Background/Purpose: It is expected that pediatric rheumatology providers prepare adolescent and young adult (AYA) patients to successfully navigate the transition from a pediatric to an adult model of care. Health insurance literacy, and how to acquire health insurance, is one often neglected topic in this preparation. The loss of health insurance can be a highly disruptive event when transitioning to adult care and preparation in the pediatric clinic could reduce the incidence and duration of such an event. The Health Insurance Marketplace is a new way for many individuals to acquire health insurance at a significant discount; however, many pediatric providers have themselves never needed to navigate the health insurance marketplace and as a result may be unprepared to counsel patients on this topic.

Methods: This educational intervention utilized a case-based learning (CBL) technique to navigate the Healthcare.gov and consider health plans for an AYA in need of health insurance amongst pediatric rheumatology providers. It was hypothesized the pediatric rheumatology providers will have high health insurance literacy (as measured by the validated Health Insurance Literacy Measure (HILM)) but low familiarity with the health insurance marketplace (as measured by a novel Affordable Care Act (ACA) instrument) that will be improved following the CBL activity. Self-reported abilities were analyzed before and after as well. Two-tailed t-tests were used. Feasibility data were gathered for using the CBL tool in clinic with AYA patients.

Results: A total of 11 pediatric rheumatology providers, representing all providers in the division, participated in the intervention. 2 participants had incomplete data that was excluded. The minority of participants had ever needed to acquire individual health insurance (33.3%) or to navigate Healthcare.gov (33.3%). Time (100%) and knowledge (88.9%) were the most frequent barriers to having health insurance discussions with patients. The pre-intervention and post-intervention results are displayed in Table 1 with significant improvements in the HILM, ACA instrument, and self-reported abilities. Quantitative feedback shown in Table 2 indicated that participants strongly agreed that the learning activity could help both patients and providers learn more about health insurance (mean 94.22 ± 6.59 and mean 96.11 ± 5.44 respectively on 100-point sliding scale). The result was more neutral if providers felt that they could complete this same learning activity in clinic with their patients (mean 58.00 ± 23.99). Time was noted as the greatest barrier by all participants in a free text response.

Conclusion: This study piloted the use of a CBL activity focused on navigating Healthcare.gov with pediatric rheumatology providers. It was hypothesized that most pediatric rheumatology providers would have a high health insurance literacy measured by the HILM but would have improvements in knowledge specific to the Affordable Care Act and Healthcare.gov. Contrary to the hypothesis, there were statistically significant improvements in both the HILM and ACA measures suggesting that providers may benefit more from this activity than anticipated.

HILM = Health Insurance Literacy Measure. 21 items with 4 item choices converting numerically to 1-4 with higher numbers indicated greater health insurance literacy. Possible scores range from 21 to 84. ACA = Affordable Card Act. 7 items (see Table 4 for individual items) with 1 correct and 3 incorrect answer choices. Possible scores range from 0 to 7 with higher numbers indicating a greater percentage of correct answers. Abilities were self-reported on 5 items (see Table 5 for individual items) on a score range from 0 to 100 using a sliding scale where 0 = strongly disagree, 50 = neutral, and 100 = strongly agree. Possible scores range from 0 to 500 with higher numbers indicating greater self-reported abilities.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/utilizing-case-based-learning-to-teach-the-teacher-and-improve-health-insurance-literacy/