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Welcome to the Webinar
Health Communica/on Ma1ers! Applying Health Literacy to Health Insurance:
How We Can Help Consumers
We will begin shortly…
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Today you’ll be hearing from. . .
Nancy Murphy, MSHC Metropolitan Group
Moderator
Kathy Paez, RN, Ph.D. American Institutes for Research
Principal Researcher
Jennifer Messenger Heilbronner,
Metropolitan Group Exec. Vice President
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Agenda 1. Review of session objec0ves 2. Introduc0on of today’s speakers 3. What do consumers know – and what do they think they
know – about health insurance? 4. Q & A 5. Cover Oregon: Real-‐0me case study on consumer outreach 6. Q & A 7. Specific ac0ons and resources 8. Next steps & conclusion
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Objectives • Describe what consumers do and don't understand as they
are shopping for and using private health insurance • Describe what consumers should understand to be health
insurance literate • Understand how audience segmenta0on informs outreach
and enrollment strategies • Describe the marke0ng mix used to build awareness, educate
and drive enrollment
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Who is speaking today: Kathy Paez
Kathy Paez, RN, Ph.D. Principal Researcher American Institutes for Research Email: [email protected] Website: http://www.air.org
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Who is speaking today: Jennifer Messenger Heilbronner
Jennifer Messenger Heilbronner Executive Vice President, Public Health Practice Lead, Metropolitan Group Email: [email protected] Website: http://www.metgroup.com
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Who is moderating our discussion today:
Nancy Murphy
Nancy Murphy, MSHC Executive Vice President Metropolitan Group Email: [email protected] Website: http://www.metgroup.com
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Introducing Kathy Paez
Kathy Paez, RN, Ph.D. Principal Researcher American Institutes for Research
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CALPACT Webinar: Applying Health Literacy to Health Insurance
September 2013
Copyright © 20XX American Institutes for Research. All rights reserved.
How we can help consumers September 25, 2013
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“The capacity to find and evaluate information about health plans, select the best plan given financial health circumstances, and use the plan once enrolled.”
Health Insurance Literacy Expert Roundtable, 2011.
What is Health Insurance Literacy?
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“I don’t know what’s
covered, the information saying what is covered is
like a bible, I neglect to read it and try to avoid the
doctor.” -Man in his 30’s
Why measure Health Insurance Literacy?
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• Tailor outreach communications • Compare effectiveness of outreach approaches • Assess effectiveness of training consumer assistants • Evaluate changes over time in consumers’ ability to select,
use health insurance
Why measure Health Insurance Literacy?
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Domains of Health Insurance Literacy Knowledge Information
Seeking Document Literacy
Cognitive Skills
§ Insurance terms
§ Insurance concepts (e.g. premium pays for insurance that protects you against an unexpected medical event)
§ Types of healthcare services (e.g. screening vs. diagnostic)
§ Beneficiary rights
§ Locate information (e.g. eligibility, coverage requirements)
§ Evaluate credibility of information sources
§ Navigate information sources (insurer telephone trees, and exchange web sites, decision support tools)
§ Articulate questions
§ Complete forms (enrollment, claim, mail order prescription, appeal)
§ Read and follow directions
§ Interpret summary of benefits and explanation of benefit documents
§ Use schedules (e.g. provider and drug tiers)
§ Assess preventive care needs and personal risk
§ Apply benefit structure to personal situation
§ Project utilization
§ Calculate out-of-pocket costs
§ Assess value
§ Formulate questions
Self-Efficacy The confidence to perform the tasks noted above
Copyright © 2013 American Institutes for Research All rights reserved.
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Self report questions How likely are you to understand what you would have to pay for prescription drugs? a. A) very likely b. B) likely c. C) unlikely d. D) very unlikely
Knowledge and skills “test” questions
Which of the following plans would you recommend to a person with a chronic condition? This person visits their doctor twice a month and is taking three prescription drugs. a. Plan 1: Premium is $50/month and the
deductible is $2,500. b. Plan 2: Premium is $70/month and the
deductible is $1,000. c. Plan 3: Premium is $100/month and the
deductible is $300.
Two Types of Questions
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§ Adults age 22-64 § Currently insured or previously insured through:
• Employer/family member’s employer or • Non-group insurance or • Medicaid Sample size 824 people, representative of U.S population
Who we surveyed
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What we learned Characteristics Gestalt
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• Men or Women • Younger adults or Older adults • Whites or Blacks or Hispanics • More educated or Less educated • Lower income or Higher income
Who’s more health insurance literate?
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• Men or Women • Younger adults or Older adults • Whites or Blacks or Hispanics • Less educated or More educated • Lower income or Higher income • Employers purchasers or Self-purchasers
Who’s more health insurance literate?
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• Employer coverage or Self-purchasers • Staff model enrollees or PPO enrollees • Rare healthcare users or More frequent healthcare users
Whose more health insurance literate?
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• Employer coverage or Self-purchasers • Staff model enrollees or PPO enrollees • Rare healthcare users or More frequent healthcare users
Whose more health insurance literate?
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§ Choosing Insurance: General understanding
Question: “How confident are you that you would choose the health plan that is best for you?”
11.5%
27.2%
40.1%
12.0% Very confident
Moderately Confident Slightly confident
Not at all confident
Global HIL Questions
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§ Using health insurance: Knowing how
Question: “You know most of the things you need to know about using health insurance.”
Global HIL Questions
22
4.5%
20.0%
58.6%
16.7%
Strongly agree
Agree
Disagree
Strongly disagree
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A ques0on for Kathy
The percentage of people who think they know all they need to seems pretty high to me. Were you surprised by that? What concerns you about that response?
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Overarching Theme: Not knowing what you don’t know
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Insurance Experience
Costly health event
It’s a hard knock life.
Health Insurance Literacy
Confidence
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Overall Knowledge and Skills Test Results
62%
39%
68% 57%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Health Insurance Terms Knowledge of Plan Types
Skills Choosing Plans Skills Using Plans
Percent Correct Responses
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A ques0on for Kathy
What are the implications of people not knowing what they don’t know, and how can practitioners help adjust that gap?
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Understanding of Terms
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a) Very confident b) Moderately confident c) Slightly confident d) Not at all confident
How confident do you feel that you understand insurance terms
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How confident do you feel that you understand insurance terms
33.7%
29.1%
26.8%
10.1% Very confident Moderately confident Slightly confident Not at all confident
§ How confident are you that…
• Question: “You understand health insurance terms?”
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a) The payment your health plan makes for covered care. b) The amount you pay each month to your health plan for
your health insurance. c) The amount you must pay for your health care before
your health plan begins to pay. d) Not sure
A premium is:
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a) The payment your health plan makes for covered care. (5%)
b) The amount you pay each month to your health plan for your health insurance. (78%)
c) The amount you must pay for your health care before your health plan begins to pay. (7%)
d) Not sure (9%)
A premium is:
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a) A type of therapy not often covered by health plans. b) A health plan policy that requires your doctor to request
the plan’s approval of an increase in the dose of medicine you take.
c) A health plan policy that encourages members to try effective but less expensive medicines to treat their condition before trying more expensive ones.
d) Not sure
Step therapy is:
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a) A type of therapy not often covered by health plans. (3%) b) A health plan policy that requires your doctor to request
the plan’s approval of an increase in the dose of medicine you take. (5%)
c) A health plan policy that encourages members to try effective but less expensive medicines to treat their condition before trying more expensive ones. (35%)
d) Not sure (59%)
Step therapy is:
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Using Insurance
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Using Insurance: Being Proactive
11.8
14.9
5.4
4.4
28.7
32.1
13.9
13.65
28.6
30.7
23.8
23.8
28.4
19.6
54.3
51.2
2.1
2.4
3.0
6.9
Not at all likely Somewhat likely Moderately likely Very likely Not applicable
Review the statements you get from your health plan showing what you owe and what they paid for a service? Find out if a doctor is in-network before you see him/her?
Look to member services to tell you what medical services your health plan covers?
Look into what your health plan will and will not cover before you get health care services?
When using your health insurance plan, how likely are you to…(%)
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You think you might have injured your knee, so you go the doctor and she takes an X-ray. The bill is $200 for the doctor and $100 for the X-ray. Your health plan covers both of these services. You have 20% coinsurance for doctor visits and 10% coinsurance for diagnostic tests, such as X-rays. Coinsurance is the percentage of a health care bill that you pay. What is your part of the bill? a) $40 b) $50 c) $90 d) Not sure
Question: Using Insurance
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You think you might have injured your knee, so you go the doctor and she takes an X-ray. The bill is $200 for the doctor and $100 for the X-ray. Your health plan covers both of these services. You have 20% coinsurance for doctor visits and 10% coinsurance for diagnostic tests, such as X-rays. Coinsurance is the percentage of a health care bill that you pay. What is your part of the bill? a) $40 (6%) b) $50 (63%) c) $90 (5%) d) Not sure (25%)
Question: Using Insurance
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63% were correct
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Early in January, Robert visits an in-network doctor to get a wart removed from his foot. The bill for this visit is $530, which is the member rate the doctor agreed to charge his health plan for that service. Robert has a $30 co-pay, a $100 deductible, and 20% coinsurance that apply for this visit. His co-pay does not count towards the deductible. How much will Robert pay for the visit? a) $130 b) $210 c) $236 d) Not sure
Question: Using Insurance
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Early in January, Robert visits an in-network doctor to get a wart removed from his foot. The bill for this visit is $530, which is the member rate the doctor agreed to charge his health plan for that service. Robert has a $30 co-pay, a $100 deductible, and 20% coinsurance that apply for this visit. His co-pay does not count towards the deductible. How much will Robert pay for the visit? a) $130 (18%) b) $210 (19%) c) $236 (33%) d) Not sure (30%)
Question: Using Insurance
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19% were correct
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• Frequent healthcare use, age, higher education, and income are related to higher health insurance literacy
• About 2/3 of people age 22 - 65 have a basic understanding of routine care coverage
• People struggle to understand complex benefit structures • People tend to be overly confident about their ability to
choose and use health insurance
Take home points
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Kathy Paez 301-592-2229 [email protected] 10720 Columbia Pike, Suite 500 Silver Spring, MD 20901-4449 General Information: 301-592-8600 www.air.org
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Introducing Jennifer Messenger Heilbronner
Jennifer Messenger Heilbronner Metropolitan Group Executive Vice President
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HEALTH LITERACY AND MARKETING
Jennifer Messenger Heilbronner, Metropolitan Group
SEPTEMBER 25, 2013
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HEALTH INSURANCE LITERACY • "Little systematic research has been done to date to
assess health insurance literacy.” § Center for Rural Health
• Not a single concept or skill. § Prose literacy
§ Numeracy
§ Document literacy
§ Etc.
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SOME CLUES
• Older adults more comfortable with insurance info than younger
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SOME CLUES
• Most help needed § comparing different plans § calculating costs
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SOME CLUES
• Helpful: case studies showing what the plan will do for different people
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CALCULATIONS ARE TOUGH
Office visit
Co-insurance
Co-pay
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A ques0on for Jennifer
Do you have any insight yet on what’s most important to people about health insurance, especially insight that might help frame messages?
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EARLY RESEARCH MOST IMPORTANT
Insured • More can get insurance, even
with pre-existing condition
• Financial help available
• Costs and what is covered in simple language
• What plans cover
• Main concern = Quality + cost
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EARLY RESEARCH MOST IMPORTANT
Insured • More can get insurance, even
with pre-existing condition
• Financial help available
• Costs and what is covered in simple language
• What plans cover
• Main concern = Quality + cost
Uninsured • Financial help available
• More can get insurance, even with pre-existing condition
• Costs and what is covered in simple language
• What plans cover
• Main concern = cost
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LANGUAGE GUIDES
• Key messages developed by RWJF to help all exchanges
• Healthcare.gov/glossary
• Community input
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AUDIENCES
• Young and healthy
• Passive and skeptical
• Sick and worried
• Experienced and enthusiastic
• Isolated and independent
DEMOGRAPHIC, BEHAVIORIAL, PSYCHOGRAPHIC
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ENGAGING OUR AUDIENCES
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INTEGRATED CAMPAIGN
Research
Paid Media
Earned Media
Online Outreach
Statewide+ Grassroots Partners
Marketing Materials
Community Meetings All
Oregonians
Multi- cultural communities
Customized approach
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• Play/show Matt Sheehy, Lifesavas, education ads
PAID MEDIA & CREATIVE
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• Editorial boards
• Priority pitching – Young and healthy
– Women/moms
– Small biz and entrepreneurs
– Multicultural communities
• Social Media
• Avoiding fraud
EARNED MEDIA
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• Reaching traditionally underserved audiences
• Range of trusted organizations § Oregon State Library § OSU Extension § Multicultural organizations
• Events and paid sponsorships
GRASSROOTS
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§ Culturally relevant and highly customizable
§ Community tells us what motivates, makes sense
MATERIALS
Starting in October 2013, you can enroll in coverage even if you already have a health condition or have been turned down before.
COVER OREGON™ IS A NEW ONLINE MARKETPLACE WHERE YOU CAN COMPARE AND ENROLL IN MEDICAL AND DENTAL COVERAGE, AND ACCESS FINANCIAL HELP.
UNINSURED? WE CAN CHANGE THAT.
CoverOregon.com | 1-855-CoverOR (1-855-268-3767)
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• Focused language and outreach in underserved communities – African American - Latino – Asian and Pacific Islander - Russian/Slavic – LGBTQ - Tribes
MULTICULTURAL OUTREACH
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• Robust network of community partners § Online dynamic search to find assistance from an
agent or community partner
• Multilingual capacity in call center
• Multilingual paper applications
MULTICULTURAL CAPACITY
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• Transcreation
• Languages: Chinese, Korean, Vietnamese, Japanese, Spanish, Russian
• Collaborative process
• Customizable
MULTICULTURAL MATERIALS
Cover Oregon es un mercado donde hallar seguro médico y ayuda económica para pagarlo
Un seguro médico te protege a ti y tu familia de tener que afrontar una gran cantidad de gastos médicos y te ayudará a cuidar tu salud.
Seguro médico para ti y tu familia
CO-C-00020 (7/13)
Pide ayuda a una organización comunitaria o agente de Cover Oregon para completar la solicitud. Ellos pueden explicarte las diferencias entre los planes de seguro médico y ayudarte a presentar la solicitud a través de Cover Oregon.
Llama al 1-855-CoverOR (1-855-268-3767) para hablar con un representante. Podrás transmitir tus necesidades y recibir instrucciones sobre cómo solicitar el seguro médico a través de Cover Oregon. También te pueden ayudar a encontrar una organización comunitaria o un agente en tu área EGTVKƂECFQU�RQT�%QXGT�1TGIQP�
Visita nuestro sitio web: CoverOregon.com para saber cómo Cover Oregon te puede ayudar a tí y a tu familia. Usa la calculadora para ver la ayuda económica que puedes recibir. Si usas el sitio web, tu privacidad está protegida por la legislación federal. La información suministrada será EQPƂFGPEKCN�
Incluso si tienes alguna enfermedad, como diabetes o asma, o si te negaron la posibilidad de contratar un seguro médico antes, ahora puedes encontrar opciones de seguro en Cover Oregon.
También podrías recibir ayuda con el pago del seguro.
¿Cómo accedo a Cover Oregon? Puedes obtener asistencia sin cargo de varias maneras:
Tenemos la obligación de brindarte ayuda en tu idioma. No dudes en consultarnos cómo te podemos ayudar.
Puedes registrarte en un plan de seguro médico a partir de octubre de 2013. La cobertura y ayuda económica tienen vigencia desde enero de 2014.
¡Regístrate!
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Puedes registrarte en un plan de seguro médico a partir de octubre de 2013. La cobertura y ayuda económica tienen vigencia desde enero de 2014.
Sign up!
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A ques/on for Jennifer
Do you have an example of how you adapted materials for a specific group and how that worked?
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• New tagline/title
• More “what is insurance”
• AI/AN exchange specifics
EARLY SUCCESS: TRIBAL MATERIALS
Cover Oregon is a marketplace for Tribal communities to find health insurance and financial help to pay for it
Cover Oregon can help you and your family if:
You currently receive services at your Tribal or Urban Indian clinic, and do not have insurance coverage.
You or your family do not have private health insurance or coverage through a public medical program.
You cannot get affordable health insurance through work.
You buy your own health insurance and want more choices.
You own a small business and employ 50 or fewer people.
Online:
CoverOregon.comToll-free:
1-855-CoverOR (1-855-268-3767)
SIGN UP
Cover Oregon is here to help you find the right health insurance for you and your family, and financial help to pay for it. Even if you receive services from your Tribal or Urban Indian clinic, Cover Oregon will work for you.
Honoring Traditions of Health
Visit CoverOregon.com to learn more and use a website calculator to see how much financial help you might receive. When you use the website, federal law protects your privacy. The information you provide will be treated confidentially.
Call 1-855-CoverOR (1-855-268-3767) to speak with someone about your needs for health insurance and how to use Cover Oregon. We can help you find a tribal community partner near you.
Visit your local Tribal oganization, clinic, or community partner. People there can explain the differences in health insurance options, and can help you use Cover Oregon.
How Do I Access Cover Oregon?
You can enroll in a health insurance plan starting in OCTOBER 2013. Coverage and
financial help begin in JANUARY 2014.
Name of OrganizationAddress line 1Address line 2
555.555.5555Email Address
website.com
LOGO
LOGO
CO-C-00020-RP-NA (7/13)
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• Awareness up from 5% in May to 37% today
• Greatest appeal: § No pre-existing conditions.
§ More people can have insurance.
§ Easier process.
• Focus group participants demonstrate fluency in basic insurance concepts
WHAT’S WORKING
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• Cover Oregon = plan? (skepticism)
• Tax credits and financial assistance?
• Connection to mandate/penalty
• Additional segmentation and specifics § Transgender
§ Women
WHAT’S STILL NEEDED
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• “Place where you can shop for health insurance.”
• “Find savings to help pay for insurance.”
• “Insurance agent”
• “No cost to use Cover Oregon or get help.”
LANGUAGE ADJUSTMENTS
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• Make it real with examples
• Look to the community
• Share messages through many channels, with different levels of info
• Be ready to learn and adapt
KEY TAKEAWAYS
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WWW.COVEROREGON.COM
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Thank you to our speakers!
Kathryn Paez, RN, Ph.D. American Institutes for Research
Jennifer Messenger Heilbronner Metropolitan Group
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Health Literacy: Undervalued by Public Health? A tool for public health professionals. Prepared for the American Public Health Associa0on Community Health Planning & Policy Development Sec0on
Tammy Pilisuk, MPH AUG 2011
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Resources • HIL Issue Brief and informa0on about the HIL measure h_p://aircpce.org/airs-‐work-‐in-‐cpce/health-‐insurance-‐literacy/
• Training modules University of Maryland developed to prepare consumers to choose and use health insurance h_p://www.extension.umd.edu/insure
• Kaiser Family Founda0on h_p://www.kff.org/health-‐reform
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Resources • RWJF Medicaid studyh_p://www.rwjf.org/content/dam/farm/reports/surveys_and_polls/2012/rwjf73113
• Enroll Americah_p://files.www.enrollamerica.org/best-‐prac0ces-‐ins0tute/public-‐educa0on-‐resources/EA_Final_Report.pdf
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Speaker Contact Informa0on
Kathyrn Paez, RN, Ph.D. [email protected] h1p://www.air.org Jennifer Messenger Heilbronner [email protected] h1p://www.metgroup.com
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Thank you to our Sponsors!
Community Health Planning and Policy Development Section, APHA
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Thank you to our planning commi1ee
• Tammy Pilisuk, MPH, APHA-‐CHPPD • Erin Brigham, MPH, CareSource, APHA-‐CHPPD • Meghan Bridgid Moran, PhD, San Diego State University, School of Communica0ons
• Lisa Peterson, MPH, CALPACT at UC Berkeley • Stephanie Bender, MS, Health Educator • Aileen Kantor, Health Literacy Innova0ons • Nancy Murphy, MSHC, Metropolitan Group
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About This Series • The Health Communica/on Ma1ers series will help par0cipants in all
walks of public health to apply health literacy principles to their everyday communica0ons.
• What audiences do you communicate with—consumers, health
professionals, disenfranchised communi0es, your public health peers? Whatever your role in public health, it’s likely that you need to communicate effec0vely. But how do you know your communica0on is effec0ve?
• Only about 10 percent of the general popula0on is considered “health
literate.” That leaves the vast majority of us with barriers to understanding the health-‐related informa0on we read.
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Conclusion
Thank you!
www.calpact.org