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All right.

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Quality Insights: Well welcome. Good afternoon and welcome to our very first health literacy lunch and learn session for this month. Today's topic is going to be focused on advancing health, equity through health literacy.

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Quality Insights: My name is Mitzi Vince, and i'm a communication specialist to your quality insights, and i'll be your host for today's presentation. We'll get started in just a few minutes. But first I wanted to mention a couple of housekeeping items. Um first. All participants entered Today's Webinar in list, and only mode.

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Quality Insights: If you have a question or comment during today's call, we just ask that you please type that into either the chat or the Q. A. Box which should be located at the bottom of your zoom window. You may need to hover your mouse around the bottom of the window to get the icons to appear if they don't already.

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Quality Insights: Uh also at the end of today's program, you'll be directed to an evaluation and some reflective questions. Once completed, you will be presented with a certificate, Fill out and print out as proof of your Webinar completion;

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Quality Insights: and even if you do not need the continuing education credits. We hope that you will still complete the evaluation as it still helps. Tell us how we did and how we can shape future programming

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Quality Insights: uh to cop to complete the course uh learners today need to watch the sixty minute Webinar. Either this live version or recorded version. You'll need to complete an evaluation, and the reflective questions, as previously mentioned.

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Quality Insights: Um, today's Webinar qualifies for um one point, two five contact hours for nursing,

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Quality Insights: and I should say, quality insights Isn't, accredited, is accredited as a provider of can of nursing, continuing professional development by the American nurses. Credentialing centers Commission on accreditation. And you may want to check with your board in your State to see if you can obtain, cease for other disciplines as well through this Webinar.

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Quality Insights: There are no disclosures from quality insights.

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Quality Insights: So after this course, learners will be able to identify the connection between health, literacy and health Equity explain the Cms framework for health, equity and its connection to health literacy, and describe what resources are available to you to assist in health literacy efforts for consumers.

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Quality Insights: Alright, So we have some great information to deliver today. So without further ado, i'd like to turn things over to Andrea more um. She is here with quality insights to talk briefly about the purpose of health Literacy month, and our goals around these legendary lunch and learn sessions, and then we'll welcome our guest presenters from the centers for Medicare and Medicaid Services Office of Minority Health. So, Andrea.

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Andrea Moore, Quality Insights: Thank you, Mitzi, and thank you all for taking the time out to join us for this lunch and learn. We do hope that you walk away with some new information. Um, you know Health Literacy month has been recognized in October, for I think a little over twenty years now. So um! It's been a long time coming here at the network. Um, We are definitely trying to put more of a focus on health literacy, not only to try to improve patients health literacy.

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Andrea Moore, Quality Insights: We're really more so for us to be a more health literate organization and to help support you all as you try to become a more health Literate organization. Um, I do want to also say um happy Hispanic heritage month for those of you who are celebrating. We are still in Hispanic heritage month. Um, and I would love to share with you that this is the first of four lunch and learns um. So this is our kickoff. We'll have three more throughout the month of October, so our second health literature

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Andrea Moore, Quality Insights: we'll see lunch and learn will be next week, Thursday, October thirteenth, from one to two o'clock. Um! So we hope that you join us here again. Um! And again. We just hope that you walk away with some new information um and more ways to engage with us. So fill up the survey um, and we'll continue to try to tailor all of these lunch and lines of webinars that we put out moving forward, so i'll turn it back over to you and see. Thank you

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all right. Thanks so much, Andrea.

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Quality Insights: All right. So now I'm going to go ahead and introduce our guest speakers. They're from the centers for Medicare and Medicaid Services office of minority health.

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Quality Insights: First we have Darcy Graves. She joined Cms. As office of minority, health in two thousand and fifteen. As part of her work. She assists in the coordination and implementation of priority agency and office-wide programs, policies and products

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Quality Insights: in addition she provides subject matter, expertise in areas such as culturally and going linguistically appropriate services, rural health, cancer, health disparities and health equity.

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Quality Insights: Ms. Graves holds graduate degrees in communications, religion and sociology, and public policy, and has over twenty years of professional experience in the fields of cultural and linguistic competency and health education,

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Quality Insights: Darcy began her career as a faculty member at the University of Missouri, Kansas City School of Medicine, where she aided in the development, implementation, and management of diversity, spirituality, communications, and geriatrics curricula

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Quality Insights: her life philosophy is that we can each enhance the quality of people's lives through a commitment to respectful understanding, a lifetime of learning, and a profound sense of community. So welcome, Darcy

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Quality Insights: and our next presenter, um will be Ashley Pedacord, Austin. She joined Cms's office of Minority Health in two thousand and fifteen.

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Quality Insights: She's focused on health equity communications and outreach, and she oversees communications, activities, including partner and stakeholder, engagement, website, content, digital media and content for lists serve distributions and equity. Messaging across the office

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Quality Insights: Ashley is also the lead on coverage to care an initiative developed by the Cms. Office of minority health to help consumers understand health coverage and connect to primary care and preventive services.

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Quality Insights: This includes partner engagement work to support, trust work to support trusted community partners working directly with communities

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Quality Insights: prior to joining Cms. Ashley worked for the Us. Senator Ben Cardon, as a case worker for Medicare, Medicaid marketplace, healthcare, social security and other Federal case work issues. Ashley graduated from Hood College with a bachelor's degree, and from the University of Maryland, Baltimore, with a masters in public health.

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Quality Insights: She lives in Maryland with her husband and two children, so welcome to both of you and I'll now turn the program over to you, ladies.

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Darci Graves | she/her | CMS OMH: Thank you so much, Mitzi, and thank you. Andrea and uh, hello, everyone, happy National Ha! Health Literacy month uh we're thrilled to be kicking off this series of uh lunch and learn webinars that you all will be hosting.

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Darci Graves | she/her | CMS OMH: As Miti indicated. My name is Darcy Graves, and I'm. A technical advisor with the Cms. Office Minority health, and I'm joined by my colleague Ashley Pedacord Austin and we're going to be breaking this presentation up into two parts.

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Darci Graves | she/her | CMS OMH: The first part I will provide some big picture information regarding our office health equity and its relationship with health literacy as well as health literacy's, relationship with other communication concepts.

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Darci Graves | she/her | CMS OMH: The second part will share an overview of resources which were developed using health, literate practices, and are intended to help Cms. Enrollees with health insurance literacy connecting to care and much more.

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Next slide, please.

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Darci Graves | she/her | CMS OMH: So first, as we've mentioned, we're both with the Cms. Office of minority, health, and the mission of our office is to lead the advancement of,

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Darci Graves | she/her | CMS OMH: and integration of health equity in the development, evaluation and implementation of Cms is policies, programs, and partnerships, and we do this so that all those served by Cfs,

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Darci Graves | she/her | CMS OMH: which is more than one in three Americans have achieved their highest level of health and well-being, and we have eliminated health disparities in health care quality. And access

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Next slide, please

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Darci Graves | she/her | CMS OMH: one of the features that differentiates our office from many of the other offices of minority. Health Within the Department of Health, and human services are the populations we choose to focus on which include racial and ethnic minorities, people with disabilities,

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Darci Graves | she/her | CMS OMH: members of the Lesbian, gay by sexual, transgender, and queer community or Lgbtq

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Darci Graves | she/her | CMS OMH: individuals with limited English proficiency, Individuals in rural communities, and those otherwise adversely affected by persistent poverty or inequality.

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Darci Graves | she/her | CMS OMH: And all of these populations were identified and selected based on the disparity data. So we let uh data dictate where we go and how we focus our energy and resources

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Darci Graves | she/her | CMS OMH: next slide, please.

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Darci Graves | she/her | CMS OMH: So on the slide is a quote, and I like this quote, because for me I think it succinctly connects a lot of different dots. We know that health and health care disparities are the result of a myriad of things

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Darci Graves | she/her | CMS OMH: uh which include not serving individuals as they should be served, and working in health care, and especially in relation to Cms. We talk a lot about high quality, patient-centered care.

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Darci Graves | she/her | CMS OMH: So with those two variables we bring together in this quote: reducing disparities requires attention to the essential components of equitable, patient-centered, high quality care

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Darci Graves | she/her | CMS OMH: that is to culturally and linguistically appropriate care as well as attention to help literacy. And of course, that's the subject that brings us together today.

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Darci Graves | she/her | CMS OMH: So, as we move on to the next slide,

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Darci Graves | she/her | CMS OMH: we want to do a bit of orientation as to how health literacy fits in with all of the Cms strategic activities. Uh, because we know sometimes things can feel a little disconnected, and we want to make sure that that the full picture is understood.

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Darci Graves | she/her | CMS OMH: So these are Cms as strategic pillars, and we've already touched on a bit about health literacy connecting to equity. And Ashley will talk more about how the important role that health, literacy and health insurance literacy play out in connecting to access.

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Darci Graves | she/her | CMS OMH: But we also, any time we engage with partners. We have to ensure. Our messages are clear and resonant. So literacy and health literacy are central to that pillar as well.

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Darci Graves | she/her | CMS OMH: And finally, we bring it full circle back to the quote from the previous slide that in order to drive innovation, we must tackle our health system, challenges and promote value-based person-centered care.

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Next slide

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Darci Graves | she/her | CMS OMH: So this is the definition of health equity that we use at Cms health. Equity is the attainment of the highest level of health for all people.

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Darci Graves | she/her | CMS OMH: Where everyone has a fair and just opportunity to attain their optimal health, regardless of a variety of socio demographic characteristics.

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Next slide,

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Darci Graves | she/her | CMS OMH: Cms has outlined an action plan that demonstrates ongoing efforts to provide high quality, affordable health care for all people, regardless of their background, and to drive health equity across Hhs or the Department of health and human services.

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Darci Graves | she/her | CMS OMH: This plan includes the following actions, which again, we can see tied to the importance of health literacy; and we see that in the closing of gaps in health care, access, quality, and outcomes for underserved population.

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Darci Graves | she/her | CMS OMH: Erez Agmoni, the promotion of culturally and linguistically appropriate services to ensure understandable and respectful care and services that are responsive to preferred languages, health, literacy levels, and other diverse communication needs two,

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Darci Graves | she/her | CMS OMH: and that we build on outreach efforts to enroll eligible people from across the country into the three different Cms. Programs, Medicare, Medicaid, Chip, and the marketplace.

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Darci Graves | she/her | CMS OMH: There are many other items from this plan and strategy that can be underpinned uh

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Darci Graves | she/her | CMS OMH: that are underpinned by the importance of health literacy. But we want to make sure that we spend enough time on the rest of the topics rather than falling down that particular rabbit hole.

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Darci Graves | she/her | CMS OMH: So going on to the next slide

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Darci Graves | she/her | CMS OMH: that in order to help operationalize how we're going to achieve health equity, because health equity is a very big and broad topic. We wanted to make sure that we could operate operationalize health equity at Cms. So we developed in consultation with stakeholders and based on

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Darci Graves | she/her | CMS OMH: decades of evidence and other information, We released the Cms framework for health equity which identifies five priority areas, for Cms to focus on

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next slide.

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Darci Graves | she/her | CMS OMH: And while there are intersections with health literacy for all of the priorities, we want to draw your attention to priority four,

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Darci Graves | she/her | CMS OMH: which is to advance how language, access, health, literacy, and the provision of culturally tailored services. And i'll be touching on a little bit of these as we go through the next portion of the the slides

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next slide, please.

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Darci Graves | she/her | CMS OMH: So people with low health, literacy report poor health status nearly twice as much as those without that barrier,

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Darci Graves | she/her | CMS OMH: and according to the national assessment of adult literacy, only twelve percent of Americans have proficient health literacy skills,

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Darci Graves | she/her | CMS OMH: whereas thirty-six of the Us. Population have low health literacy

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Darci Graves | she/her | CMS OMH: compared to those with proficient health literacy. Adults with low health literacy, experience, four times higher health care, costs,

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Darci Graves | she/her | CMS OMH: six percent more hospital visits and two-day longer hospital stays,

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Darci Graves | she/her | CMS OMH: and anyone can understand why we would want to try to limit, mitigate, and prevent all of those things uh and help individuals at their highest level of health.

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Darci Graves | she/her | CMS OMH: Cms has a powerful role in strengthening these efforts across the health care system to improve access to culturally and linguistically tailored health, literate care and services for our increasingly diverse population.

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Darci Graves | she/her | CMS OMH: And by doing all of these things we also help uh shore up our health care system and make sure that everyone receives the care uh that is right for them. Uh, in the time that they need it

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next slide.

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Darci Graves | she/her | CMS OMH: So we've already touched on help equity. But I like to share this slide just to remind folks that we are focused on equity rather than a quality,

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Darci Graves | she/her | CMS OMH: because we are focused on fair and just opportunities that need people and meet people's individual needs, as we see in this bicycle example, making sure that everyone has the bike that allows them to actively participate in a meaningful way in this particular event. And when we apply this to our work lens that means being able to actively participate in a meaningful way in the in your health care

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Darci Graves | she/her | CMS OMH: to make informed decisions, to be able to understand and consent to the care that you're giving, or the care that you're receiving, as well as making sure that you understand everything, that as it is being presented to you

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next slide, please,

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Darci Graves | she/her | CMS OMH: and of course we would be remiss if we didn't also stress the intersection of health, literacy and communication broadly across all the areas or social determinants of health. Where people are born, live, learn, work, play, worship and age. One

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next slide, please.

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Darci Graves | she/her | CMS OMH: Okay. So I've already spoken a lot about health literacy. But here are two official definitions from healthy people, two thousand and thirty,

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Darci Graves | she/her | CMS OMH: where for the first time, we focus on both uh personal health literacy as where is organizational health literacy. And you heard Andrea speak earlier about how quality insights is seeking to improve It's organizational health literacy.

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Darci Graves | she/her | CMS OMH: So with personal health literacy we're looking to see uh the degree to which individuals have the ability to find, understand, and use information and services to inform health, related decisions and actions

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Darci Graves | she/her | CMS OMH: for themselves and others;

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Darci Graves | she/her | CMS OMH: and we can just imagine that. Uh, you know all of the times that we've had to use our health literacy skills to work through uh finding an appointment. Finding a doctor that takes our coverage and understanding our medical options based on what diagnosis that we have been presented with.

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Darci Graves | she/her | CMS OMH: Then there's also organizational health literacy, which is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health, related decisions and actions for themselves and others,

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Darci Graves | she/her | CMS OMH: and this may be through written documentation you receive in the mail or uh things that you would have to try to search and find on a website. Uh, there's lots of different opportunities to make sure that you are providing things in a help Literate manner.

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Darci Graves | she/her | CMS OMH: And so we'll talk a little bit more about that in Ashley's portion, as well as probably in the many sessions to come as a part of your national history. Health, literacy, month,

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events

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next slide, please.

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Darci Graves | she/her | CMS OMH: So here's a few things that I always like to underscore when we're talking about health literacy, so health literacy is dynamic, unlike a not of other characteristics which can kind of be static. You know your your income doesn't change

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Darci Graves | she/her | CMS OMH: day to day generally, or your education Level doesn't change day to day generally,

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Darci Graves | she/her | CMS OMH: but someone may have high or proficient health literacy under the best of circumstances. Under normal times, you know, we have great health literacy. I understand what you're saying to me, um and i'm able to communicate and participate in the conversation fully.

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Darci Graves | she/her | CMS OMH: But once health, literacy, or and one's understanding can plummet if they are handed band news such as a life changing diagnosis, and suddenly their ability to understand what is being presented to them

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Darci Graves | she/her | CMS OMH: is drastically changed. So that's always something to keep in mind when we're thinking about health literacy.

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Darci Graves | she/her | CMS OMH: You also can't tell someone's health literacy by looking

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Darci Graves | she/her | CMS OMH: and uh health literacy skills does not hire literacy skills. So not health literacy skills, but higher literacy skills does not necessarily equal understanding. So someone may have a Phd. In one

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Darci Graves | she/her | CMS OMH: in electrical engineering, but that does not necessarily translate into high health literacy skills.

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Darci Graves | she/her | CMS OMH: Health literacy is also interrelated with numerous other areas, including numeracy or understanding numbers. Financial literacy, Digital literacy, which is huge now. Um, with the intersection of health, literacy, and digital literacy. When we're talking about telehealth, when we're talking about patient portals

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Darci Graves | she/her | CMS OMH: and and other situations where where health and the digital age have kind of intersected

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Darci Graves | she/her | CMS OMH: insurance literacy, which I actually will also be talking about a little bit more. Um, And this is just to name a a few. So bottom line. Everyone benefits from clear communication, so we all do better when we all do better, and we can all understand. Next slide, please.

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Darci Graves | she/her | CMS OMH: So just a few more definitions before I hand it off to Ashley, so that we can see a health, literacy, health, health, literacy and Health literate resources in practice

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Darci Graves | she/her | CMS OMH: uh just wanted to touch on plain language for a second. Oftentimes plain language is used interchangeably with health literacy, and while they might not, and while they may be interrelated, they are not synonyms,

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Darci Graves | she/her | CMS OMH: plain languages, communication. Your audience can understand the first time they read it or hear it. But language that is playing to one set of readers may not be plain to others.

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Next slide, please.

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Darci Graves | she/her | CMS OMH: And then we also have individuals with limited English proficiency,

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Darci Graves | she/her | CMS OMH: and that also has an impact on communication and health literacy. An individual who has limited English proficiency speaks English less than very well. So individuals with lep maybe titled to language assistance with respect to a particular type of service, benefit, or encounter,

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Darci Graves | she/her | CMS OMH: and this requires being prepared with language, assistance, services such as next slide, please,

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Darci Graves | she/her | CMS OMH: such as interpretation and translation as,

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Darci Graves | she/her | CMS OMH: and so not only do they, things need to be into another language, but we also need to be cognizant of plain language and health literacy needs when we're moving from one language to another.

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Darci Graves | she/her | CMS OMH: Okay, next slide, please.

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Darci Graves | she/her | CMS OMH: Okay. So now we have laid the foundation, and I want to provide some initial areas

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Darci Graves | she/her | CMS OMH: where uh action is still needed. When it comes to health literacy, there's still a lot of work to do,

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Darci Graves | she/her | CMS OMH: and, as I mentioned earlier, health healthy people, two thousand and thirty has a strong emphasis on health literacy. Uh, for the next decade six healthy people. Two thousand and thirty objectives are related to health literacy.

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Darci Graves | she/her | CMS OMH: Those on the left hand side include the proportion of adults whose health, care provider checked their understanding,

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Darci Graves | she/her | CMS OMH: and one would think that that would be a fairly basic and routine part of care.

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Darci Graves | she/her | CMS OMH: But, uh, the baseline data for that this objective is only twenty-six point six of adults, aged eighteen years, and over, reported that a health care provider asked them to describe how they will follow instructions,

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Darci Graves | she/her | CMS OMH: so that means nearly seventy-five percent weren't asked how, if and how they could follow instructions

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Darci Graves | she/her | CMS OMH: for the next one, not nearly nine percent of adults, aged eighteen years and over, reported poor provider communication,

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Darci Graves | she/her | CMS OMH: and the next one uh fifty-two point. Eight of adults, aged eighteen, and over reported that their health care providers always involved them in decisions about their health care as much as they wanted.

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Darci Graves | she/her | CMS OMH: Now that's one that's kind of a little uh daunting, and kind of takes me back because that means

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Darci Graves | she/her | CMS OMH: fifty, you know, fifty, two percent, so nearly forty, eight percent, nearly half of adults that were surveyed

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Darci Graves | she/her | CMS OMH: weren't consulted in decisions about their health care as much as they would like to, and that's a huge disparity for a huge area of opportunity to to improve

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Darci Graves | she/her | CMS OMH: um the items on the right hand side. These are objectives that are still in development or in the initial stages of gathering uh up data on research.

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Darci Graves | she/her | CMS OMH: So again, areas where we can improve things or areas to look at, to make sure that we are uh helping those that we are serving. So they set out to increase the proportion of people who say their online medical record is easy to understand.

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Darci Graves | she/her | CMS OMH: They want to increase the proportion of adults with limited English proficiency, who say that their providers explain things clearly,

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Darci Graves | she/her | CMS OMH: and then, finally, they want to increase the health literacy of the population.

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Darci Graves | she/her | CMS OMH: So huts off to quality uh insights for making sure that we are helping to move along on so many of these pieces, and increasing not only our own health literacy, but preparing us to better serve those uh

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Darci Graves | she/her | CMS OMH: in our uh catchment areas or in our programs, and making sure that they are able to actively understand and participate in their own health care. And so with that I will pass the microphone over to Ashley, so that she may,

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Darci Graves | she/her | CMS OMH: erez agmoni to talk about uh coverage to care, and a number of other resources. Thank you over to you, Ashley. Thanks, Charlie, and thank you. Everyone for having us today. So Darcy set up such a great stage for us to think about one hundred and one.

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Ashley Peddicord-Austin: What um health, equity and health literacy, how they're connected. And um! How how you can think about what in your own work you can do to address literacy. Plain language,

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Ashley Peddicord-Austin: limited English for efficiency, and all of those important points that she talked through. Um, we're gonna give you a specific example of how one way that our office is trying to help with health literacy. And of course we come to you from the centers for Medicare and marketplace services. So our piece of this is kind of the insurance piece.

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Ashley Peddicord-Austin: So this is actually specific, more so to health insurance literacy. But there's still the general idea of being staying connected to care and staying healthy.

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Ashley Peddicord-Austin: So,

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Ashley Peddicord-Austin: in in short, any of us could really truly use coverage to care. Um if you ask most people. Um, I forget the the numbers that this particular survey. But most people would say, Yeah, I know what a premium is. I know. To Copay is okay. Can you define it for me? No, they can't. And um! A lot of people wouldn't be able to.

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Ashley Peddicord-Austin: Maybe the people in this call could. But in general a lot of people, Aren't really able to figure out a lot of those basics. Um, or truly feel that they're comfortable with them. So a lot of us could use coverage to care and could use this insurance literacy piece it.

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Ashley Peddicord-Austin: Um. This program initiative is truly designed for any person. It. It could be Medicare marketplace, employer, coverage, or even Medicaid. Um. But we do keep our offices, populations, and help equity terms in mind when we're designing the pieces and our outreach approaches,

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Ashley Peddicord-Austin: so given that we rely on trusted community partners to actually be the intermediary uh to share this information, and to actually be the ones to connect with consumers and patients. Uh. So sometimes it's a provider that might be using these resources. Um! It could be a

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Ashley Peddicord-Austin: private provider or a Federal fairly qualified Health center,

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Ashley Peddicord-Austin: a community organization, maybe not even health focus uh other advocacy groups, ship counselors, navigators, libraries, churches. There's lots of different places. Um, we we know that are using coverage to care, so i'll give you an overview today. Uh we can go ahead to the next slide

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Ashley Peddicord-Austin: um, and as you think, through these, you know, think if there is a particular way that maybe you could use it, or suggestions that you might have, or if there's something that maybe could apply um to what you're doing. So again, coverage to care is a health literacy focused initiative,

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Ashley Peddicord-Austin: and we're hoping to increase a consumer's connection to care and eventually better their health outcomes. So again, just matter the type of insurance. But in general we want people to use their coverage and understand it enough to use it, and actually connect to care. Make that appointment and stay healthy.

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Ashley Peddicord-Austin: So uh, we have several resources. Um, Some are for partners. Um, but most are for consumers to help in this story. Our signature piece is the roadmap to better care, and i'm actually going to talk through that within a couple of slides, but we have several others as well. Um, that we'll talk through today,

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Ashley Peddicord-Austin: and so we've listed a few of those here. These are most of our main ones, and then a partner toolkit that i'll address at the end. We can go to the next slide.

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Ashley Peddicord-Austin: So before I started talking about this. I just wanted to give you a an update uh so covers your care has been around for several years, but in the last year we've actually gone through every single resource and um thought through whether we needed to update it in terms of content, design, or user experience.

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Ashley Peddicord-Austin: So some of them uh hadn't been updated since two thousand and fourteen when they first released, or had barely been, and some of them are a little bit newer. So each one is a little different. But in general we went through each piece to think. Okay, content. Is there anything that's outdated first off?

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Ashley Peddicord-Austin: And of course, any hyperlinks or things that made a change. You might not be needed, or um, because it might be new. That might need to be added in uh, maybe from the no surprises act, or whatever you have uh. So focusing on the actual information,

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Ashley Peddicord-Austin: then looking at design, So

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Ashley Peddicord-Austin: one bringing them to a little bit more of a modern design. Um, using people that are in all different types of backgrounds, different hairstyles, different clothing, and different skin tones, all kinds of different abilities and settings, and making sure that the people in our little graphics look like

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Ashley Peddicord-Austin: anybody in America could. So

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Ashley Peddicord-Austin: each person you can kind of identify, maybe, with some of the graphics, and there's a little bit of um something for everybody. Um! But also just using it um, using the design as a way, not just for people to identify with the Graphic,

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Ashley Peddicord-Austin: but using the design to help someone connect. Okay, that has an insurance card. I can go to insurance price section and just look for the graphics in order to help you using graphics to help with the literacy piece and to help make language more plain. Um, because that those visuals can be important to helping people with that.

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Ashley Peddicord-Austin: And then I user experience as well, so making sure that they are accessible, culturally appropriate pieces that are translated um lots of white space, so that you know it's not too overwhelming for eyes or for reading um One hundred and fifty.

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Ashley Peddicord-Austin: Some of these pieces do get a little long. Um. So cutting back on the text when we can. Um, but because health insurance is complex, you know. Some of them still are pretty long, so making sure they are. We've broken it up into sections um shorter pages, and again, with like the white space and using the design to try and help.

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Ashley Peddicord-Austin: So that's where we've been. It's It's over one hundred resources when you count all the translations, so it has taken us the last year, but most of them are either posted or about to be posted to our site at this point,

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Ashley Peddicord-Austin: so we'll go ahead to the next slide here and start talking about our main resource, which is the roadmap to better care.

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Ashley Peddicord-Austin: So this is actually before and after the the original one, and then the one that has been updated this past summer.

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Ashley Peddicord-Austin: Um, in case you're familiar with the coverage to care, we'll kind of do it before and after. On each of these slides. Um! We'll. We'll do those on our presentations for a little bit until the the new ones are um

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Ashley Peddicord-Austin: out there a little longer. Um, but this is what I kind of like to call the visual roadmap. Um. So if you were to look at this as a poster, which it is. Um! You can see how this we've outlined. Steps one through eight

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Ashley Peddicord-Austin: of how to connect to care, so it's starting with the A. Um. Why am I here in the first place? Why does this even matter all the way through, following up after an appointment? And so you can see the roadmap outlined here so somebody could take this journey, either starting in the beginning or jumping in halfway through, meeting the person wherever they are,

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Ashley Peddicord-Austin: and personalizing. Um, That approach. So a partner, maybe, is going to want to start at step one with particular consumer and the next consumer they work with is maybe really coming in at step five. So

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Ashley Peddicord-Austin: feeling free to jump in at any point in this um in this journey, and any point in the of the steps in the roadmap,

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Ashley Peddicord-Austin: so we'll go ahead to the next slide,

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Ashley Peddicord-Austin: and i'll just talk through the eight steps so you you could call this the sou to Nuts version. I if you like that terms of why we care about health coverage. Um. But we do have outlined eight steps to try and get to better care. And again, this is a primary care preventive kind of journal health care focus.

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Ashley Peddicord-Austin: Um. So one is putting your health first. We actually use this as a way to talk about prevention. So this is where it gets in, leads a little bit into the general health literacy approach, and working with some of our Federal colleagues to talk about um preventive services. Um. But in particular one of the things that tests really well for people

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Ashley Peddicord-Austin: is um people like hearing zero dollar coke and hearing no cost. Um, So there are a lot of preventive services that people can get. Um, which may sound more appealing to them.

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Ashley Peddicord-Austin: An individual level, then, you know, go to your doctor for your annual checkup and

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Ashley Peddicord-Austin: um. So, depending on the person you might want to kind of talk through some of those, and this is another place where people can customize um and make it more applicable to a person. So if you know somebody has a history or a family history of high blood pressure, you could say, Well, you know you can get a pretty high blood pressure screening. If you go to your doctor as opposed to you, should go to your doctor for your annual visit. That might sound overwhelming. So, thinking about how to talk to people about prevent it as steps. Um!

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Ashley Peddicord-Austin: And why it's so important the connection to staying healthy for your family, staying healthy um and knowing that knowing if anything's wrong before it's truly wrong, or in in catching things early. Um. Generally speaking, that the message that resonates the best is state healthy for your family. Um!

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Ashley Peddicord-Austin: So that's another piece that we like to talk to here.

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Ashley Peddicord-Austin: Uh the second step is uh understanding your health coverage. So this is the big one for a lot of people those key terms that are so tricky. Copay versus coinsurance premium deductible. Um. We actually offer the definitions, and we try and help people think through what that means for their own.

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Ashley Peddicord-Austin: Um. So if you're looking for cleared Cms definitions. This is where you can find them all

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Ashley Peddicord-Austin: the step three

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Ashley Peddicord-Austin: that is, knowing where to go for care. So that's where we discuss the differences between primary care and emergency care. Um! We actually have a chart that helps um distinguish those differences. So primary care. You're going to see um oftentimes the same provider each time you make an appointment. Um

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Ashley Peddicord-Austin: you may not have depending on the type of visit. You might not have a copay, or it may be a lower copay uh, you know. Look at your insurance card to find out um versus the emergency care. You would have um probably a weight. You're going to see whoever's there and talking about the differences between um between the two to help people know

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Ashley Peddicord-Austin: the right use of emergency department

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Ashley Peddicord-Austin: Uh, one of the new changes that we added was bringing up the uh urgent care, because this is a big one for um, and you know, since the original roommap was posted, this uh urgent care uses, of course, climbed a line much more popular everywhere.

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Ashley Peddicord-Austin: So we address urgent here here, and one thing that we can tell our partners to do when you talk about urgent care is saying, What about

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Ashley Peddicord-Austin: virgin cares in your area? Do you know which ones might might be more popular, or which ones,

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Ashley Peddicord-Austin: you know there are people using them for sick appointments because they can't get into their provider. So some areas may have differences. Um, The other thing to point out is depending on the insurance plan.

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Ashley Peddicord-Austin: A copay for your provider's office might be twenty or thirty dollars a copay for your urgent care could be seventy or ninety dollars, and it that depends on the insurance. So it's something that's important to kind of bring up with people there as well

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Ashley Peddicord-Austin: uh step. Four is finding the provider who takes your coverage, of course. Uh. So that is

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Ashley Peddicord-Austin: sounds easier, and it and sometimes is depending on your insurance. They might have a really great directory online, we can go. You can search, find um based on your area. Who's accepting patience? Um, Maybe if you have preferences for language or gender, um. Then you can enter those in and filter. But for some people they have

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Ashley Peddicord-Austin: that it might not work for a particular insurance or a particular area, or maybe they want a more personal touch. So we talk through different ways of finding provider recommendations from family, your friends um,

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Ashley Peddicord-Austin: and what else people can think about, and then we have um to actually make that appointment. So step five sounds so simple. Right? Make the appointment, and it seems obvious, but it's true if it's not because it's you have to stop your day oftentimes call um it really think about what you're doing,

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Ashley Peddicord-Austin: and

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Ashley Peddicord-Austin: I we have. We had to think about what we

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Ashley Peddicord-Austin: our schedule is going to be for that day when you make an appointment, can you?

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Ashley Peddicord-Austin: I

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Ashley Peddicord-Austin: excuse me, sorry my since school is calling. So i'm gonna

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Ashley Peddicord-Austin: I message my husband real quick to come get the phone? Um.

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Ashley Peddicord-Austin: So uh, when you make that appointment, do you have um to take leave. Can you make that appointment? Do you need to figure out childcare?

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Ashley Peddicord-Austin: Do you need to figure out um how to get there? Is there a bus, Is it on your bus route? If it's? If you don't have the bus Um, do you need to ride, or how how else are you gonna get there and thinking through all of this different things, so that when you make the appointment you are able to actually go and

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Ashley Peddicord-Austin: I stick to the appointment. When the day comes you're prepared, which leads you into the next part which is being prepared for your visit. So, thinking through, if you

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Ashley Peddicord-Austin: I have a list of medications that you want to take, or if you have

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Ashley Peddicord-Austin: a uh

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Ashley Peddicord-Austin: particular topic that you want to bring up, you know, maybe it's a prevent an appointment. But if there's something that's been bothering you, either physically or uh behavioral health wise that you want to bring up. So maybe jotting some of those things down. Even um can be useful. But also do you have your insurance cards? You have copay um, your sometimes a license or a paperwork that might be needed to be filled out ahead of time,

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Ashley Peddicord-Austin: and then step seven is decided. The provider is right for you. So this is one that people generally

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Ashley Peddicord-Austin: never think about um. You go, you do your appointment and then go about your day. You go to a virgin store, you pick up your kid. You go to your mother's house and take care of her. You do whatever it is that you're doing, and never, never really come back to it, and then a year, whatever passes. But did you feel like you were respected if you asked for um

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Ashley Peddicord-Austin: something accessible like a particular

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Ashley Peddicord-Austin: scales needed, or you need a the physical accessibility or a translator where those needs met.

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Ashley Peddicord-Austin: Um. So

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Ashley Peddicord-Austin: sorry it's not school again. It's it's always join a webinar. Uh. So I thank you through all of that, and knowing if if it's something wasn't right that you can come back to it, and then finally, next steps after your appointment. So maybe um,

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Ashley Peddicord-Austin: it's could be as simple as updating on a healthcare that your income change, or it could be um making sure that you did a prescription or a follow up visit, and going um going forward with a care plan.

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Ashley Peddicord-Austin: All right, so we can go ahead and to the next slide.

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Ashley Peddicord-Austin: Um!

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Ashley Peddicord-Austin: So this is

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Ashley Peddicord-Austin: uh the roadmap to behavioral health, and it's essentially companion guide to the one that I just talked through. There are eight steps that align with the eight steps that we just talked through. But these are particular to behavioral health. So, thinking through for mental health and substance, use disorder. What you would need to do. Um for each of those eight steps. So it take It follows Maria on this journey of

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Ashley Peddicord-Austin: okay, I got health insurance. I'm a role in the marketplace panel. And what else?

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Ashley Peddicord-Austin: What else do I need to think through? So I it walks her through, and she's having some anxiety and a little bit of alcohol use issues. So

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Ashley Peddicord-Austin: um helping. Walking through this with her as she goes and meets her provider finds one that takes her coverage. That's the right type for her, and following her through those steps.

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Ashley Peddicord-Austin: So

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Ashley Peddicord-Austin: I it again, you know, walks through those eight steps. Um, but they're particular to behavioral health, because behavioral health has so many nuances that are just a little bit more confusing than even regular health insurance. Um. These are again general. Now each state, each plan is a little bit different, but we add in definitions that can help like, what is the definition of behavioral help itself?

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Ashley Peddicord-Austin: Um! What are the different types of behavioral health providers? We did this resource along with Samhsa. Um. We wrote the original with them and the updated version with them. So we we use a lot of the same definitions that they do, but putting together um

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Ashley Peddicord-Austin: what those are, so I know I can't tell you off the top of my head. What if the difference between clinical psychologists or a psychiatrist, or a license, clinical, social worker and peer support? And all this different. I know where to find them, though they're in this road vow. Ah, so just have you in a place where you can refer to all of that, so we'll go ahead to the next slide.

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Ashley Peddicord-Austin: Uh. So get into care. You need it as a guide for people with disabilities. Uh again, Similar ideas to the roadmap, but having specifics for people with uh various accessibility problems that they not problems just it needs that they need to.

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Ashley Peddicord-Austin: Oh, when you go to the provider's office. It's going to be a little bit different sometimes. There are certain things that you need, and that you need for them to uh

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Ashley Peddicord-Austin: be able to help with. So I

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Ashley Peddicord-Austin: this version kind of walks you through um how to advocate for yourself, and getting all the things that you need to be uh, truly see well with a quality appointment, and have all of your needs addressed. Um! So we do have it. It's just as English and Spanish, but we actually um have it in eight languages, coming very soon

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Ashley Peddicord-Austin: the next one, if we could have one more slide here.

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Ashley Peddicord-Austin: Thank you. So

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Ashley Peddicord-Austin: this is actually um started as a Medicare facing resource, but we've expanded it recently in our revisions that we did to make it apply for Medicare and marketplace in particular. We worked with the Cpc. Um for this one um, and we decided to do the diabetes one, because it is such an important and necessary topic for a lot of our consumers.

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Ashley Peddicord-Austin: Um, but it talks through the kind of the overview of what is healthy living things, but as well as Okay, what is? What is my insurance going to cover when it comes to to this? Um. So it is also available in eight languages. Um,

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Ashley Peddicord-Austin: the updated ones that there's all eight or up there now, but the updated ones are coming in the next week.

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Ashley Peddicord-Austin: I always like to bring up the translations for this one, because it's a good example of

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Ashley Peddicord-Austin: not just. Are we trying to make it playing language and put things together in terms of what I need to do. And what do I need to know for my insurance? But it's also I

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Ashley Peddicord-Austin: They're an an example of how you should translate, because it's not just the words, and and making sure that the words are translated and the words are plain language, but making sure that the piece itself is culturally appropriate,

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Ashley Peddicord-Austin: So a good example is that um the photos of the people, you see, they change with the different resources, and they could possibly speak the language

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Ashley Peddicord-Austin: uh the photos of Uh. The first one is Tesla, eating healthy, one of the Cdc's uh ten key steps in, so the English version has broccoli. A few of the languages have broccoli uh, but the Haitian Creole has an avocado, and the Chinese version has spoken to. So thinking about. You know just small little tweaks that can make something

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Ashley Peddicord-Austin: I feel like it actually applies to a person more appropriately.

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Ashley Peddicord-Austin: Ah! The next slide bill building on that idea of diabetes Ah needs and care management is our connected care pieces. So these were around a couple of years ago. Um! They looked a little different then. They are our only medicare-focused pieces. Um at least as of right now.

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Ashley Peddicord-Austin: Um we do in the background when I do a little bit of work, and thinking through what other care management needs there might be, because there is. This is in particular to the chronic care management codes under Medicare. Um. But we know care management is a need. It's a growing need, and there's um and definitely some

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Ashley Peddicord-Austin: Mit

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Ashley Peddicord-Austin: people who might like to do a little bit more. Here

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Ashley Peddicord-Austin: you can go to the next slide.

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Ashley Peddicord-Austin: Excuse me my apologies.

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Ashley Peddicord-Austin: Um! So you can see where we worked with the Federal Office Royal health policy, and we did a um large campaign on this a couple of years ago. Um, but people really had a lot more questions, so we we kept them going. Uh, the postcard is Now this part is new. Uh is available in those eight languages listed on the screen.

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Ashley Peddicord-Austin: So that's same. Eight languages that we use for the other coverage to care pieces of English, Arabic, Chinese, patient, Koreo, Korean, Russian, Spanish, and Vietnamese.

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Ashley Peddicord-Austin: All right. We can advance the next slide

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Ashley Peddicord-Austin: uh So prevention we mentioned under step one of the roadmap. Uh. But this is actually one of our most popular set of resources, or the prevention fliers. Uh, so we have one. That's just kind of general, the one on the right hand side. Here, um is a generally applicable prevention, and four pieces to prevention, and what you need to do to to to stay healthy, both with and without health insurance. So that was the one we we worked with our Federal colleagues to put together some

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Ashley Peddicord-Austin: um some tips, some talking points in this general.

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Ashley Peddicord-Austin: You know what to do, what to do to say healthy book in and out of health insurance, and then some links to some further information, and then we have the ones that are um different flyers that apply to adults, and then one for men, women, children, infants teens, um, and then just kind of journal adults.

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Ashley Peddicord-Austin: So those are also all the um and translated into eight languages. Um, and they're the ones that mentioned the zero dollar co-pays and the services that are available under most plans at no cost. And they are very popular. If you're interested in prevention.

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Ashley Peddicord-Austin: Okay, next slide. Uh. So this Tommy here it's almost open enrollment. Um, whether it's Medicare or marketplace. Um, and a lot of employer plans is open enrollment season um and time to get pretty. So uh one of the resources we'd like to point out this time of Here is our enrollment toolkit

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Ashley Peddicord-Austin: uh this one is marketplace specific. I do like to note that. But uh, that these generally apply to a lot of insurance types. Um. So making sure that someone is picking. The right plan is crucial to them, actually using the plan, and we know studies has shown that if someone um can't afford their plan,

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Ashley Peddicord-Austin: they don't use it, which seems logical. But a lot of times people just enroll in whatever plan or whatever plan it looks good or plan appears cheapest. Um! And then Aren't actually able to use it. So we have an enrollment toolkit, and we have um manager health care cost which help people

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Ashley Peddicord-Austin: think through. First off. How do I budget for monthly healthcare expenses, budgeting for copays and premiums? Um! And thinking through what those costs are actually going to look like at the end so can you afford the deductible? Can you afford the premiums and the co-pays and thinking through those pieces of it?

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Ashley Peddicord-Austin: Um! The enrollment toolkit and helps you talk through. Why is this important? What do I need to know? What are these metal levels? What's financial assistance to? Uh to providing all of that information. This is actually because uh partner facing piece. But we heard from partners that they were often giving it to consumers and letting consumers do um to walk, use this themselves to walk through picking a plan.

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Ashley Peddicord-Austin: So with that in mind when we updated it. Um, we kind of simplified it a little bit um made the design a little more consumer friendly. Um! And the Spanish version is coming very soon,

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Ashley Peddicord-Austin: all right. So our um

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Ashley Peddicord-Austin: next slide here, I think

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Ashley Peddicord-Austin: I think this is my last resource. Yes, this my the last one that i'll show you today. Um! It's so. It's called my health coverage at a glance. I like to bring this one up the same year as well, because when someone has picked a plan or looked at their plan again and said, Yeah, this is the one i'll keep. This can be a really handy resource. Um, You have again that before and after shots on the screen,

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Ashley Peddicord-Austin: but it helps people to understand um their plan in particular. So the roadmap is all those definitions and insurance card has a lot of information, but this one puts all of that together. So you have a term like premium, the definition.

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Ashley Peddicord-Austin: And then what is my premium? So this is could actually be used as a learning tool. Um, if you were able to do that much in deaf work with the uh with the consumer patient. Um. So what? Walking through? Okay, there's a premium. Now, here's what your premium is. Copay. Here's where you can find out on your insurance card, and here we're going to write it in here.

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Ashley Peddicord-Austin: Um! And so the front side is all cost, and on the backside is knowing where to go.

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Ashley Peddicord-Austin: Uh. So this one is um also one of the ones that we are. It's in our queue to get up to on it to our website. In all eight languages

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Ashley Peddicord-Austin: we'll go ahead to the next slide. We have just a couple more before we wrap up um, and these will just talk about how to get involved in what maybe you could do, or um other partners or advocates that you work with um to think through how how we can all work together to advance health, equity, and help literacy, and so go ahead to the next slide.

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Ashley Peddicord-Austin: And so for coverage to care. And in particular we think about, How do I even start this conversation? The right back can actually be a a way to do that. So, looking at that poster again of those eight steps, you know, talking through those with a consumer, and you know, where do you think you are in this? And let's let's jump in there.

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Ashley Peddicord-Austin: Um! Personalizing. It is a really great thing if you actually know the person. If it's a patient you've been working with um. You might be able to easily customize and personalize the conversation. Uh, be it, you know. Hey you? I know you have a lot of prescriptions. Let's think through which of these plans is going to be most affordable. Or um,

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Ashley Peddicord-Austin: you know, Okay, you haven't had. Uh you, Haven't, been active on your health insurance for a while, but you know we're renewing your plan. Let's really think about how we can get you into a primary care appointment. Um, so, or maybe it's uh just being able to help them find primary care providers in the area that are accepting new patients

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Ashley Peddicord-Austin: uh so thinking through, or it could just be as simple as Here's my phone number. Call me when you have questions uh so personalizing that that conversation and using the roadmap to to help you in that,

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Ashley Peddicord-Austin: and we can go ahead.

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Ashley Peddicord-Austin: Um. So how to involve your organization can also mean, you know, seeing us give us some help uh. So we have some partner toolkits and some Powerpoints and things that are already prepared information.

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Ashley Peddicord-Austin: I blog um blurbs that you can put into a list of a blog email website. What have you, Um, or just uses talking points and a community Powerpoint presentation walks through all those eight steps that I talked about earlier, the slides for each of the eight steps with a script and everything all written out.

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Ashley Peddicord-Austin: Um. So those are available for you to use um to tweak. We want you to use comfort, to care resources as they work for your organization. So That means tapping a pacing, or you know, changing it up a little bit.

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Ashley Peddicord-Austin: That's fine by us. We We want it to make sense for you.

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Ashley Peddicord-Austin: So go ahead to the next slide.

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Ashley Peddicord-Austin: Um. The resources that we walk through are on our website, and, like other Medicare and marketplace materials, you can also order them from the Cms product. Order warehouse. Uh, there is no cost for that,

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Ashley Peddicord-Austin: as said we do have

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Ashley Peddicord-Austin: they? If they're not posted yet, they will be in the next week the eight languages for all of the coverage to care resources. And then there's a note on here that Ukrainian will be coming soon, probably in the next month we've been working on those as well.

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Ashley Peddicord-Austin: We also have a tribal version of our roadmap that we do with our division and tribal affairs here in it, posted recently to our website as well. So if you have any uh travel nations that you work with, uh, you able to use that one instead.

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All right, we'll go ahead to the next slide.

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Ashley Peddicord-Austin: Um, if you have questions um in particular about health, equity, or how you can bet equity into your own work. Uh, be at the disparities, impact statement, or questions about data collection or making culture your perfect materials. Uh: do reach out to us. Uh, you can see at the bottom of the slide. There's the email health. Actually, I can talk health equity T. A. At Cms. At Hhs stack of um. We have lots of uh people reading through those and and helping out with any questions that come up. It's all personalized, so that doesn't have to be a

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Ashley Peddicord-Austin: thing that you can ask on. You know anything that you think we could assist us would be happy to hear from you,

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Ashley Peddicord-Austin: and we can go ahead to the next slide,

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Ashley Peddicord-Austin: which is just one last slide on some resources. So there's our main website, and then some some of the plain language and health letters see, like resources that Darcy had mentioned.

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Ashley Peddicord-Austin: And then the final one is the Cs toolkit for clear and effective materials,

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and we have um,

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Ashley Peddicord-Austin: actually just one more last slide after this one

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Ashley Peddicord-Austin: uh, which is different ways to connect with us. We have multiple. This serves, if you like, to sign up for those. There's minority health, which is where you get health, equity, info, coverage, care, which is just the coverage to care um resources overall health one.

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Ashley Peddicord-Austin: And then of our last one. If you don't want a lot of email, you only want to send things here and there, we have a quarterly Newsletter, so that one sent out to four times a year. If you only want a couple of emails. Um, but feel free to reach out to us anytime at Om. At Cms. Dot Hhs Gov:

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Ashley Peddicord-Austin: um, and Darcy and I and Team will will get your email and respond if you have questions or be it about this presentation or other ways that you can work equally into your everyday,

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Ashley Peddicord-Austin: and I will turn it back, I believe, to Mitzi.

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Quality Insights: Okay, thank you so much, Ashley and Darcy. Uh, this has been great information. Um! We are coming up on the hour. We probably only have time for a couple of questions. So i'll just remind everyone if you do have a question, and we don't get to it today. Um! We can certainly reach out and get those answers back to you um through follow up after today's Webinar.

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Quality Insights: Um. One question that we do have uh Ashley and Darcy is regarding um healthiterate health, literacy, assessment tools, they ask, Does Cms recommend a particular health literacy assessment tool um to? Maybe one assess individuals or to assess organizations?

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Ashley Peddicord-Austin: So I know that there is um! The slide before is, I don't know if we're able to go back at this point, but there was a

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Ashley Peddicord-Austin: um a tool for written materials that might help um. And then some of these are just more so concepts and things to incorporate. I don't believe, Darcy, that we have a particular tool that's recommended. I know there's several in terms of um

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Ashley Peddicord-Austin: like plain language and lowering literacy levels. There's a lot of different writing tools out there. Um, I don't think cms generally um for the written part at least, would look to um a particular tool so much as um mixing in and doing what you can for plain language translations

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Ashley Peddicord-Austin: um using visuals to assist when possible. Um low low grade level is good, but it's not the only thing. Um,

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Darci Graves | she/her | CMS OMH: And then, for actually many with patients. Darcy, do you have any um to add their say hr queue, or Arc has a tool that helps look at written materials, brochures, and those sorts of things from a health literacy a checklist point. Um. The acronym is Pm.

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Darci Graves | she/her | CMS OMH: Um. But of course I can't remember what that is off the top of my head, but we can be sure to share it with with Andrea and and Mitzi Um,

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Darci Graves | she/her | CMS OMH: and to all of our I don't. I don't have one. Uh I don't think we have anything that we can recommend per se for the actual patient encounter, because, of course, so much of that would be dependent um

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Darci Graves | she/her | CMS OMH: on the patients themselves or the enrollie uh, and the interaction that you're you're trying to have, because there will be some cultural nuances there as well at the pmet tool, is actually on this resources and website page. The patient to education, materials, assessment, tool and users guide is from a Hr queue or arc.

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Darci Graves | she/her | CMS OMH: Um, And that is a a great tool to help uh assess any written materials that that folks may have.

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Okay,

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Quality Insights: Um, Well, thank you. We are at the hour, Mark um! And I did want to just remind everyone about the evaluation. I've put a link up here on the slide. You can also scan the Qr code with your phone to take the evaluation as well, and then you will receive a link after submitting your evaluation where you can get your serve, your your certificate

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Quality Insights: Um, with your continuing education credits, and I also wanted to let everyone know that slides and recordings for today will be posted on each network's website after today's session.

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Quality Insights: I'll put the links to those in the chat um as well as what states each network covers. If you're not um coming from the Esrd community, I know we probably have some other individuals coming from the quality improvement uh network

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Quality Insights: field today that are also attending. So that information is in the chat, and I also wanted to remind everyone about next Week's session. It will be on Thursday, October the thirteenth at one Pm. We'll be talking about developing health Literate materials.

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Quality Insights: Um, and the link to register for that. I also included in the chat. If you haven't all if you haven't already registered.

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Quality Insights: So uh at this time I just want to say thank you again to our guest presenters. Um! This has been a wonderful presentation. We really appreciate uh the information, and if you have any closing remarks, or Andrea, if you have anything that you would like to say before we close out. Um, please feel free to do that now.

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Andrea Moore, Quality Insights: Uh, just thank you. Everyone for joining us. Thank you again. Darcy and Ashley and Ashley way to Multitask. We appreciate it. So you worked right through that. So as a as a working mom, i'll say hats off to you. Thank you very much for those of you who didn't get an opportunity to ask questions. You all have my email on the flyer feel free to send me an email, and i'm happy to direct them to Darcy and Ashley as necessary. So thank you again.

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Andrea Moore, Quality Insights: Everyone enjoyed the rest of your day, and i'll see you here again next week. Thursday at one o'clock.

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Andrea Moore, Quality Insights: Alright, Thanks, everyone. Thank you. Bye, bye, bye,