October is National Health Literacy Month, so to help celebrate Lambert van der Walde, Executive Director of the Center for Health Care Research at UnitedHealth Group, joins the Weekly Dose to explain new health literacy research.
New research from UnitedHealth Group shows people who live in communities with lower health literacy levels are at greater risk for poor health outcomes and high costs. The impact is substantial: Improving health literacy could prevent nearly 1 million hospital visits and save over $25 billion a year. To help explain health literacy, Lambert van der Walde, SVP & Executive Director, Center for Health Care Research at UnitedHealth Group, joins the podcast.
SPEAKERS
Evan Sweeney, Lambert van der Walde
Evan Sweeney00:05
Hello, and welcome to UnitedHealth Group’s Weekly Dose Podcast, where we’ll get you up to speed on the latest trends shaping the future of health care. I’m your host, Evan Sweeney. This week we’re taking a closer look at how health literacy impacts health care. New research from UnitedHealth Group shows people who live in communities with lower health literacy levels are at greater risk for poor health outcomes and high costs. seniors who need and use health care the most have the lowest health literacy levels of any age group. But there are huge disparities across the country. In the best performing counties. About a quarter of the population has limited health literacy. And in the lowest performing counties, that figure is as high as 60%. The impact is substantial. improving health literacy could prevent nearly 1 million hospital visits and save over $25 billion a year. To help us dig into this research and better understand health literacy, we’re speaking with Lambert van der Walde, who leads the Center for Healthcare Research at United Health Group. Lambert, welcome to the podcast.
Lambert van der Walde 01:10
Thanks for having me, Evan, it’s great to be with you.
Evan Sweeney01:12
Great. Well, I’m really glad to have you on because I think this is a topic that might fly under the radar for some people and is probably deserving for have a bit more attention. So just to start with the basics. Can you tell me, what is health literacy?
Lambert van der Walde 01:29
Sure, the traditional definition of health literacy has been the ability of individuals to access, understand and use information to promote and maintain good health. So it’s no surprise that the effective use of information leads to good health outcomes. The issue is where you have individuals that have limited health literacy. And with the possible exception of school aged children, it’s really not practical to address health literacy at just the individual level. So because of this challenge, the definition really needs to expand.
Evan Sweeney02:04
Okay, so has it expanded? I mean, do we have a broader definition of what that is?
Lambert van der Walde 02:08
Absolutely. Recently, the US Department of Health and Human Services created a new organizational definition of health literacy. And that is the degree to which organizations equitably enable individuals to find, understand and use information and services to inform health related decisions and actions. So this acknowledges a system level opportunity to ensure that health information is conveyed in a way that people can access it, understand it, and use it. So we can all recognize that the responsibility for health literacy extends beyond individuals to the organizations and professionals who serve those individuals.
Evan Sweeney02:51
So maybe you can provide an example of you know, what is a person with limited health literacy look like? How does that differ from someone with high health literacy?
Lambert van der Walde 03:02
A person with limited health literacy may struggle, for example, with a medicine looking at the label on the drug bottle, it’s not clear how often that medication should be taken or, or what other medications or other foods should be avoided to avoid the negative interaction. On the other hand, a person with high health literacy may have no issues in that regard. And in fact, could look at a chart that shows for example, the age range for specific childhood vaccinations.
Evan Sweeney03:35
And so in terms of the implications of that, I mean, that means that somebody with low health literacy could, you know, take their medication improperly, let’s say,
Lambert van der Walde 03:47
absolutely, and improper medication administration, drug to drug interactions, that that can actually exacerbate the underlying medical condition, it can lead to really adverse outcomes and you know, a trip to the emergency room, which is obviously expensive and undesirable,
Evan Sweeney04:05
right. So you can see how something very simple not, you know, having difficulty reading a prescription label with which I’ll be honest, I sometimes have difficulty reading those two can just lead to a bad outcome essentially.
Lambert van der Walde 04:22
Absolutely. And you add on the notion that sometimes the doctor says despite what the label tells you, I want you to take the drug a slightly different way, then you’re relying on the patient to a understand that and be implement those instructions that may diverged from the typical course of treatment.
Evan Sweeney04:41
So I guess getting back to the research you guys conducted, what were some of the key takeaways not just in terms of you know what you found, but the tangible takeaways that this research uncovered.
Lambert van der Walde 04:55
So when we started this research, we did not expect that we’d be releasing it during a pandemic however, the pandemic makes the results even more relevant and effective response to COVID-19 requires that people receive, understand and use health information to prevent the further spread of the disease. So for example, the flu shot is actually an important component of our public health response to COVID-19. And we’ve learned in the research that many more Medicare beneficiaries get the flu shot in high health literacy counties than those in low health literacy counties. So this tells us we need to redouble our communications efforts. And make sure that individuals in low health literacy counties have the opportunity and go and get the flu shot. We can also look at existing flu vaccination rates to get a sense for what we expect the vaccination rates to be when the COVID-19 vaccine is ultimately available. in there, we have the opportunity for the public sector and the private sector to work together to make sure that we get adequate vaccine administration around the country.
Evan Sweeney06:06
Can you tell me a little bit more about you know, the broad importance of health literacy and really why UHG conducted this research.
Lambert van der Walde 06:16
So think about our goal to achieve health care’s quadruple aim. And our efforts to make the health care system work better for everyone. We can approve, improve upon the access to affordable care, but we don’t get to better outcomes, if the experience that a member has is confusing. So put it another way, we can congratulate ourselves for getting someone covered, and then in to see the doctor and then diagnosed. But if the medical staff doesn’t offer a clear explanation to the patient, have a have a diagnosis or a plan of care. The opportunity to achieve adherence can get really low. And we can wonder if we’ve really accomplished anything clear communication in the exam room, I think is really foundational. In failure to communicate wipes away the gains that we’re trying to achieve.
Evan Sweeney07:13
That’s interesting, because I mean, there’s a lot of effort put into, you know, preventative care, keeping people out of the emergency room, and understandably so. But all that can sort of be in some sense washed away with just sort of a simple misunderstanding or, or inability to, you know, sort of understand that the information that’s being put in front of them.
Lambert van der Walde 07:35
Right, the medical analogy might be someone goes to the emergency room, and the doctors and nurses working at the hospital can stop the bleeding. But the conversation that follows to avoid that proverbial bleeding in the future, or maybe literal bleeding. If that’s not conveyed in an effective manner, you can anticipate a return trip. And that’s not good for anybody. It’s certainly not good for the system.
Evan Sweeney07:59
And this has a substantial impact, right? I mean, we’re talking about it right now. But your research actually does tie this to, you know, hospitalizations, millions 10s of millions dollars in costs, correct?
Lambert van der Walde 08:10
Yeah, that’s right. We looked at the Medicare fee for service population at large national group of beneficiaries and determined that if the population had health literacy at the at the higher levels, you would see a million fewer hospital visits, and $25 billion in savings. That’s pretty significant. That’s pretty substantial. And it’s not just about episodes and dollars, it’s also about these individuals, these people in their lives and their families and the impact that they face.
Evan Sweeney08:44
Yeah, absolutely. The other thing that stuck out to me, with your research is just the wide discrepancy between counties. Why was that?
Lambert van der Walde 08:54
Yeah, health literacy levels in a county can really vary principally based on educational attainment in those counties, but it’s also impacted by poverty, status, marital status, the language spoken in the home, the length of residence in the United States, and also Ah,
Evan Sweeney09:14
okay. And in terms of age, I mean, the research shows that, that seniors actually have the lowest health literacy levels of any group. And I mean, this is a group that that oftentimes uses the health system the most so why are we seeing those low levels?
Lambert van der Walde 09:29
Yeah, it’s a really good question, Evan. And that that’s my way of saying we don’t really have a great answer to this, but there are several age-related elements that could contribute to the decrease of health literacy for the for older adults. First age related decline in cognitive ability could contribute to an older adult’s ability to understand and recall new topics. Second, physical impairments. Just a decrease in the ability to hear or see may contribute To decrease comprehension in third socio economic status, coping may negatively influence the understanding and the ability to process the self health information.
Evan Sweeney10:13
Okay, so what is UHG doing to help improve health literacy, not just in seniors, but more broadly?
Lambert van der Walde 10:20
Yeah, in the research, one of the most rewarding findings was that UnitedHealth Group is actually doing a lot to address health literacy. We’re improving the way we communicate, including the training of our consumer facing professionals. We’re testing written communications to ensure they’re accurate and clear and actionable. And we’re offering materials in the languages spoken by our members. One way that UHG is leading the industry is with our just plain clear glossary at just plain clear calm, which provides simple alternatives to complex health terms. It’s online, it’s publicly available, and it’s used by consumers and employers, clinicians, health organizations, literacy programs around the country. It’s the largest of its kind, it has more than 20,000 terms of English, Spanish and Portuguese.
Evan Sweeney11:15
What role do clinicians play in health literacy? I mean, they seem like the ones that are probably interacting with patients the most and could, you know, presumably make significant headway here?
Lambert van der Walde 11:27
Absolutely. Clinicians communicate really important information, including what’s wrong with the patient, the diagnosis, treatment instructions, any referrals. And so, patient’s ability to understand this information is really critical for effective disease prevention, effective disease management.
Evan Sweeney11:46
Can you give me an example of how clinicians might be able to do a better job?
Lambert van der Walde 11:51
there’s an approach called the teach back method. And it’s a simple technique. The, the essence of it is that the clinician takes on the responsibility with the patient for being clear in his or her communication. And this is as opposed to appearing to test the patient’s understanding and turning it into a stressful quiz. So when a clinician uses this teach back method, she checks the clarity of her explanation by asking the patient who just received instructions or advice, to share or teach back the information he or she just learned. So the opportunity here is for medical teams to normalize this approach into their ongoing workflow.
Evan Sweeney12:35
So how might that work?
Lambert van der Walde 12:36
Sure, a doctor could say to a patient. You know, Evan, we’ve been talking about a few different things here. And I’ve given you some instructions, would you mind saying it back to me, so I can know if I was clear in my explanation. Or you might be Evan, your wife is going to ask what happened today? What are you going to tell her when you get home? And that gives the patient the opportunity to relate back to the physician what, what the patient heard?
Evan Sweeney13:05
So what’s next? In this area, is there any follow up research that UHG is looking to conduct?
Lambert van der Walde 13:12
Yeah, we’re really proud of this research and it shines a light on some really terrific work that’s being done across the enterprise. You know, I’d like to come back to this at some point and see if we can measure which interventions have the largest impact on improving health literacy. And hopefully we can continue to improve this health literacy gap through better information about what works and what doesn’t.
Evan Sweeney13:39
Great Lambert, thank you so much for joining us today.
Lambert van der Walde 13:43
Thank you, Evan. Appreciate the time.
Evan Sweeney13:45
That’s it for this episode. Thanks for listening to UnitedHealth Group’s Weekly Dose Podcast. Have a great rest of your week.