Monthly Archive for October, 2009

Rx for Health Literacy

Published on October 30, 2009 in Health Care, Jennifer Sweeney and Quality. 1 Comment
Jennifer Sweeney

Jennifer Sweeney

October is health literacy month and, as Congress debates the widespread challenges in health care, we also need to address the problem of low health literacy — an obstacle people face in doctors’ offices across the country everyday and one that has a big impact on health outcomes.

According to the Institute of Medicine (IOM), 90 million people in the United States, nearly half the population, lack the ability to read, understand, and act on health care information. Low health literacy skills are often a result of limited literacy skills, generally. Consider this daunting dose of reality: One out of five American adults reads at the 5th grade level or below, and the average American reads at the 8th to 9th grade level, yet most healthcare materials are written above the 10th grade level. And while low health literacy affects people of all education and income levels, older people, non-whites, immigrants, and those with low incomes are more likely to have trouble reading and understanding health-related information.

Health literacy is defined as the degree to which someone is able to obtain, process, and understand health information in order to make the best health decisions. These are the skills that everyone needs in order to do things like fill out medical and insurance forms, follow medication instructions, and understand the doctor’s orders for before or after surgery.

Schools and hospitals around the country are raising awareness about health literacy month this October because the impact on individuals and families is considerable and, as usual, any stigma linked to a specific struggle will only exacerbate the problem. In this case, many patients are embarrassed to ask their health care providers to explain health information and, as a result, they are less likely to follow prescribed treatment, more likely to experience medication errors, and often don’t seek preventive care. Beyond the impact on individuals and families, low health literacy takes a toll on our health care system too — adding approximately $50 to $73 billion in health care costs, according to the IOM.

The good news is that positive change is within our reach. Health care providers can help by avoiding acronyms and technical medical terminology when possible. And since one of the biggest barriers to addressing the problem is actually identifying patients who are struggling to understand health information — providers should ask every patient questions to determine if they need help.

And (not that we needed another reason besides improving health to invest in tackling this problem) we’re now seeing that improving health literacy rates could also enhance people’s frame of mind. According to a recent study, researchers from the University of Alabama at Birmingham’s Center for Education and Research on Therapeutics (CERT) and the University of Oklahoma have actually found a positive correlation between health literacy and personal levels of happiness. The study revealed that happiness scores increased steadily with higher levels of health literacy even after controlling for demographic variables, poverty levels, and self-reported health.

As we’ve learned during the course of the current health care debate, the solutions we need in order to improve the health and well being of families across the country come in many shapes and sizes. Broad systemic changes, many of which we’ve seen proposed in Congress in the past year, are going to be necessary. But those changes must be underpinned by strategies — like improving health literacy — that can help ensure patients benefit from health reform. To learn more about what you can do to help tackle the problem of low health literacy, please visit the Department of Health and Human Services’ (HHS) Health Literacy Improvement page.

What Did You Just Sign?

Published on October 26, 2009 in Sharyn Tejani and Workplace Fairness. 0 Comments
Sharyn Tejani

Sharyn Tejani

Every day, women’s rights and civil rights groups work to improve the laws that govern our lives. And several times each day, workers sign away their right to enforce those laws in court.

Workers, of course, have no choice — if they don’t sign, they won’t get the job or risk losing their job.

Despite this blatant imbalance of power, courts routinely enforce what workers sign, and workers who are sexually harassed, fired for their race, or refused a reasonable accommodation for their disability find out too late that they can’t go to court to vindicate their rights. Instead, they have to go through a secret arbitration process where the person making the decision relies on the fact that employers hire them to hear these types of cases, the federal rules of evidence may not apply, damages that are in the statute don’t have to be given, and any decision is kept secret.

But some workers have the courage to take this system public — and hopefully you have already heard the story of one of them: Jamie Leigh Jones.

In 2005, Jones, a former employee of Halliburton/KBR, was viciously assaulted, gang raped, and sexually harassed by co-workers while working for Halliburton in Iraq. After she reported the attack, Halliburton locked up Ms. Jones in a shipping container with an armed guard out front. She was only able to contact her family after convincing her guard to lend her his cell phone.

Her dad got in touch with a Republican Congressman who got her help. Upon her rescue from Iraq and her return to the States, Ms. Jones filed a lawsuit against Halliburton for the appalling harm she endured. Halliburton insisted that Ms. Jones submit her claims to forced arbitration, because when she started working for them, she had signed an agreement to not bring claims against the company in court.

Four years after the attack, the Fifth Circuit ruled that Ms. Jones’ sexual assault claims could proceed to court, but that her sexual harassment claims could be forced into arbitration. So only now, four years later, a court will hear part of Ms. Jones’ case. Here is the testimony she gave in front of a Senate committee this month.

Ms. Jones’ case has become well known thanks to her willingness to go public — and thanks to Senator Al Franken, who is working to make sure that the Department of Defense does not spend our tax payer dollars to support companies that make their workers sign this type of agreement. See him talking about the Amendment he introduced to stop this here.

Sixty-eight Senators — including all the Republican women — voted for it. (See how your Senator voted.)

Now we’re working to make sure that the Franken Amendment survives the negotiations between the House and the Senate as this legislation is reconciled, and that efforts to weaken it fail.

How can you help? Call your Representative and Senators at 202/224-3121 and tell them you support the Franken Amendment to the DOD Spending Bill because you want your tax money spent with companies that treat workers fairly. And educate yourself about the dangers of mandatory arbitration here.

The Evidence is There: Better Coordinated Care Makes Sense and Saves Money. Duh.

Published on October 14, 2009 in Campaign for Better Care, Christine Bechtel and Health Care. 0 Comments
Christine Bechtel

Christine Bechtel

This just in.  What health care experts have suspected for some time has been demonstrated by a new study published in the American Journal of Managed Care: patients who can rely on a coordinated system where their providers talk to each other, their medical information is available electronically, and they have improved access to doctors and nurses – have better health outcomes.

Quick Fact: What is a Patient-Centered Medical Home?

A “medical home” — aka: “patient-centered medical home”— is a medical office or clinic where a team of health professionals work together to provide a new, expanded type of care to patients. It’s not an institution or nursing home, but a medical office or clinic that offers coordinated, comprehensive primary care that is personal and focused on making sure the patient’s health care needs are met.

The study compared four components – patient experience, quality of care, costs, and staff burnout – at a pilot patient-centered medical home (PCMH) in Seattle.  The outcome is compelling. 

Patients at the PCMH fared far better than patients at control sites in some significant ways.  After 12 months, patients at the PCMH had 29 percent fewer visits to the emergency room and 11 percent fewer hospitalizations.   These patients reported higher levels of satisfaction with their care and took a more active role in their own health care through regular communications with doctors and more participation in patient groups and self-management workshops.  These outcomes are good for patients, good for providers, and good for our nation’s pocket book. 

Another reason the medical home model is so promising?  Staff burnout (a long-time problem for primary care clinics that threatens the important role they play in preventing disease and keeping people healthy) was significantly less after one year at the PCMH.  Only 10%  of staff reported high burnout compared to 30% at the control sites.

And– because we love it when higher quality of care makes financial sense too – even though the PCMH had some significant initial start-up costs, those costs were recouped quickly (after one year).  The study estimates this is because of savings from fewer emergency visits and hospitalizations.   From the patient’s perspective, there was no detectable difference in cost between the PCMH and the control sites; meaning the PCMH was providing better care and patients were getting better outcomes and it didn’t cost them more.

But of course there’s bad news – there always is.  The problem is that all those savings generated by the PCMH didn’t actually accrue to the same people who made the wise investment in the first place.  For example, reduced hospitalizations are a worthy outcome, but those savings don’t benefit the PCMH directly; they really save health plans money.  That’s a function of the way we currently pay for health care, which promotes fragmentation over coordination and leaves patients feeling as though they’re a collection of body parts instead of the whole person they really are.

Evidence like this should play a central role in re-organizing health care payment and delivery systems in this country.  As Congress debates the future of health care, we must make sure that the way we pay for and deliver care helps every patient receives the high quality, coordinated care they deserve. 

For more information about the Patient-Centered Medical Home and how you can help advance this exciting new model of care in your area, click here.

The Costs of Family Caregiving in an Aging Society: What Is Your Experience?

Published on October 5, 2009 in Campaign for Better Care, Health Care and Lynn Feinberg. 2 Comments
Lynn Feinberg

Lynn Feinberg

Everyone I know has at least one personal story about the overwhelming stress and frustration in trying to arrange, coordinate or provide the best possible care for an aging parent, spouse, grandparent, other older relative or friend, not to mention the spiraling costs of health care.

More than three decades of research clearly show that family caregiving is a public health issue — that family members who provide care to older adults with chronic or disabling health conditions are themselves at risk — emotionally, physically and financially — particularly when the care is for a loved one with Alzheimer’s disease or another form of dementia.

Given our current economic recession, the financial aspects of family caregiving can be particularly distressing for the estimated 34 million Americans — most of whom are women — who provide care for an older (50+) family member or friend. The financial strain on this group, as they try to manage work, family, and caregiving responsibilities, was highlighted in a recent article in the New York Times. “Taking Care of Parents Also Means Taking Care of Finances” describes the growing numbers of Americans who are facing the “financial squeeze that can come from caring for elderly parents.”

The costs can be significant. Caregivers to persons age 50 and older spent an average of $5,531 per year out-of-pocket in 2007 for expenses ranging from household goods, food and meals, travel and transportation costs, to medical care co-pays and prescription medications.

According to a recent study by the National Alliance for Caregiving and Evercare, family caregivers have experienced the economic downturn in major ways. Consider these sobering statistics:

  • 50% of working caregivers (that is, those who have worked at some point while providing care in the past 12 months) said they were less comfortable taking time off from work to provide care;
  • One in three working caregivers said they had to work more hours or get another job;
  • One in six (15%) said that the economic downturn has caused them to lose their job or be laid off;
  • Six out of 10 caregivers who reported increasing their out-of-pocket spending for caregiving also reported having difficulty paying for their own basic care needs; and
  • 63% say they are saving less for their own retirement.

When it happens to you, when it becomes a personal issue in your own family, you are more likely to act.

For years at the National Partnership, we have talked about helping Americans meet the dual demands of work and family. A lot of people think about working parents when they hear those words, but millions of working people in this country are caring for frail, older relatives. The time has come to organize family caregivers as a strong and powerful force for meaningful and lasting change.

Stories about the real-life experiences of older adults and their family caregivers can help increase attention to the urgent need for better and more affordable, coordinated care.

Please take a moment to share your personal story about your caregiving experiences for an aging relative or friend.

Your story can make a difference!