In 2012, Tom Chamberlain, PharmD, founded EdLogics, our gamified health education platform. Recently he shared how he first got the idea from working with patients, and the results so far.
Right. As a PharmD and an entrepreneur, I’ve been involved in starting and growing a number of companies, all of them focused on healthcare education and improving the utilization of healthcare services. My primary objective has always been to improve clinical outcomes and reduce healthcare costs for consumers and payors of healthcare services.
I was fortunate to have had the opportunity to manage my own patients during my doctor of pharmacy program and residency training. Having firsthand experience treating patients with chronic conditions like diabetes, high blood pressure, and COPD, I knew the challenges of educating and engaging patients in the self-management of their conditions. Traditional educational strategies such as pamphlets and printouts weren’t effective in teaching patients what they needed to know to improve their conditions.
For people with diabetes, testing blood sugar is a routine part of managing their condition. If you’re injecting insulin or using a pump, you may have to test several times a day. Without accurate blood sugar tests, you might not get the right amount of insulin at the right times.
If you can’t measure your blood sugar, you can’t control it. And if you can’t control your blood sugar, you raise your risk of amputations, heart attacks, blindness, erectile dysfunction, and many other problems. One immediate risk is diabetic ketoacidosis, which comes on quickly and can be fatal. Even if you survive, your ER trip will cost thousands of dollars. And it all can be avoided with appropriate education.
Many patients seem to understand how to check their blood sugar once someone shows them. But it was clear to me that most of my patients had forgotten what they’d learned by their next visit. They still weren’t retaining the information needed to manage their diabetes.
This happened over and over again – and similar scenarios occurred with a number of patients with various chronic conditions. I realized we’d never be able to help our patients if we couldn’t find a better way to teach them what to do.
Yes, but a lot of people aren’t familiar with the term. Here’s one definition:
“Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
Or to put it more simply:
“Health literacy means you can find and understand the information you need to make good decisions about your health.”
Low health literacy is now recognized as a critical barrier to effective and efficient healthcare. It’s an enormous problem, and the consequences are far-reaching. For instance, did you know that compared to patients with adequate health literacy, patients with low health literacy have:
In fact, the cost of low health literacy in the US is somewhere between $106 billion and $238 billion per year. It’s unreal!
If we want to improve health outcomes and lower healthcare costs, we need a way to reach consumers – a way that works for them long term.
Since I started working in the healthcare industry, the concept of health literacy has matured into an academic discipline. Institutions like Vanderbilt University have devoted teams of talented experts and researchers—like Russell Rothman, MD, MPP, arguably one of the top health literacy experts in the world—to help healthcare providers, employers, payors, and the public understand the implications of low health literacy—and develop effective solutions to address this major healthcare issue.
At EdLogics, we’ve teamed up with many leading academic medical centers and Centers of Excellence (CoE), as well as industry thought leaders like Dr. Rothman and former US Secretary of Health and Human Services Governor Tommy Thompson, to identify specific ways to improve health literacy.
The first step is to make learning fun and engaging. To do this, we employ and work with experienced clinicians, developers, designers, and gamification experts to create stimulating, engaging games that educate users on important health topics, from diabetes to the Zika virus, all developed with the low health literate user in mind.
To keep users coming back, we’ve developed innovative gamification and unique incentive strategies where users earn rewards by playing games and completing educational activities.
Employers can purchase a customized version of the platform, enabling employees and their families to play, learn, and win. And the cost is minimal: roughly $20 a year per family.
I’m very proud of our platform. It’s a product that educates consumers about chronic diseases, common medical conditions, general health, well-being, medications, and how to navigate the healthcare system. We’ve heard inspiring testimonials from employers and employees, and we have impressive statistics on knowledge improvement and consumer engagement. In fact, 100% of users improve their knowledge of a given condition after completing our learning activities, and 79% of users say they will change their behavior based on what they learned.
We’re continuously making enhancements, all with a focus on improving consumer engagement. That’s the key to being able to influence positive behavior change and deliver the most important, lifesaving knowledge. Not to mention the opportunity to reduce pain and suffering – both physical and financial.
A version of this article was originally published on2/22/2017.
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:
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.
“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.”
“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.”
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
✅ Improved outcomes for:
“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.”
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.
“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.
“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.”
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.
“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.”
“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.”
“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.”
“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.”
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.
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.
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.
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.
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.
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.
(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.
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 EdLogics Platform will serve as the technological backbone of Empower Community Health. The Platform features:
“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:
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.
A version of this article was originally published 11/29/2018.
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?
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 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.
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 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.
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:
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.
Some barriers for patients with low literacy include:
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.
A version of this article was originally publshed 10/09/2017.
n estimated 80% of large US employers offer wellness programs for their employees. In fact, wellness programs are often touted as key employee benefits.
But new research questions if wellness programs actually do reduce health care costs. Research published in the Journal of the American Medical Association was jointly conducted by Harvard and the University of Chicago.
The researchers randomly offered different wellness programs at various work sites and then tracked the results. Specifically, they offered new wellness programs at randomly selected locations of BJ’s Wholesale Clubs. Those results were compared to existing programs at other locations to identify any changes in individual behavior as well as any changes in the corporate culture.
The results showed some demonstrated behavior changes ... but little effect on other outcomes.
Behavior changes recorded at sites offering Wellness Programs:
Outcomes showing no significant impacts included:
Researchers noted that the field of studying wellness programs is still relatively new. Others have commented that 18 months might not be enough time to effectively measure the success/impact of wellness programs. Might it not take decades?
One of the coauthors of the study, Zirui Song, MD, PhD, assistant professor of health care policy and medicine at Harvard Medical School’s Blavatnik Institute, stated her summary.
As we grow to understand how best to encourage healthy behavior, it may be that workplace wellness programs will play an important role in improving health and lowering the cost of health care. ... For now, however, we should remain cautious about our expectations from such interventions. Rigorous research to measure the effects of such programs can help make sure we’re spending society’s health and wellness dollars in the most effective way.
One missing variable is the role that education plays. Would behavior change absent of an increase in health literacy even be sustainable? Conversely, if employees better understand their personal health — how to properly use an asthma inhaler, for example – would behavior change persist longer?
We’ll be fielding these questions to several health literacy experts so check back for their responses.
A version of this article was originally published 4/19/2019.
e’ve all been there. Sitting in a cold exam room, tense and nervous, perhaps embarrassed in one of those awkward gowns. Not understanding what the doctor is saying — or even knowing what to ask.
Not knowing how to make informed healthcare choices can take a toll — physical, financial, emotional — even professional.
And the numbers don’t lie. Compared to people with higher health literacy, patients with low health literacy have:
In our webinar, “Why Health Literacy Matters to Your Business,” leading experts Cynthia Baur, PhD, Endowed Professor and Director of the University of Maryland’s Horowitz Center for Health Literacy, and Dr. Russell Rothman, MD, MPP, Director of the Center for Health Services Research at Vanderbilt University, discussed with EdLogics moderator and population health expert Fred Goldstein how, by focusing on statistics, we may be missing the bigger picture.
Watch the complete webinar:
Here’s just a small part of what they had to say:
Fred Goldstein: Given all of the statistics, what are some of the key reasons patients with lower health literacy experience poorer health and require more care?
Dr. Baur: One of the things I like people to think about is even the framing of that question. Because you are right about the data that’s been collected on people’s experiences and outcomes with getting healthcare services.
But that approach of looking at people’s health literacy levels and the use of emergency services and what-not — many times, that approach puts the blame on them. Because it makes them seem like they’re doing things that are inappropriate or costing the system or themselves more money.
Dr. Baur: The reality is that we live in a very complex set of health systems. There are multiple healthcare systems.
There’s the public health system. There’s the educational system which influences people’s knowledge and skills about health.
So all of those different systems are part of that larger environment in which people are trying to get information and services. …
Health literacy has really been an issue that’s been out there for a while. The data have been accumulating about these costs.
We’re at a point where people are taking a step back and saying, if you want patient-centered or person-centered health and healthcare, you really have to look at what people’s experiences with these systems are.
You have to look at the challenges they face and the demands being placed on them to try to get information and services. And that will lead us toward looking at organizational practices, system redesign, and ways that will make it easier for people to get what they need.
Dr. Rothman: Poor health literacy is a common problem. We know that over 90 million Americans have basic or below basic skills, and over 110 million have only basic or below basic quantitative skills, which can make it very challenging in our very numbers-focused healthcare environment.
Even people with good health literacy skills can now struggle to navigate what’s become a very complex healthcare system. Trying to figure out how to take their medicines, how to follow a good diet, how to follow up specific recommendations from providers — even just navigating where to go in the hospital, or how to get to appointments, or how to navigate insurance — it’s all become very complex. The amount of time patients have to interact with their doctors or other clinicians whether it’s at a clinic or even in the hospital — it’s very short.
Dr. Rothman: There are real opportunities for us to improve how we provide health information to patients and families to help them to improve their health.
The information and opinions attributed to Drs. Baur and Rothman are their opinions only and do not necessarily represent the views of their affiliated organizations, including the University of Maryland, the Centers for Disease Control and Prevention, and Vanderbilt University Medical Center.
A version of this article was originally published 3/24/2017.