Health literacy is the essential backbone of informed patient engagement, said Howard Koh, Assistant Secretary for Health at the Department of Health and Human Services, at a February 6 Health Affairs briefing. The event was held to unveil the journal’s February issue, “New Era Of Patient Engagement.”

Health literacy is particularly important now as tens of millions of Americans are faced with new choices about coverage and treatment under the Affordable Care Act, said Koh, a physician who also has a master’s degree in public health. Yet only about 12 percent of Americans have the skills necessary to navigate the health care system, leaving the vast majority of Americans at greater risk for unnecessary hospital admissions and readmissions, medication errors, and failure to manage their health conditions effectively.

Physicians and other health care providers often assume that patients understand what they are told unless they indicate otherwise, Koh noted. But the health system has gotten so complex that it challenges the comprehension even of sophisticated patients. The answer is to change the paradigm from a focus on correcting individual deficits in understanding to a systems approach: “The assumption is that everybody is at risk for not understanding, and that we should institute what we call ‘health literacy universal precautions.’”

Specifically, in an article in the issue coauthored with Cindy Brach, Linda Harris, and Michael Parchman, Koh proposes a “health literate care model.” This framework updates the widely used Care Model (called the Chronic Care model when it was introduced by Edward Wagner in 1996) by weaving into it health literacy strategies included in the 2010 Agency for Healthcare Research and Quality (AHRQ) Health Literacy Universal Precautions Toolkit.

One example of such strategies is the “teach-back method,” in which providers confirm patient understanding by asking patients to explain back in their own words what they’ve learned, their understanding of their own condition, and the options available to them. Another example: brown-bag medication reviews, in which patients are encouraged to bring in all their medications and dietary supplements to a physician or other provider can discuss what each medication is for and how it should be taken. Under the health literate care model, reminders for health literacy-related tasks would be added to electronic health records.

For more details, listen to Koh’s presentation (and Harris’ talk later in the briefing) and read Koh’s article in the February issue, as well as a 2012 Health Affairs article in which he and several prominent coauthors discuss the health literacy elements of three key federal initiatives (subscription required for both articles). In addition, check out the entire Health Affairs February issue on patient engagement and the briefing on the issue.