Health Literacy

By Ginny Hosbach, RN, MSN

Health literacy is the ability to read, understand and act on health information. About 90 million Americans (nearly 1 in 2 adults) do not understand basic health information, according to the Institute of Medicine (IOM) Report.  By some IOM estimates, low literacy levels cost the healthcare system more than $58 billion annually.  The Partnership for Clear Health Communication is the first national coalition of organizations who are working together to promote awareness and solutions around the issue of low health literacy and its effect on health outcomes. This organization supports the findings in the IOM report, “Health Literacy: A Prescription to End Confusion.”

The organization’s first initiative is “Ask Me 3”, a quick and effective tool designed to improve communication between patients and providers. “Ask Me 3” promotes three simple but essential questions that patients should ask their providers in every health care interaction: What is my main problem? What do I need to do? And Why is it important for me to do this?

“Ask Me 3” provides tips for clearer health communication.  Some of these tips include having the patient commit to asking these 3 questions, bring a friend or family member to help at their doctor visit, make a list of health concerns to tell their doctor or nurse, bring a list of all medicines, and ask their pharmacist for help when they have questions about my medicines.

Is your patient able to read their prescription drug bottles, appointment slips, medical education brochures, doctor's directions and consent forms? What is their numerical or computational ability to calculate or reason numerically? With the development of the Internet as a source of health information, health literacy may also include the ability to search the Internet and evaluate websites.

There are three tools that were designed to specifically measure health literacy, The Test of Functional Health Literacy in Adults (TOFHLA), The Rapid Estimate of Adult Literacy in Medicine (REALM) and the Newest Vital Sign (NVS). Check these out for use in your situation.

Offer help confidentially, provide privacy and be non-judgmental. Offer assistance and get feedback from the patients to identify what they know.  Use the teach-back and show-back strategies to identify the patient’s understanding of the information provided. 

PTI and NCQA in Austin, Texas!

Austin, TX

Practice Transformation Institute’s Lisa Allen, RN, BSN, and Carla Irvin, RN, BSN, braved the hot, humid weather of Austin, Texas to attend training on NCQA’s Patient Centered Medical Home (PCMH) Recognition Program. With the comprehensive knowledge they gained about the requirements, application process and documentation of the NCQA PCMH Recognition Program, they can now help practices work toward this important national achievement.

With over 6000 recognized practices in nearly every state, NCQA’s PCMH Recognition Program is the most sought after and widely accepted PCMH program in the nation. Becoming NCQA recognized requires deliberate strategies and efforts in transforming a practice into a medical home.

NCQA is a private, non-profit organization dedicated to improving health care quality located in Washington, D.C. They are committed to providing health care quality information for consumers, purchasers, health care providers and researchers.

URAC Patient Centered Health Care Home Practice Achievement Program

Practice transformation realigns an office to become patient-centric. This is a tough job for a practice to accomplish as it takes a lot of time, effort and patience. All team members need to be engaged in the transformation process to make it a success. If a practice wanted to be formally recognized for their efforts, there are many PCMH recognition programs at the state and national levels.

One of the reasons that PTI recommends URAC’s Patient Centered Health Care Home (PCHCH) Practice Achievement Program is because it requires a comprehensive onsite review. Only through a physical onsite can a true culture change and transformation to a PCMH model of care be determined. This cannot be done by uploading paperwork to a website.

An onsite review:

·      Determines behavior change

·      Reveals adaptation to the PCMH philosophy

·      Shows how your team has transformed

·      Validates how your policies, procedures, processes and documents support 
 URAC PCHCH Standards and Elements

·      Establishes how the practice monitors quality improvement activities

The objectives of practice transformation are to become a better practice, a better team and a cheerleader for your empowered and engaged patients. Don’t just go through the motions. Improving quality of care is the primary goal. Let that be your inspiration.

Prepare, Transform, Improve: Website Makeover

Practice Transformation Institute underwent its own transforming process recently as we undertook a total redesign of our website. As in any change process, we had to start where we were and ask ourselves numerous questions to lay the groundwork: What information to keep? What type graphics would we like to use? What keywords or phrases will people use to search for our services? What do we want it to look like and what DON’T we want it to look like? What company do we choose for designing it? What is our budget? How long will it take? Will the web company’s deadlines mesh with our internal workload? Who will maintain it once it is done? These and many other questions were discussed and bantered about. Once completed and we were testing it, more questions came up: Is the website easy to read?  Is it easy to navigate? How consistent are the graphics, typeface and content throughout the site? It took a team effort to make these decisions and more as every department was affected.

Was it work? Yes!

Was it fun? Yes!

And the new site was worth the effort. It looks fresh, is easy to navigate and allows PTI staff to update it as our program offerings change. We invite you to visit the site at www.transformcoach.org.  While perusing our new site, connect with us on Facebook, Twitter and Linked-in.  We’d love to hear what you have to say. 

San Francisco Quality Summit

Q: What do cable cars, the Golden Gate Bridge, and Fisherman’s Wharf have in common with PTI?

A: The URAC Quality Summit conference with Carla Irvin and Lisa Allen attending!

Carla and Lisa spent 4 wonderful days in San Francisco attending URAC’s Quality Summit and Best Practices Awards conference. The theme of this years’ conference was “Framing the Future of Health Care and Health Insurance Exchanges: Quality, Value and Innovation.” Much of the joint sessions of the conference were dedicated to discussing the exchanges and preparing health care organizations, health plans, physicians and patients on navigating the upcoming health care challenges. One speaker said it best when he referred to our current progress in building a new health care system as “the ground zero” point. The hardest work is occurring now because it hasn’t been done before.

J.D.Kleinke, medical economist, author and Resident Fellow at the American Enterprise Institute, delivered the keynote address, “Countdown to Meltdown? Preparing Your Organization for the Affordable Care Act, Market Reform and the Brave New Healthcare World.” This dynamic session was followed by a federal and state level health policy panel discussion with a lively debate between Joel Ario (Manatt Health Solutions), Christopher Koller (state of Rhode Island Health Insurance Commissioner), Brent Barnhart, (Director, California Department of Managed Care), and The Honorable Greg Wren (Alabama House of Representatives). Carla and Lisa participated in several break-out sessions on patient centered medical homes, radiation calculator tracking, patient wellness programs, medication management, and behavioral health. All breakout sessions were facilitated by the finalists for the Best Practices awards. The Best Practices are based on those health care organizations that actively pursue practices to advance consumer empowerment and protection in an exceptional, measurable and reproducible way.

The second keynote speaker, Carolyn M. Clancy, MD, Director, Agency for Healthcare Research and Quality, delivered enlightening comments with her speech on “Improving Health Care Quality through Collaboration and Patient-Centered Care.” Rounding out the conference was updates from URAC on new products and revisions to current programs. All in all, it was a great opportunity to network with colleagues and enjoy the sights and sounds of the little city on the bay-San Francisco. 

2012 Michigan Association of Health Plans (MAHP) Summer Conference

Welcome to the Practice Transformation Companion! I’m Carla Irvin and I work in Validation Programs at PTI as a URAC PCHCH Certified Auditor.

My PTI colleague, Lisa Allen, and I recently returned from the 27^th Annual MAHP Summer Conference held at the Grand Traverse Resort near gorgeous Traverse City. The Michigan Association of Health Plans is a nonprofit corporation established to promote the interests of member health plans. Their mission is to provide leadership for the promotion and advocacy of high quality, affordable and accessible health care for the citizens of Michigan.

Lisa and I made our first appearance at the pre-conference session. Cynthia Whitaker, a URAC Accreditation Reviewer, gave an introduction to URAC and its various accreditation programs.  I was pleased to discuss the URAC Patient Centered Health Care Home (PCHCH) Practice Achievement Program in action, aided by a video featuring Country Creek Pediatrics from Rochester, the first practice in the country to attain URAC PCHCH Practice Achievement. Lisa followed with an introduction to Practice Transformation Institute and our various learning programs for implementing the principles of the patient centered medical home and other primary care transformation initiatives. The next couple of days were spent in educational sessions and, not surprisingly, quite a bit of the conference focused on the Accountable Care Act (ACA) and the Supreme Court decision. Sara Rosenbaum, JD, Chair of the Department of Health Policy at The George Washington University School of Public Health and Health Services in Washington, DC delivered the Opening Keynote: Making Sense of Federal Health Care Reform: Where Do We Go From Here?  Other session topics included Future Directions in the Michigan Medicaid Program: A National and State Perspective and The Status and Direction of Michigan’s Insurance Exchange, among others.

Practice Transformation Institute had a table in the Exhibit Hall right next to our friends from URAC. Conference attendees stopped by to hear about services URAC and PTI could provide for their companies. PTI had a raffle for a dazzling gift basket filled with Michigan-made products and gifts. The lucky winner was a thrilled Diane Lecerf from Meridian Health Plan.

All in all, we enjoyed this stimulating week filled with timely updates and great conversation. With Traverse City as the backdrop, what could possibly be better? Were you at the conference with us? PTI wants to hear your feedback.

Carla Irvin, RN, BSN

Validation Programs, Practice Transformation Institute

Self Management Enters the Primary Care Vernacular

One of the hallmarks of the Patient Centered Medical Home (PCMH) and Patient Centered Health Care Home (PCHCH), and likely any other acronym that arises to emphasize patient-centric care, is self-management support.  Self management is a growing practice in primary care for working with patients with a chronic condition(s).  Self management techniques can also be used with well patients who want to maintain a healthy lifestyle.

What does self management support mean? In a nutshell, it is a means to teach patients to take ownership for their illness or care and live a healthy life with a chronic condition.  Self management support is a proven method to teach problem-solving skills to help patients overcome the physical and emotional problems caused by the disease. Patients learn how to set short term goals that are actionable and specific. Through self management support and active goal setting, patients learn how to take care of their illness, how to carry out normal daily activities and to manage the emotional changes that occur with a chronic condition. By setting small, specific goals, patients become an active participant in their health care and gain a sense of accomplishment and empowerment as they achieve success in managing their illness.

How do patients learn these skills? By working with trained staff in their primary care physician’s (PCP) office. These trained individuals can be any member of the PCP office, both clinical and non-clinical. Another learning method is to take a self-management course that is offered in the local community or through another health care venue. With self management skills, individuals are better equipped to accept responsibility for managing their chronic condition. The key to success in transferring self management skill knowledge, as with most things, is education. What do you have to say about teaching your patients self management skills? PTI wants to hear it.

A Word on Validation

We all want validation in our work. For primary care physician practices, validation has taken on an entirely new meaning in recent years with the aggressive move towards transformation to Patient Centered Medical Homes (PCMH) and URAC’s Patient Centered Health Care Homes (PCHCH –https://www.urac.org/healthcare/prog_accred_pchch_toolkit.aspx).  

For practices seeking official validation as a PCMH and/or a PCHCH, it is important to make sure that all practice members have been involved in the transformation process and are prepared to be part of the validation visit.  The ultimate goal of validation is to assess/confirm the transformation of a practice from the ground level up to ensure that optimal patient- centeredness has been achieved.  This undertaking requires full commitment by members of the office team, not to mention an investment of time and money for practice reengineering.

Not only must a practice be ready for a validation visit, but the person performing the audit also must fully understand the PCMH/PCHCH process to be able to assess the practice appropriately.  An auditor should be able to offer suggestions and guidance to make sure that the changes the practice is making are sustainable in the long-term.  Whether you are the auditor or a member of the practice team, we all want the same thing- to improve the quality of care for the patient and the health care system.

2012 will see a surge in validations now that URAC is launching its PCHCH Practice Achievement Recognition program on an international scope.  When you are looking for a validation team, consider PTI.   Why? Experience counts.  We have trained auditors and are the first organization to receive PCHCH Certified Auditor status.  

What do you have to say about validation? PTI wants to hear it.

It’s a Lovely Day in the (Medical) Neighborhood

Just when the majority of the primary care community gets familiar with the Patient Centered Medical Home/PCMH terminology, a new term moves in next door.  The Patient Centered Medical Home “Neighborhood” entered the primary care vernacular in 2011 but is sure to increase in usage and understanding in 2012. So just who are these neighbors? Simply, they are specialists who are neighbors to the primary care home.  Examples of neighborhood specialists who could serve the medical home include oncologists, nephrologists, endocrinologists, cardiologists, neurologists and gastroenterologists. With the primary care physician handling coordinated care in the medical home model, it makes sense that specialists who serve patients with chronic and often complex illnesses be welcomed into the neighborhood of care.  Stay tuned while the financial structure of PCMH neighborhood physicians takes shape.  

What do you have to say about the medical neighborhood?  PTI wants to hear about it.

Your Practice Transformation Companion

The concept of practice transformation was developed over the past decade, but not until recently has the phrase started to have tangible meaning for those most impacted by it: physicians and their primary care practice teams.  In simple terms, practice transformation aims to realign the physician’s office to a more patient-centric practice, generally known as a Patient-Centered Medical Home (PCMH) or, following URAC, a Patient-Centered Health Care Home (PCHCH). Practice Transformation Institute, established in 2007 was the first non-profit organization in Michigan to address the need for training and education to realize the goals of practice transformation.

Practice transformation is accomplished by taking baby steps towards the particular goals that you have identified for your practice.  Each baby step  inches towards milestone goals like meaningful use technology, accessible office hours , coordination of care between the physician’s office, specialty physicians and myriad community resources, planned visits and team huddles, and smart office administration policies that address hiring, firing and performance reviews.  Phew, that’s a lot of milestones!  Don’t worry though. The most difficult part of practice transformation, like most journeys, is the first step. In this case, that is accepting the need to transform and investing time and money (at least up front) to make it happen.   Once acceptance has been achieved, the practice transformation journey does get easier.  That’s because there is an understanding and appreciation of the ultimate value in developing patient centric practices: improving patient health and quality outcomes and office efficiencies and creating a stronger, empowered physician/practice team.

This PTI blog, starting with today’s introductory post, isn’t intended to create converts to PCMH or PCHCH. It’s to serve as a soul mate on the journey for those who have decided to hit the patient-centric trail.  I’ve done about 240 PCMH on-site validation visits in my career and am gearing up for URAC validations (PTI is the first organization in the nation to receive URAC’s PCHCH Auditor Certification) so expect to do hundreds more. I’ll offer input, suggestions and who knows, maybe even an occasional gripe along the way.  Your comments are always welcome.