ou can’t control many of the factors that contribute to high healthcare costs: expensive drugs, the cost of providers, rising insurance premiums. So, what can you do?

Improve health literacy, the ability to understand and act on health information.

Watch health literacy expert Russell Rothman, MD, MPP of Vanderbilt University and gamification guru Brian Primack, MD, PhD, then of the University of Pittsburgh (now at University of Oregon), outline problems with existing health education programs and describe real-life solutions.

Watch the entire webinar recording below.

Here's the skinny: 

Low Health Literacy Costs More, High Health Literacy Costs Less

EdLogics wants to improve low health literacy through education.

It’s not about avoiding medical care. It’s about getting the right care at the right time.

We want to empower people to make real changes in their day-to-day habits, so they can stay healthy and keep their families healthy, too.

We want to educate people to prevent sickness before it starts, to show them what to do and where to get care when they do get sick, and help them become well-informed, proactive healthcare consumers.

Ultimately, EdLogics wants to improve health outcomes, reduce the number of claims, and lower costs. For everyone.

Dr. Primack:
“In the US, 1 in 3 Americans can’t follow directions on a drug label. And I have to say, even with a medical degree, I sometimes get a prescription for one of my kids or something and I have to look at it pretty carefully with that small print and the code that it’s in. So it’s not surprising that it’s a challenge for many different people.”

Dr. Primack:
“When someone, for example, just has an ankle sprain — if they can access and follow good information that they have — then they very well might be the kind of person who will say, ‘You know, I don’t need to go the emergency room. I can wait.’

A couple days later, they’ve already improved with ice, elevation and rest — all things that are free.

Whereas another person who is having more difficulty understanding or accessing information might decide to go to the ER for the same condition, and the second they get through the ER door, already they’ve racked up very high costs. They’ve put themselves at risk for getting some kind of a hospital-acquired infection or some additional problem.

Even though this is one small example, when we start quoting issues like ‘90 million Americans have poor health literacy, and this costs an extra $150-200 a year,’ you can see how these numbers add up.”

Improving Health Literacy Makes a Difference

Knowing what to do to prevent chronic disease, how to take medications, and where to go when you’re sick — and acting on that knowledge — can have a huge impact on both personal health and the number of costly healthcare claims.

✅ Improved knowledge of health issues

✅ Improved behaviors

• Medication adherence
• Vaccines
• Childhood obesity prevention
• Diabetes self-management
• Asthma management

✅ Improved outcomes for:

• Diabetes
• Heart failure
• Obesity prevention
• Depression

Dr. Rothman:
“Even after you take into account a patient’s education level, their income, their insurance, and a host of other factors, we find that their literacy level is an independent predictor of how they do with their health.”

The Problem with Existing Health Education Programs

Of course, health education programs trying to raise people’s health literacy already exist.

But are they actually making a difference?

Pamphlets: Often don’t make it from the doctor’s office to the car.

Health websites: Too high-literacy, not personalized, and not always trustworthy.

Doctor visits: Patients may misunderstand, forget instructions, or feel too embarrassed to ask questions.

Dr. Rothman:
“And, unfortunately — and I say this as a primary care physician [laughing] — but there’s also a lot of variation in how well doctors communicate with their patients and their families. If you ask most clinicians we would, of course, tell you that we’re excellent communicators, and our patients all nod their heads and seem to understand everything that we say to them.  … Some studies suggest patients only recall about 20% of what’s said to them by the time they get home.

So we like to think we’re all good communicators as clinicians, but a lot of us struggle — using a lot of jargon that might be hard for patients to understand, maybe speaking at too high of a literacy level without enough plain language, and giving people too much information to try to take in during one single visit. We often don’t assess patient understanding before they leave.”

Poorly designed games: Many focus on the wrong goal.

Dr. Primack:
“So there would be hamburgers and pieces of pizza, and you are supposed to shoot those, but the salad you are supposed to let live. You can probably imagine the next step, which was that they studied this and they found that being exposed to this game and playing this game a lot didn’t actually make people change their diet in any way.

It’s just a caution that even though sometimes gamification is really valuable, if the game is poorly designed, that’s just not a magic quick fix.”

Improving Health Literacy: What Actually Works

It’s one thing to learn more health facts. It’s another thing to change your daily habits — the one thing that has more of an effect on health than any other single factor.

• Gamification and game-based learning
• Key principles:
• Competition, leaderboards, and peer comparisons
• Teamwork, shared goals
• Leveling up, increasing challenges, improving skill and knowledge
• Interactive content for better retention than passively-consumed content
• Unique incentives, cash drawings, charitable contributions, other benefits

Dr. Primack:
“The question is: Can we take principles of gamification and game based learning — the interactivity, the unique incentives — and can we use that to leverage for positive change? And what we have found is that, especially in the area of health literacy, there is a lot that we can do.”

• Multiple formats: words, pictures, videos
• Personalization: Content is tailored to the individual user based on age, gender, health conditions, interests, and family roles like caregiving
• Motivation and sustainability: Keep people engaged for real-life behavior changes
• Community resources: Further education and support

Dr. Rothman:
“What we really need to think about more is how to link people to other social support mechanisms to help them with their health. We have lots of studies now that really demonstrate that patients who have strong social support do much better with their health. There’s actually an epidemic of loneliness going on in a lot of countries.

And even when people are with their family, they may not have social support for disease that they’re dealing with.

So it can be really helpful to help a patient or employee and their family link to community resources — maybe to disease-specific organizations if they have a certain disease, or to a community organization that provides peer support. Or we can help them gain access to exercise or healthy food. Even to help them with getting additional support from their own family.”

Effective Health Literacy Education

• Personalized and engaging
• Addresses readiness for behavior change
• Applies principles of motivation for goal setting
• Activates participants
• Sets concrete, feasible goals
• Promotes follow-up for sustained behavior change
• Provides community resources for support

4 Things to Remember:

1. Health literacy is a major problem in the US.
2. Improving health literacy benefits everyone.
3. We need a multi-faceted approach.
4. There is no quick fix — but there IS hope.

Dr. Rothman:
“Health literacy is a major problem in the United States. We have at least 90 million Americans with only basic or below basic literacy skills. Even patients with good literacy skills can struggle to navigate what’s become a very complex healthcare system when trying to take care of their health or the health of their family.

We have found that by addressing health literacy issues, we can improve care for patients with low literacy. Studies have suggested that using good forms of health communication and addressing health literacy can even improve knowledge and behavior for people with high health literacy. So improving how we educate and communicate can be of great value to everyone.”

Dr. Primack:
“There are so many challenges here. If it were easy, we wouldn’t have 90 million Americans with low health literacy. But I think that it’s important to end on a positive note and say that we really are moving the needle. There have been studies that show that using the kind of principles that we talked about today really do help and change people’s lives. I think that that is what we need to hold up as we move forward.”

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A version of this article was first published 10/12/2018.

ooner or later, we all get sick, and we all need healthcare.

Of course, not all Americans have equal access to healthcare. Some of us can’t afford it. Some live far from quality providers. Some experience bias based on race, sex, age, or gender identity.

The result?

People suffer and die from health problems they could have avoided — if they’d gotten the care they needed.

Untreated conditions require more expensive treatments down the line. And — whether it’s the person, the hospital, health insurance, or the government — someone has to pay for it.

Low health literacy and less access to healthcare for some people means higher healthcare costs for everyone.

February is Black History Month. Research shows that historically, people of color often receive poorer healthcare than white people, for many reasons. This is known as healthcare inequality, and it’s a problem that affects us all.

We asked Dr. Seth Serxner, PhD, MPH, EdLogics Chief Health Officer, to answer some key questions about healthcare inequality — and why we all should care.

What are healthcare disparities?

Basically, it means that not everyone has equal access to healthcare or health education. Those disparities have been documented among African Americans, women, the elderly, the LGBTQ+ community, and many ethnic groups.

How do disparities in access to healthcare disproportionately affect communities of color?

Disparities in healthcare can occur because of provider bias. The providers themselves may or may not be aware they have certain biases.

This is also an issue: Currently available medical science tends to be based on clinical findings of white male study participants. Those results may or may not generalize to people of color, women — anyone who is not a white male.

Disparities in health literacy put those populations who are already experiencing disparities in service at an even greater disadvantage. Because of a lower ability to understand health information and navigate the system, they are not as well equipped to advocate for themselves or others in their care.

Why should everyone care?

Health disparities put people’s lives and health at risk. For example, women are often not treated for heart attacks with the same urgency as men, which puts women at greater risk of death.

Delayed treatment or lack of treatment for people of color can lead to later stage disease diagnosis or disease mismanagement, which in turn may lead to more serious health consequences.

In addition to the unnecessary pain and suffering, there are increased cost consequences of treating people at later disease stages. These greater costs affect the healthcare system as a whole and result in greater costs for everyone.

👉 Overall, the goal of health equity is to provide everyone the opportunity to live healthy and active lives by addressing disparities in healthcare and health literacy. 👈

Equally important are social health essentials and personal determinants of health — such as housing and access to nutritious food, having social connections, a sense of purpose, and a positive outlook.

What can everyone do about it?

Our healthcare system needs to do a better job of training medical professionals about health disparities and help them be aware of their biases.

Those that pay for healthcare, such as insurance companies and employers, need to hold providers accountable for disparities with key performance metrics.

And individuals — regardless of ethnic background or gender identity — can strive to be prepared to advocate for themselves and others by increasing their health literacy.

At the community and employer level, providing opportunities for people to increase their health literacy is key to addressing this issue.

It’s important to note that our health system is complicated and health information is complex. Translating public health and clinical information to the personal level is challenging for most people from all walks of life. Low health literacy does not necessarily mean low literacy — some very intelligent and well-read people find it difficult to navigate our health system no matter their education level. It is NOT an issue of intelligence.

No matter who you are or what you know, you can and should improve your health literacy. It could save you some pain, some money, and even your life.

Log in now. Learn more about healthcare inequality, how it affects all of us, and what we can do about it.

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(This is an example of the weekly newsletters that go out to all users of The EdLogics Platform, a gamified space that improves employee engagement and health literacy. Contact us to learn how to get access for your organization.)

EdLogics and Global Action Platform recently hosted a conference focused on the economic benefits of improving health literacy in communities.

The event, held November 5 in Norfolk, Virginia, highlighted the specific needs and benefits to the Hampton Roads and Nashville areas.

EdLogics Founder and CEO Thomas M. Chamberlain, PharmD, opened the event by sharing the economic impact of low health literacy.

‍“Low health literacy is a multibillion-dollar problem,” he said. “Patients with low health literacy are more likely to visit an emergency room, less likely to follow a doctor’s instructions, and have higher mortality rates.”

Patients with low health literacy are more likely to visit an emergency room, less likely to follow a doctor’s instructions, and have higher mortality rates.

Low Health Literacy by the Numbers:

• Patients forget up to 80% of what their doctor told them before they reach the parking lot.
• Close to 40% of Americans suffer from one or more chronic conditions, accounting for over 85% of the total US health costs.
• Over 90 million Americans are at risk for preventable health issues because they have difficulty understanding health information.
• On average, healthcare costs for a low literacy patient are $8,000 higher per year.
• One in three Americans can’t follow the instructions on a drug label.

To address this crisis, Global Action Platform and EdLogics are creating Empower Community Health, an initiative utilizing technology to improve health literacy. This platform, through which communities can connect health and prosperity, will in turn create a competitive economic advantage for their regions in the ongoing competition for investments, talent and markets.

The goal is simple: To increase both the health and prosperity of communities.

The EdLogics Platform will serve as the technological backbone of Empower Community Health. The Platform features:

• Game-based learning
• Rewards for progress
• Rich, user-friendly content covering a broad range of health topics, from chronic conditions to preventive health to navigating the healthcare system

“The Platform is proven, easy-to-use, and can be accessed on desktop and mobile devices, making it readily accessible to anyone with access to the internet,” added presenter James Spore, President and CEO of Reinvent Hampton Roads.

Through Empower Community Health, the EdLogics Platform will be available to the citizens of Hampton Roads and Nashville, including underserved populations, the public school system,  and university students. EdLogics and Global Action Platform will work with schools, libraries, community health clinics, churches, YMCAs and other civic organizations to provide access.

The comprehensive community implementation has many innovative and important features, including:

• Advanced data analytics
• Multi-sector/community implementation
• National expert review

At the community level, Global Action Platform will provide regional program managers to work with sponsors, community organizations, and other stakeholders to leverage local resources, networks, and existing programs to drive awareness. Local universities will serve as strategic outreach partners and provide academic research expertise.

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A version of this article was originally published 11/29/2018.

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There’s no end in sight.

Total costs of providing medical and pharmacy benefits are expected to rise 5%, according to an annual survey by the National Business Group on Health.

That means employers at big companies can expect to pay around $15,000 per worker in the coming year. Blame it on costly claims, specialty medications, and certain diseases, say many employers.

But here’s something you may not know:

Health literacy — the ability to understand and act on health information — plays a role, too. According to a University of Connecticut study, low health literacy costs the US healthcare system about $238 billion a year.

Simply put, when people don’t have the knowledge they need to make good decisions about their health, they make poorer decisions — choices that lead to poorer health and higher costs.

Low health literacy costs more. High health literacy costs less.

Consider these scenarios:

1. An employee’s child sprains her ankle. In a panic, the parent rushes the child to the ER. They rack up a huge bill, even though they could have treated the child at home for free.
2. A doctor prescribes an expensive medicine for one of your staff. The employee doesn’t know to ask for a generic version, so they end up paying much more for the brand-name drug.
3. A 53-year-old worker puts off his colonoscopy year after year, saying he doesn’t have time for silly tests. Doctors don’t find he has cancer until much later, resulting in expensive hospital bills and treatments — not to mention pain, suffering, and weeks or even months of missed work —or worse.

In each scenario, improving health literacy could mean better health for less money. Studies show that people with low health literacy tend to have more health claims, more hospital stays, more trips to the ER, less compliance with treatment plans, and higher death rates.

In contrast, people with high health literacy tend to have fewer health claims, fewer needs for special services, more compliance with medication and treatment plans, and better health overall.

People with high health literacy tend to have fewer health claims, fewer needs for special services, more compliance with medication and treatment plans, and better health overall.

Finding the Right Health Literacy Resources

Improving health literacy isn’t easy. “There’s no quick fix,” said EdLogics advisor Brian Primack, MD, PhD, director of the Center for Research, Media, Technology, and Health at the University of Pittsburgh, in a recent EdLogics webinar. Still, Dr. Primack added, “We are moving the needle.”

If you’re an employer, a human resources manager, or other business leader who’s committed to finding ways to improve health literacy in your organization, these resources can help:

Developing a Plan in Your Organization

Use the CDC’s workbook, sample action plan, and links to government sites to create your organization’s health literacy plan. Includes state and county estimates of low literacy.

Health Literacy Online

You know your company needs a health literacy program, but you’re not sure where to start? This guide will walk you through the basics, including best practices and simple, concrete tips for writing and designing good content.

Everyday Words for Public Health Communication

The first rule in developing health content for low-literacy users: Avoid doctor-speak. This simple tool shows you how, with an index of commonly used medical terms and their plain-language alternatives.

Webinar: Improving Health Literacy: What Works & Why

Health literacy expert Russell Rothman, MD, MPP, of Vanderbilt University and gamification expert Brian Primack, MD, PhD, of the University of Pittsburgh share an overview of what makes health literacy programs effective.

EdLogics’ gamified learning platform combines engaging, personalized content and activities with unique incentives to help users improve their health literacy. Want a demo? Contact us!

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A version of this article was originally published 10/25/2018.

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ecently, Sean Parker, the first president of Facebook, issued some harsh criticism of social networks in an interview on Axios.

He claims they work to exploit “a vulnerability in human psychology” and that those networks will eventually “consume as much of your time and conscious attention as possible.”  He claims the networks do this by creating a system to generate addictive loops that “sort of give you a little dopamine hit every once in a while, because someone liked or commented on a photo or a post or whatever.”

The “social-validation feedback loop.”

It's very powerful and used by all of the major social media sites which continue to grow and consume our time and attention.

But what if we could take those same techniques Facebook used to grow to over 2 billion active users a month and applied them to something positive, like health education?

Recently, Tom Chamberlain, PharmD, CEO and Founder of EdLogics, gave a presentation to the Global Action Summit on the gamification of health.  In his presentation, Dr. Chamberlain described various types of gaming technologies, such as video games, mobile apps, virtual reality, augmented reality, and interactive learning, and how they are being used in the medical field.

Chamberlain went on to discuss the key principles of gamification, including instant rewards, milestones, status, and competition. He described how a “little dopamine hit” is generated through playing these games and through the use of gamification technologies.

Driving engagement and facilitating behavior changes are the “holy grails” of health improvement programs. If we can get individuals, employees, plan members, and/or communities more engaged in understanding and acting on their own health, we can see vast improvements in a population’s health and lowered costs. This is why applying gamification principles to health education is so exciting.

EdLogics is using the social validation feedback loop improve health literacy.

Low health literacy is associated with poor health outcomes and higher costs. It’s pretty clear that if a person does not understand their health, their health issues, the healthcare system, or their health insurance, they won’t be able to maintain or improve their health, select the right provider, adhere to treatment, and more.

These approaches are not just fun and games when it comes to health — they are using real science in an effort to drive behavior change and improve one’s life.

If you’d like more information on the EdLogics platform for your employees, health plan or as a broker/consultant, please contact us.

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A version of this article was originally published 11/11/2017.

Mr. Garcia is a 65-year-old man with prediabetes.

He’s just retired and moved to a new area. At his first visit with his new primary care doctor, a nurse asks if he can usually understand a doctor’s instructions.

“Absolutely,” he says. “I understand perfectly.”

But does he really?

Subjective vs. Objective  Health Literacy

Situations like this highlight the importance of measuring two kinds of health literacy — how much a patient thinks they know compared to how much they actually know. If doctors measure just one kind of health literacy, they may not realize how much a patient understands and how well they can follow basic health advice..

Better understanding might allow Mr. Garcia to act sooner. He might get treatment or make healthier choices — and avoid diabetes. Smart changes now could mean avoiding the pain and expense of a chronic health problem later.

That’s why, when possible, it’s best to measure both subjective and objective health literacy.

Subjective Health Literacy: What You Think You Know

Subjective health literacy measures how health literate someone thinks they are.

You can gauge subjective health literacy with questions like:

“How confident are you in filling out medical forms by yourself?”

The nurse in the story above was measuring subjective health literacy, albeit informally. The questions don’t have objectively correct answers, which may feel less threatening to the patient. It doesn’t feel like a test you’d take in school.

But there are disadvantages too. People often overestimate their own ability. And they may tell you what they think you want to hear. In other words, they may report strong health literacy even if they rarely understand or act on what a doctor tells them.

Objective Health Literacy: Measuring What You Know

A patient has to actually demonstrate factual knowledge to measure objective health literacy. One popular tool, The Newest Vital Sign, shows the patient a nutrition label and asks how many calories they’d get by eating multiple servings, as well as other basic questions.

With objective health literacy, you know patients aren’t overestimating their own ability, or telling you what they think you want to hear. But because there are right and wrong answers, some patients feel like they’re back in school, and the memories aren’t always pleasant.

EdLogics’ Approach to Measuring Health Literacy

EdLogics measures — and strives to cultivate — improvements in both kinds of health literacy.

We use only validated surveys. When we measure objective health literacy, we present questions a little differently, making them fun, adding graphics, and incorporating great design. It’s all gamified and has fun incentives to encourage continued engagement. You can even win cash drawings, where the more you play, the more likely you are to win.

Users do not feel like they’re back in school.

By measuring both types of health literacy, we put ourselves in the best position to understand how health literacy changes over time. This can help us further refine our suite of health literacy education games, and be even more effective in our mission to improve health literacy.

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A version of this article was originally published 7/6/2017.

ospital emergency departments, as the name implies, are meant to be used for true emergencies.

Unfortunately many trips to the ER are not life-threatening. Many are, in fact, both unnecessary and avoidable.

A study published in 2013 found that:

• Only 29% of ER visits reviewed were actual emergency situations.
• Less than half of those visits that were not an emergency required medical attention, but could have been treated in a primary care facility.
• One in four did not require any immediate attention.

Low health literacy leads many patients to the ER when they could have received care at a less expensive setting – like at their doctor’s office or at a walk-in clinic. It’s also known that patients with low health literacy are more likely to make return visits to ERs within two weeks.

Removing barriers, lowering costs

Some barriers for patients with low literacy include:

• Not understanding or following doctor’s instructions for managing chronic conditions.
• Misunderstanding information they find about symptoms online.
• Not recognizing the importance of proper preventive care.

More recent research, presented at the Society for Academic Emergency Medicine Annual Meeting in Orlando, explored how low health literacy was related to preventable ER visits. The study looked at over 1,200 participants and a total of 4,444 ER visits. Over 10% of the visits were found to have been preventable.

Of the preventable visits, over 60% led to hospital admission. The average cost of a hospital stay is estimated to be close to $10,000.

When researchers looked at the health literacy of the participants, those with lower health literacy were over twice as likely to have made a preventable ER visit. Having below an eighth-grade reading level was the definition used for low literacy.

The most common preventable conditions leading to ER visits included chronic obstructive pulmonary disease (COPD), urinary tract infections and long-term complications from diabetes.

While not surprising, the study illustrates that patients with low literacy are more likely to make preventable visits to ER and other emergency services. And increasing the literacy of patients can help dramatically decrease unnecessary healthcare costs.

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A version of this article was originally publshed 10/09/2017.

doctor prescribes an antibiotic for a toddler’s first ear infection. Eager to help their daughter, the girl’s parents pick up the medicine on their way home. Frantically, they open the bottle and start to pour the thick pink liquid into the crying child’s ear.

The problem: It should have gone in her mouth.

This story is a classic in the health literacy community. While obvious errors like this aren’t the norm, millions of patients do make dangerous healthcare mistakes every year.

One important reason: 90 million American adults have limited health literacy.

That means they have trouble finding, understanding, and using health information to make informed decisions about their health.

You can’t blame them. Even though most healthcare professionals are committed to educating their patients — including those with limited health literacy — we don’t always do a great job of it.

Here’s one example:

In a 2009 New England Journal article, Ruth Parker tells the story of two parents—one of whom was a physician—who struggled to understand the instructions for their child’s flu medication. The directions were so unclear that the physician had to solve a complex equation to figure out the right dose.

If a doctor has a hard time understanding such instructions, how can we expect patients to?

It’s not surprising that millions of patients with limited health literacy can’t interpret medication labels correctly, or use other health information to help prevent and manage disease.

These health literacy issues have been linked to serious health consequences. Adults with limited health literacy get fewer mammograms and flu shots. They have more ER visits and hospitalizations. They cost much more to the healthcare system. And they don’t understand their health conditions as well as people who are health literate.

Health literacy should matter to you if:

1. You have a chronic condition. If you or a loved one has a chronic condition, you know there’s a lot to learn. You need to use health information to help manage conditions like diabetes, heart disease, COPD, and many others.

2. You’re a parent. Once you become a mom or dad, you’ll need to use health information to learn how to care for your child.

3. You can’t get health insurance. Patients with limited health literacy cost more, so insurers pay more. That drives up premiums, which can quickly become unaffordable.

4. You have insurance. If you pay health insurance premiums, the price is based on the cost of caring for a large group of people. The extra costs linked to limited health literacy mean the group’s costs go up. That means you pay more in premiums.

5. You’ll someday die. Every mortal adult should have advance directives. These documents list the treatments you would or wouldn’t want if you got too sick to share your wishes. They also let you name someone to make medical decisions for you if you get too sick to communicate. To understand advance directives, you need to understand some basic health information.

If you’re not in any of these groups, stop reading.

If you do fall into one of these categories, you need to educate yourself on health literacy — and learn how to become more health literate. This blog is a good place to start. We’ll help you learn what you need to know about health literacy.

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A version of this article was originally published 2/27/2017.