Health Literacy: A Key Ingredient for ACO Success

Gregory A. Hood, MD

Disclosures

September 10, 2014

Introduction

Are your accountable care organization (ACO) policies developed from a perspective that takes the degrees of health literacy of your covered lives into account? Does your ACO proactively foster an environment in which patients, regardless of degree of literacy, feel comfortable seeking help and asking questions? Are your ACO staff members able to communicate on an educational level at which your patients can understand them clearly? Are your patients able to understand what their providers tell them?

Without managing health literacy, ACO success is left to chance. Health literacy is a variable that has a fundamentally significant impact on the success and challenges facing each medical case. ACOs in particular face challenges stemming from issues of health literacy, or lack thereof, because of the financial ties of organizational accountability.

The Patient Protection and Affordable Care Act (ACA) of 2010, Title V, defines health literacy as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions.

In the ACO of which I am a medical director, we conducted an analysis of a small but suitable sample of patients this year. We found that 6% of our patients studied are unable to read at a sixth-grade level. However, this level of health illiteracy ranged to as high as 20% of ACO patients within some medical practices. Lest someone think that this is a problem isolated to our area, the Centers for Disease Control and Prevention (CDC) has published long-term studies, with follow-up, which demonstrate not only that national literacy scores are lower than would be desired but also that they have changed "relatively little over time."[1]

It was beyond the scope of our analysis to estimate the capacity that each patient possessed. Literacy is the numerator, capacity the denominator. Capacity, again as defined by the CDC, is the potential that a person has to do or accomplish something. Health literacy skills are what people use to realize their potential in health situations. Patients apply these skills either to make sense of health information and services or to provide health information and services to others.

Decision-Making Depends on the Conduit of Successful Communication

Awareness of limitations, either of capacity or of literacy within the patient population of one's ACO, is critical if one is to optimize the care and outcomes of each patient. Efforts to avoid ambulatory sensitive admissions, in particular, as well as to receive the shared savings necessary for the continuation of the product's viability, depend on a comprehensive understanding of this issue. This understanding must translate into coordinated efforts at all levels of ACO and medical practice staffing.

Each patient who needs to receive health information or health services must be able to communicate his or her needs and preferences. The capability to respond to information imparted is also required. This requires the ability to process the meaning of the information provided and services rendered. The literacy is an incumbent requirement in order to understand and process the choices given, the context and consequences thereof as well.

Ultimately, each patient will make choices based upon his or her own interpretation of how the proposed services match individual preferences and understanding of needs. Additionally, it is important to remember that, just as a student will have strong and weak areas of study, the degree of a patient's own literacy may vary among the topics of diagnoses, medications, medical testing, and disease monitoring, to name some key topics.

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