Practical Implementation Steps for Partners Other Considerations

Leadership Buy-inHealth Literacy (HL) should be a PPS priority with support from governing bodies. Partner organizations should commit to ‘Becoming Health Literate Organizations’

Form a Team

Each partner organization should form a ‘Health Literacy Team’. Members may include C-suite, clinicians, educators, front-line, marketing, outreach, quality, behavioral, care coordination

Create a Plan

Using AHRQ’s HL Toolkit and IOM’s 10 Attributes for guidance, conduct organizational assessments to give each team a baseline of their needs and assets. Create implementation plans based on partner priorities

Roll-out Training

Health Literacy should be a required training for all partner employees. Training Examples:1. HL Bootcamp Train the

Trainer2. 3-part HL Bootcamp3. Online CDC Modules

Improve Communication

Conduct QI or PDSA initiatives using AHRQ’s Communicate Clearly or Teach Back tools. Conduct self-assessments of communication and solicit patient feedback. Include Teach Back documentation in EHR.

Patient Ed Simplification

Teams should receive plain language training on HL Universal Precautions and assess patient education, marketing/social media and legal material. IHA’s HL Advisor platform can be introduced as tech-tool

Measuring Partner Success

Community Health Literacy

Topics OfferedCommunity Resources

Asthma Action Planning

Talking About Substance Use

Understanding Dementia

Talking to My Doctor

Diabetes Self-Management

Stress and Meditation

Food Shopping on a Budget

Navigating the Health System

Nutrition: Eat Well, Play Hard

Debunking Dr. Google

Prevention and Detection

Understanding My Insurance

What’s in a Wellness Visit?

Brown Bag Medicine

Behavioral Health

PPS should consider funding or partnering with local community organizations who can help improve the health literacy skills of constituents. Examples of potential topics (above) and partnerships (below).

❖ Currently the New York Public Library contracts Staten Island PPS to assist with Health Programming at all of their Staten Island branch locations. Recognizing the importance of empowering and engaging potential patients through improving health literacy, to-date we have hosted approximately 20 workshops for hundreds of community members

❖ We also work with ArchCare's TimeBank initiative and have connected an estimated 100+ places of worship across the island to these valuable Health Literacy community workshops

Key Performance IndicatorsPatient Education

Health Comm Always Use Teach Back

Numerator HL materials from reliable resources

Providers using plain language at discharge

Documented teach back used at Dx, consent, D/C, education

Denominator Total materials

Total discharges

Total Medicaid or uninsured patients

Data Source Relationship Performance MeasureC&G CAHPS Health Literacy Someone from providers office usually or always talked about all prescription medications being taken

C&G CAHPS Health Comm Someone from providers office usually or always followed up with you to give you results of blood test, x-ray or other test

C&G CAHPS Health Comm Provider usually or always listened carefully to you

C&G CAHPS Health Comm Provider usually or always showed respect for what you had to say

C&G CAHPS Health Comm Usually or always got answer to medical question the same day you contacted provider's office

C&G CAHPS Health Literacy Provider usually or always gave easy to understand instructions for caring for illness or health condition

C&G CAHPS Health Literacy Provider usually or always explained things in way that was easy to understand

C&G CAHPS Health Comm Provider usually or always spent enough time with you

C&G CAHPS Health Literacy Provider usually or always asked you to describe how you would follow instructions for caring for illness or health condition

C&G CAHPS Health Literacy Provider usually or always explained what to do if illness or health condition got worse or came back

DOH Claims Health Literacy Adult Access to Preventive or Ambulatory Care - 20 to 44 years

DOH Claims Health Literacy Adult Access to Preventive or Ambulatory Care - 45 to 64 years

DOH Claims Health Literacy Adult Access to Preventive or Ambulatory Care - 65 and older

C&G CAHPS Health Comm Care Coordination with provider up-to-date about care received

DOH Claims Health Literacy Children's Access to Primary Care - 12 to 19 years

DOH Claims Health Literacy Children's Access to Primary Care - 12 to 24 months

DOH Claims Health Literacy Children's Access to Primary Care - 25 months to 6 years

DOH Claims Health Literacy Children's Access to Primary Care - 7 to 11 years

DOH Claims Health Literacy PDI 90 - Composite of all measures (per 100,000 members)

DOH Claims Health Literacy PQI 90 - Composite of all measures (per 100,000 members)

DOH Claims Health Literacy Potentially Avoidable ER Visits (per 100 members)HP

DOH Claims Health Literacy Potentially Avoidable Readmissions (per 100,000 members)HP

NYS w/SPARCS Health Literacy ED use by uninsured

DOH Claims Health Literacy Non-use of primary and preventive care services

DOH Claims Health Comm Adherence to Antipsychotic Meds for People w Schizophrenia

DOH Claims Health Comm Follow up for children prescribed ADHD meds - continuation

DOH Claims Health Literacy Potentially Preventable ER Visits (people w/ BH diagnosis per 100 members)HP

DOH Claims Health Literacy PQI 1 - Diabetes ST Complications (per 100,000 members)

Med Rec Review Health Literacy Comprehensive Diabetes Care- Poor A1C control

Med Rec Review Health Literacy Comprehensive Diabetes Care- A1c, eye, LDL, nephropathy screen

C&G CAHPS Health Comm Medical Assistance with Smoking Advised to Quit

C&G CAHPS Health Comm Medical Assistance with Smoking Discussed Cessation Medication

C&G CAHPS Health Comm Medical Assistance with Smoking Discussed Cessation Strategies

IPOS Health Comm Advanced Directives- Talked about appointing for health decisions

C&G CAHPS Health Comm Hospital Stay- Staff took my preferences and those of my family or caregiver into account in deciding my health care needs

C&G CAHPS Health Literacy Hospital Stay- When I left the hospital I had a good understanding of the things I was responsible for in managing my health

C&G CAHPS Health Literacy Hospital Stay- When I left the hospital, I clearly understood the purpose for taking each of my medications

This Health Literacy Bootcamp training was rolled out for all health coaches and community navigators. It is now being made into a 3-day train-the-trainer (TTT) with an additional MI and BSI component.

Launching in March ‘18, the TTT option will help partners meet this mandatory training requirement.

These Health Literacy patient and provider communication tools were created so that our partners could post and distribute to all patients and providers. We’ve also shared these tools with MCO’s and CBO’s to ensure widespread

community impact and hope to see noticeable shifts in our performance measures.

Health Literacy

Skills

Health Literacy: BIG BIG IGNORE IGNORE

Design a Health Literacy Action Plan to Impact Performance MeasuresCelina Ramsey, MShc; Clarissa Padilla, MPH; Lauren Tepfer, BS

Staten Island Performing Provider System

SI PPS Performance Measures Impacted by Health Literacy

Health Literacy, or the ability to get, understand and use health information meaningfully is at the intersection of everything DSRIP hopes to accomplish for Medicaid and uninsured users across the state. Nearly 80% of people have limited health literacy skills- these are our families, communities and patients!

It’s imperative that we begin to empower both patients and providers by developing skills, improving communication and fostering trusting relationships. Dedicating time and resources into making small changes to promote health literacy will provide long-term return on investments.

Improving providers’ and patients’ health literacy and health communication skills can positively impact both survey and claims-based performance measures and represent a large source of funding for PPSs.

❖ Most of the provider communication survey measures are soft skills that need to be taught and practiced routinely

❖ Most of the survey measure results are based on whether a patient feels like they were heard, plus an assessment of their actual health literacy skill set

❖ Most of the access measures are determined by a person’s knowledge of where and how to access services, how to navigate the system and whether there are other social determinant influencers

❖ Most of the claims-based measure results depend on a person’s knowledge of health issues and other social or lifestyle factors

In order for a person to be successful on their journey to get or stay well, they need to be able to:

✓ Communicate✓ Write✓ Do math✓ Listen

✓ Navigate✓ Trust✓ Analyze✓ Search

✓ Ask Questions✓ Make Decisions✓ Follow

Directions

Introduction

PPS should consider measuring the success of any health literacy initiatives implemented by partners. Above are 3 examples of performance indicators created for SI PPS partners.

Partner Organization Type PCMH HL Training Comm Tool AHRQ Tool

Staten Island University Hospital X X X4, 13, 14,

15, 16

Richmond University Medical Center Hospital X X X 4

Community Health Center of Richmond FQHC X X 4

Metro Community Health Center FQHC X

Brightpoint FQHC X X 4

Community Health Action of SI CBO X 4

Eger Nursing Home SNF X X 4

Clove Lakes Nursing Home SNF X

E.G. Healthcare Primary Care X X X

Victory Internal Medicine Primary Care X X X 11, 12, 14

University Physicians Group Primary Care X X

Visiting Nurse Association of SI Home Care X

Coordinated Behavioral Care (CBC) Care Coord. X X 4

Northshore Home Care Home Care X X 4

We have had successful collaborations with a range of PPS partners through the Diversity and Inclusion task force, which governs the Cultural Competency and Health Literacy workstream, since September 2015.

These 14 organizations have been working as the Health Literacy Team workgroup for the last 8 months. Together, we have met these milestones:

❖Created Health Literacy guidelines from AHRQ and IOM tools

❖Conducted workgroup training on:▪ Health Literacy basics▪ Effective communication ▪ Plain language simplification

❖Each partner site is currently using tools created by the PPS or AHRQ to implement quality improvement projects

❖Partners are using KPI’s or patient satisfaction survey results to measure success of each initiative

Partner Participation