Creating a Business Case for Health Literacy

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Creating a Business Case for Health Literacy

• April 4, 2007
• Joan Somes, RN HealthEast
• Lane Stiles, Director, Fairview Press
• Alisha Ellwood, MA, Project Mgr, BCBSM

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Objectives

• Describe components of a basic business case
• Discuss recommendations from AMA, HHS and Joint
  Commission
• Provide financial implications to support Health
  Literacy business case

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Definition

• Business Case A structured proposal for business
  change that is justified in terms of costs and
  benefits. It is a typical pre-requisite for the
  initiation of a larger project and is explicitly
  required by many Project Management
  methodologies. Wikipedia 3-7-07

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Business Case Basics

• Why should we do this?
• What are the risks/benefits/costs?
• Who will benefit from this project?
• What are the key deliverables?
• What is the timeline for this project?
• How will we measure success?
• Where will you find resources?

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Why should we do this?

• Look at the business need the project seeks to
  resolve
• Rationale for the project
• Include reference context
• Project name, origins, background current state
• Objectives, opportunities and strategic alignment

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Why should we do this?

• Gap Analysis
• What is currently out there
• available materials
• ability of those using
  materials
• What is minimally needed
• any rules in place
• have rules changed
• are rules expected to
  change
• What would be the ideal
• What are others doing
• Who knows there is a problem (awareness)

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Risks / Benefits / Cost

• Financial
• Personnel
• Reputation
• Regulatory
• Ideal vs. minimal need
• Desired outcomes
• Being involved vs. not being involved
• Short term and long term focus

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Who will benefit?

• Determine the scope of your project - who will be
  impacted
• System / corporate wide
• Clinic / site level
• Provider level
• Member / patient

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Key Deliverables / Timeline

• What are the outcomes from your project?
• Milestones
• Must be measurable (quantitative or qualitative)
• Determine key stakeholders
• What is the timeline for reaching outcomes?
• Workload, project plan and schedule

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Measurement / Resources

• How will you measure success?
• Define measurement process
• Determine how often to measure
• Consider action after evaluation of measures
• Project controls and reporting needs
• Resources
• Project Champion / team - staff
• Funding financial

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Be sure your case is

• Understandable
• Measurable
• Transparent
• Accountable

• Adaptable
• Consistent
• Business oriented
• Comprehensive

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Rationale for using a business case

• 1. Lead people with authority to recommend
  projects to first think about
• as fundamental elements when considering the
  project(s) they are going to select.

• value
• risk
• relative priority

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Rationale for using a business case

• 2. Require those proposing a project to justify
  its value to firm and self cull any proposals not
  of demonstrable value
• 3. Enable management to determine if project
  proposed is of value to the business and
  achievable compared to relative merits of other
  proposals
• 4. Enable management to objectively measure
  achievement of the proposal

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Resources needed for creating a business case
specific to Health Literacy
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Identify Stake holders for literacy

• HIPPA/compliance
• Diversity folks
• Legal dept
• CEO/finance
• Foundation/funding
• Community
• Patient safety
• Clinical affairs
• Interpreters
• Public health
• Nursing councils

• Business complaints
• Customer service
• Pharmacy
• Human resources
• Educators
• Forms clearinghouse
• Marketing
• Social work service
• Care givers MDs, RNs, etc
• Parish nurses
• Quality improvement
• Clinics

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Recommendations from the AMA, HHS, and the Joint
Commission
What Did the Doctor Say? Improving Health
Literacy to Protect Patient Safety The Joint
Commission White Papers 2007
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Business opportunities (AMA)

• Strengthen mission
• Improve quality of care
• Enhance consumer loyalty, retention, appropriate
  utilization and public image
• Increase market share
• Promote cost-effective care
• Enhance workforce and stakeholder morale
• Solidify leadership position

Appendix C The Case for Promoting
Patient-Centered Communication in Health Care
Organizations, pp. 110-119, Improving
CommunicationImproving Care, American Medical
Association, 2006 http//www.ama-assn.org/ama/pub
/category/16245.html
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Risks of ineffective communication (AMA)

• Legal
• --informed consent
• --civil rights and antidiscrimination laws
• Regulatory obligations
• --CLAS standards
• --accreditation and other requirements
• --avoiding medical errors, other adverse
  events and lawsuits

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Advocating for health literacy (HHS)

• Make the case for health literacy
• Include health literacy in staff training and
  orientation
• Identify special projects programs affected by
  low literacy
• Target key opinion leaders with health literacy
  information

Advocate for Health Literacy in Your
Organization. From Quick Guide to Health
Literacy, US Dept Health Human Services,
7.17.4. http//www.health.gov/communication/liter
acy/quickguide
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Advocating for health literacy (HHS)

• Incorporate health literacy into mission and
  planning
• Convene work group to develop health literacy
  agenda for organization
• Include health literacy in grants, contracts, and
  memorandums of understanding

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Advocating for health literacy (HHS)

• Establish accountability
• Include health literacy improvement in program
  evaluation
• Include health literacy in budget requests
• Implement health literacy metrics

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Recommendations from the Joint Commission

• Make effective communications an organization
  priority to protect the safety of patients.
• Address patients communication needs across the
  continuum of care.
• Pursue policy changes that promote improved
  practioner-patient communications.

What Did the Doctor Say? Improving Health
Literacy to Protect Patient Safety, Joint
Commission, 2007 http//www.jointcommission.org/N
ewsRoom/PressKits/Health_Literacy/
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Make effective communications an organization
priority to protect the safety of patients.

• Raise awareness of impact of health literacy on
  patient safety
• Train all staff to recognize and respond to
  literacy/language needs
• Stress clear communication in all patient
  interactions
• Strategies to comply with Joint Commissions
  National Patient Safety Goals (www.jointcommission
  .org/PatientSafety/NationalPatientSafetyGoals/)

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Make effective communications an organization
priority to protect the safety of patients.

• Use well-trained medical interpreters
• Reimbursement for using interpreters
• Create culture of safety/quality with
  patient-centered communications an integral part
  of patient-centered care
• Assess organizations patient safety culture

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Make effective communications an organization
priority to protect the safety of patients.

• Assess organizations patient-centered
  communications
• Know literacy and language needs of communities
  served
• Make cultural competency a priority (hiring
  diverse staff and educating staff)
• Pursue research agenda that looks at
  communication issues re patient safety, health
  disparities, access

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Address patients communication needs across the
continuum of care entry.

• Eliminate barriers by educating about access
• Develop insurance/benefit forms that are
  client-centered
• Use clear communications for wayfinding/signage
• Design interventions/communications with messages
  and format that fit targeted audience

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Address patients communication needs across the
continuum of care the health care encounter.

• Use plain language, teach-back, visuals limit
  number of messages
• Encourage patients to ask questions
• Employ universal precautions
• Train professionals in patient-centered
  communication skills

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Address patients communication needs across the
continuum of care the health care encounter.

• Adopt disease management practices such as
  individualized education and multidisciplinary
  teams
• Redesign informed consent process
• Partner with patients for shared decision-making
• Engage patients as advocates for their own safety

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Address patients communication needs across the
continuum of care transition.

• Standardize hand-offs (clear language,
  teach-back, reporting, transitions to new care
  settings, discharge/after care)
• Reconcile patient medications across the
  continuum of care

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Address patients communication needs across the
continuum of care self-management.

• Address special needs of the chronically ill
  (using, e.g., Wagner Chronic Care Model)
• Individualize self-management education
• Outreach to patients to ensure understanding and
  adherence
• Expand patient safety taxonomies to understand
  risks associated with self-management

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Pursue policy changes that promote improved
practioner-patient communications.

• Refer low-literacy patients to adult learning
  centers
• Encourage partnerships between adult educators,
  adult learners, and health professionals
• Broaden reimbursement for patient education
  provided in physicians offices

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Pursue policy changes that promote improved
practioner-patient communications.

• Pursue pay-for-performance incentives for
  patient-centered communications and cultural
  competence
• Expand the number of medical liability insurance
  companies that provide discounts for physicians
  trained in patient-centered communications
• Expand development of patient-centered education

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Myths

• Literate patients are insulted by low literacy
  materials
• You can tell by looking someone has low
  literacy
• Patients will share with you that they have
  health care literacy problems
• A college degree means the patient will
  understand medical information
• My patients dont have low literacy problems

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Statistics - scope

• Nearly 50 of all adults (90 million) may have
  problems understanding health information
• NALS 1993 survey
• By 2050, an estimated 1 in 2 Americans will be
  African American, American Indian/Alaska native,
  Asian, Hispanic/Latino, or native Hawaiian or
  other Pacific Islander.
• U.S. Census Bureau

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Statistics financial cost

• Low health literacy increases US health care
  costs by 50 73 billion annually
• American Medical Association
• Patients with low health literacy were found to
  have a 50 increased risk of hospitalization
  compared with those who had adequate literacy
  skills.
• Baker, Parker, Williams, et al. J Gen Intern Med
  1998
• Predicted inpatient spending for a patient with
  inadequate health literacy was 993 higher than
  that of a patient with adequate reading skills.
• Baker, et al. Am J Public Health, 2002

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Statistics financial cost

• Those with low health literacy have an average
  health care cost of 13,000 compared to only
  3,000 for those with higher literacy levels.
• AMA Foundation "Health Literacy A Manual for
  Clinicians
• by Barry Weiss, MD
• Increased length of hospital stay by 1 day for
  those with limited literacy skills.
• Need source

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Statistics financial cost

• Annual health care costs for individuals with low
  literacy skills are 4 times higher than those
  with higher literacy skills.
• Weiss, 20 Common Problems in Primary Care. 1999
• With 70 of consumers failing to adhere to
  prescribed medications at a cost to the
  pharmaceutical industry of 15-20 billion
  annually, writing for understanding in critical.
• National Pharmaceutical Council. Noncompliance
  with medication regimens an economic tragedy,
  June 1992

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Statistics patient safety

• 18,000 elderly outpatients die or are seriously
  injured by prescribed medications/year
• ( 50 preventable)
• 7,000 patients die from drug errors/year
• Forbes, June 20, 2005 pg.72
• Communication breakdowns remain the primary root
  cause of more than 60 of the 2034 sentinel
  events analyzed.
• Joint Commission

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Statistics specific to you

• Go to https//www.casas.org/lit/litcode/Search.cfm
  for specific literacy information for your area
• Research your own information / reporting
• Customer satisfaction ratings
• Understandability
• Ease of use
• Wayfinding
• Repeat hospitalizations ER utilization non
  adherence to medication/treatment regimens
• Information available on ethnicity preferred
  language reading level

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What are we doing? These are the tag lines the
HealthEast site champion is using to get groups
interested

• Could you use help with
• Patient safety goals?
• Decreased cost of patient care?
• Improved patient outcomes?
• Decreased length of stay?
• New Joint Commission initiative?
• Diversity?
• Beliefs ( patients/MD/RN)?
• Attitudes (patient/MD/RN)?

We can help your staff recognize signs of low
literacy and actions they can take to address the
issue. Call..
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What are we doing?

• Fairview
• Strategic alignment of Fairview Press and access
  to key stakeholders

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What are we doing?

• BCBSM
• Keys to securing leadership support
• Be inspired
• Build a knowledge base (business case)
• Introduce concepts locally
• Take the topic to a decision making body
• Identify an executive champion
• Begin awareness campaign

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Top 10 Hints to Help Increase Literacy Awareness
at Your Site

• Be able to describe problem in relationship to
  your sphere of influence
• Identify key stakeholders
• Have a concrete plan
• Have a budget (why you need the resources)
• Identify risks of not, and benefits of, doing it
• Have a way to measure impact
• Know who you could get help from including
• Find an administrative/site champion
• Match goal with strategic initiatives (patient
  safety)
• Use appropriate regulatory agency as leverage i.e
  Joint Commission, or agencies that reimburse for
  care

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Questions Discussion