Part one of three-part series

TUESDAY, Sept. 7, 2010 (HealthDay News) -- Are American consumers "health literate" enough to play a leading role in their health care and coverage decisions?

That question will be put to the test in 2014, when more than 30 million uninsured adults begin shopping for health plans through state insurance exchanges -- a core element of the national health reform package signed into law by President Barack Obama in March.

Stakeholders hope to avoid another debacle like the one that occurred nearly five years ago when Medicare launched its then-new prescription drug benefit, called Medicare Part D.

"If you look back at Part D, we learned a lot about how multiple choices in plans and in drug-plan coverage overwhelms, confuses, undermines people's confidence that they can manage the system," said Christina Zarcadoolas, an associate professor in the department of preventive medicine at the Mount Sinai School of Medicine in New York City and a health literacy expert.

Health literacy -- the capacity to obtain, process and understand basic health information to make appropriate health decisions -- isn't a new concept. But as consumers are encouraged to play a more active role in choosing health insurance coverage, using preventive services and screening tests and managing chronic health conditions, it's becoming more critical.

"Health literacy is needed to make health reform a reality," U.S. Health and Human Services Secretary Kathleen Sebelius said in a statement in May announcing the National Action Plan to Improve Health Literacy, a set of goals and strategies for creating a "health-literate society."

"Without health information that makes sense to them, people can't access cost-effective, safe and high-quality health services," she said.

More than one-third of U.S. adults have only basic (22 percent) or below basic (14 percent) health literacy. Just 12 percent have "proficient" health literacy skills, while less educated and poorer individuals, in general, have lower health literacy, according to a U.S. Department of Education analysis.

To improve health literacy, the Department of Health and Human Services (HHS) is encouraging health organizations and insurers to use plain language and pictures or graphs to communicate with consumers, among other enhancements.

These strategies "have the potential to both reduce the complexity and demands of the health care delivery system and educate and empower Americans so they are able to fully benefit from the Affordable Care Act and take charge of their health," an HHS spokeswoman said in statement prepared for HealthDay.

"Even someone who is well educated may not understand certain medical terminology," noted Ilene Margolin, senior vice president of public affairs and communications at EmblemHealth Inc., a New York City-based health insurer.

EmblemHealth uses Health Literacy Advisor, a software tool developed by Health Literacy Innovations in Bethesda, Md., to remove medical jargon and produce more readable brochures and other documents.

The insurer also is working with the nonprofit Literacy Assistance Center in New York City to tweak the letters it sends to people explaining their health benefits.

Part of the challenge of health reform is helping Americans sift through and understand their health plan options. Engaging people's interest in managing their health is another, Zarcadoolas explained.

"If people do not have enough health literacy to use these plans appropriately and effectively, we shouldn't expect that we're going to see enormous changes in health status," she said.

Just one-third of Americans consistently perform many of the actions that would benefit their health, according to an analysis published in May by the Center for Advancing Health in Washington, D.C. The other two-thirds never perform these actions or do so inconsistently or tentatively. Those who are less engaged or disengaged in their health tend to have marginal health literacy, the study found.

To help close the health literacy gap, Zarcadoolas sees the need for providers and consumers to communicate in new and potentially more effective ways.

A few health insurers, in fact, are testing non-traditional tools, such as electronic messaging between physicians and patients.

At Kaiser Permanente in Southern California, patients with diabetes, hypertension or both who e-mailed their physician had significantly better health outcomes than non-users of its secure messaging system. The results were published in the July issue of Health Affairs.

A few health plans and wellness vendors are testing the use of mobile phone technology to help patients manage health conditions. WellDoc Inc., a Baltimore-based software developer, announced this month that the U.S. Food and Drug Administration cleared its DiabetesManager System, which provides real-time feedback on blood glucose readings and disease management advice via a patient's cell phone.

Pittsburgh-based insurer Highmark Inc. recently rolled out a free iPhone application to help members, wherever they may be, locate participating Highmark providers, look up medical information and get wellness tips.

"Are health insurers thinking about this and incentivized to look at this? Only very few, and that's the sad truth," Zarcadoolas said. "They are still pumping out pamphlets and sending them to you by snail mail."

More information

Visit the U.S. Department of Health and Human Services to learn more about the government's health literacy action plan.

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