Medical-Legal Partnerships: Working to Address Problems in Health Literacy

By: Katie Broyles, Spring 2019 HeLP Legal Services Clinic Intern

Most commonly, medical-legal partnerships (MLPs) are recognized for their vision to improve low-income patient and client situations by addressing the social determinants of health via both a medical and legal lens. However, most MLPs today are operating to solve a number of additional healthcare access and population problems for providers and patients behind the scenes. One of these problems is that of health literacy in low-income patients and clients. Health literacy is defined by the Department of Health and Human Services as the “degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” A recent study found that “[m]ost American adults – 53 percent – have intermediate health literacy…they can perform ‘moderately challenging’ activities, like reading denser texts and handling unfamiliar arithmetic,” but about 20 percent have only “basic” health literacy that could cause problems, and 14 percent have scores “below basic” on the National Assessment of Adult Literacy. In addressing the social determinants of health at the outset of a physician-patient or attorney-client relationship, MLPs work to examine possible risk factors for low health literacy that may be causing initial problems in a patient or client’s case, such as low health plan compliance rates, lower percentages of advanced screening or usage of preventative care services, difficulty finding access to healthcare resources or services, or failure to use resources or services they are aware of altogether. In aiming to resolve these underlying issues, MLPs help to provide a long-term solution to the patient or client, in turn improving low-income population health and long-term health literacy.

Even among literate adults, the complex nature of the healthcare system combined with complicated medical jargon and electronic health record (EHR) notations are enough to complicate anyone’s understanding of their own healthcare status. In addition, healthcare entities do not assess patient literacy at the outset of patient care interactions, leading to a mechanistic approach that involves handing patients their medical forms at discharge, printed from an EHR system, and telling them to follow up in a few days if they encounter any problems. Medical forms may not be comprehensible for patients with lower health literacy, or for any number of reasons a healthcare provider may not fully explain a medical diagnosis or prognosis to a patient. Within the MLP system, however, legal representatives can work to mitigate this misunderstanding and help bridge the relationship between provider and patients who may not know what questions to ask, or why having a relationship with their provider in the first place is vital to resolving many of their corresponding legal issues. For example, as a law student working in the Health Law Partnership (HeLP) Legal Services Clinic, it has been crucial for my interactions with several clients to explain the importance of following up on questions with physicians, and complying with physician-scheduled medication programs when a client is seeking Supplemental Security Income (SSI) benefits, as the Social Security Administration often looks to patient compliance with scheduled healthcare programs as a persuasive factor in favor of receipt of SSI benefits. MLPs engage with patients and clients to empower them to navigate the healthcare system in a way that cultivates a lifetime understanding of the importance of health plan adherence and use of preventative services, and allows them to avoid legal problems resulting from a problematic health status and improve health literacy in the long run.