, discharge planners, etc.)*Contains both action items and nudges to help gather needed information and bring attention to details that could be overlooked.*Specifically engages caregivers and tells you how to get additional help.*This flow chart has developed from our testing of the Medicare & You Handbook, and has been distributed to beneficiaries and our partners. The full guide is available for download on the web.**We are exploring the use of innovative methods, such as Max-Diff scaling to differentiate the salience of motivational messages.This toolkit is available for download on the web. Go to, select Outreach & Education, and then select Outreach. Click on the toolkit to read or download it.*Overcome low health literacy by using other communication channels/techniques remind folks that not all communication needs to be written. Some people need more guidance 1-800 lines, SHIPs, community-based partners can give support and individualized counseling. Dont leave low literacy groups behind.*


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