Gregg Masters 00:07
This is PopHealth Week on HealthcareNOW Radio. I’m Gregg Masters Managing Director of Health Innovation media the executive producer and co host of the show. Joining me in the virtual studio is co founder and principal co host Fred Goldstein, president of Accountable Health LLC. PopHealth Week engages industry leadership and stakeholder voices spanning payer provider patient, vendor and regulatory communities in population health best practices and strategy connect with us via www.popupstudio.productions or follow and direct message me on Twitter via @GreggMastersmph and that’s Gregg with two G’s. On today’s episode, our guest is industry veteran Seth Serxner PhD,MPH , the Chief Health Officer for Edlogics, a digital communications and engagement company dedicated to improving health literacy and to empowering individuals to make better healthcare decisions. Dr. Serxner brings an extensive background in health literacy, public health, population health management, health equity and well being and with that introduction, Fred, over to you.
Fred Goldstein 01:22
Thanks so much, Gregg. And Seth, welcome to pop health week.
Seth Serxner 01:25
Thanks, Fred. Happy to be here.
Fred Goldstein 01:27
Yeah, it’s great to get you on, longtime colleague, and obviously you’ve done a ton of work in the population health space. So why don’t you give us a little sense of your background?
Seth Serxner 01:36
Yeah, I appreciate it. So as you said, I’ve been in the industry, my whole career, starting in academics with a master’s in public health, and then a PhD also in, in population health. I’m a California kid. So all through the University of California, thank you very much. But then moved to the private sector where I started actually in a patient education company, and wellbeing company, then I moved to Mercer, and was a senior partner there for about 10 years, I lead the health management practice in a number of national initiatives. And then for the past 10 years, I was at Optum, as the Chief Health Officer leading population health strategy, and a number of major initiatives, including social determinants of health, the last two years, as well as behavior change, health literacy, a lot around measurement. So that was very good. And I only recently left them to kind of do my own work advising companies in this space, including one that we’ll talk about today. Edlogics.
Fred Goldstein 02:40
Absolutely. And obviously, as we talked about before, and one of the issues we’ve dealt with on the show is this whole area of health literacy. And it’s really been out there forever. Everybody’s been talking about for a long time. But maybe we’re finally starting to see some progress. So what are some of the statistics around health literacy in the country? Now? Where are we with that?
Seth Serxner 02:58
Yeah, it’s so interesting, Fred, for me, as you just kind of outlined this in this space, 30 years public health, we all know how important it is for patient education, health literacy, we get information from our our providers all the time and from community health people. And it’s usually in a pretty boring, complicated way, very clinical, very, maybe legalese, because of this country. And what we’re finding is that really only one out of 10 people can navigate the kind of health information that they get, whether it’s insurance forms, the recommendations on the prescription bottle, that’s so teeny don’t they know, some of us are wearing glasses these days. So it’s a it’s a major issue. And the data is very clear that people who, you know, we’re talking about 90 million people have, are at risk have preventable problems, because of their difficulty understanding health literacy and health information. About 133 million or 41% of Americans have at least one chronic condition. And its major costs, it’s 86% of the total healthcare costs. So you’ve got all these people with these complicated conditions, taking multiple medications a little bit compromised, you can be a really smart person, but when you’re sick or in pain, or, you know, having some kind of emotional issues, it’s really hard to absorb all this. So we think it’s a real focus. We know that people with poor literacy are more likely to use the emergency room, have longer hospital stays, are less likely to adhere to treatment plans and, and frankly, have higher mortality rates, higher death rates. So it’s it’s a pretty big linchpin to the whole thing.
Fred Goldstein 04:48
Yeah, it’s fascinating, you know, having worked in Medicaid, you 20 plus years ago, and obviously back then it was make all of your materials at the sixth grade level, you know, and all of that kind of stuff, but that really wasn’t quite enough one, was it? There’s much more to the ability to help people with their health literacy than just setting the reading levels appropriately.
Seth Serxner 05:05
Exactly even way back when we talked about something called participant burden. But the idea is, what about numeracy. So much of the time it’s take this pill three times a day before this, there’s a lot of math that sometimes even goes with some of this. So very, very important. What we are seeing is that even the CDC has redefined how they’re thinking about health literacy. So they used to think about a kind of, in a unit dimensional way, it’s all about how organizations communicate in this kind of low literate, culturally appropriate, all good, but very kind of flat, and and dynamic. And they really didn’t focus on is the individual gaining knowledge, skills, confidence and behaviors to navigate the system. So now they have these two dimensions, a personal health literacy and organizational health literacy. And I think that’s really going to help us think about how we go about this overall,
Fred Goldstein 06:08
when you think about that, Seth, and you suddenly go from, well, the organization is responsible for this. And then now we’re going to look at the individual and how well they’re doing and their ability to do this, that sort of complicates the burden on the organization, doesn’t it? In terms of trying to meet what can be a very diverse population, broad needs, education levels, etc?
Seth Serxner 06:29
Yeah, I mean, the old days, it used to be called Return Demonstration, when you were in person with a nurse or a doc, you’d have, they’d show you how to use a peak flow meter for your asthma or do your glucose, and you’d have to show them that you were able to do it again, probably got home and totally forgot again, but at least. So now, though, it’s even more that way. In my opinion, so much of what we’ve been doing is that classic, give a man a fish not teach a man to fish. So we’ve been really, you know, trying to help people with advocacy services and other good phone lines and things. But we really haven’t been helping people navigate helping the caregivers navigate helping the patients and the provider. So this is a big opportunity, in my opinion.
Fred Goldstein 07:14
Yeah. When you think about that idea of the physician or a physician’s team member, asking them to demonstrate a skill set, you know, that they’ve tried to teach them? I mean, how do you do that as a health plan? How do you do that as the PBM, or some of these other groups that are interacting with the individual? So it really creates a difficulty, and, and providing unique tools, obviously, must be one of the new solutions and using some technology?
Seth Serxner 07:38
Yeah, I mean, now we’re able to so imagine, you know, everyone learns by YouTube, let’s face it, whether you’re, whether you’re fixing the sink, or you’re about to get your knee done, you go to YouTube, and in fact, YouTube is I think, the second most search used osearch engine, and healthcare is one of the top things that people go to. So why wouldn’t we use YouTube like videos for people? Why wouldn’t we use some of the things that we know about how adults learn with interactivity. And now we can start to build into the technology, whether a person, what their level of understanding was before and after, whether their likelihood of doing a behavior was high before and how it is after. So there are ways now with this technology that we can kind of document the impact as well.
Fred Goldstein 08:29
So you’re talking about taking, for example, some of these educational approaches, and then going back and looking at clinical or claims data and saying, Hey, we’ve been able to demonstrate a difference in outcomes, because this person now is making different decisions about their health, or seeing a doctor or hasn’t been to the ER as much.
Seth Serxner 08:45
Well, that’s the that’s the ultimate for sure. And that’s what the data when people do studies, but even an interim is, are people on a platform, are they using it? Are they seeing videos? Are they reading materials? Are they looking at graphics? And are they then kind of filling out a pre post kind of knowledge and awareness? So for me, we’re starting to talk about this concept. Fred, you and I’ve talked about already a little bit this moving from old school health literacy 1.0 to health literacy. 2.0.
Fred Goldstein 09:18
And so when you think about health literacy 2.0, what are the key features that would differentiate that from the old approach?
Seth Serxner 09:24
Yeah, so for me, it’s almost like a bridge, you have 1.0 on one side, and 1.0 is a nice brochure. It could be well done, it might have some pictures, but it’s pretty flat. It’s pretty unidimensional. There is not much interaction. 2.0 leverages three big areas. It leverages behavioral science and gamification. So while mentioned adult learning theory, recognition and rewards, competitions and challenges, in gaming, there’s levels of whether you knew it or not, they kind of hooked you by making the first couple games really easy. And now you go, oh, I want to make to the next level and the next level. Well, we can do that in health information too. We can make it fun and entertaining. We can have quizzes, and, and games and beat the clock and all these different things. So we can use behavioral science. We can use data, and personalization, right? Everyone’s a personalized experience. It needs to be relevant to me. So serve up topics that are relevant to me in the kind of style that I like. Let me see a for example, feedback. How many other people also didn’t know this answer, it’s kind of helpful to know that some reporting and analytics, so you’ve got the behavioral science and gamification, you’ve got data and personalization. And then you’ve got technology and multimedia content, of really dynamic content that we talked about, that’s everything from, you know, infographics, to deep articles and curriculum to all these short videos, and fun games, and interesting ways to go about it all, again, with that old school filter of plain clear, simple language, culturally appropriate, low participant burden. So those three principles of the behavioral science, the data and the technology, to me build us this bridge to 2.0.
Fred Goldstein 11:24
And I think that’s a great underpinning for all of this, and you’ve talked about this culturally appropriate, and we have this whole issue of health equity, and really trying to do that I’ve seen one of the biggest things was, you know, how do you you have one brochure, you know, one thing, and you’re sending it to people of different, you know, education levels, different cultural norms, different cultures, etc? And, really, it can’t be solved with that, unless you’re gonna make hundreds of these things, I guess. But if you start building those technology, I guess we can start to make it really personalized.
Seth Serxner 12:01
Well, and to your point, right, so so many health plans are challenged with, I won’t have the number, right, but I’ll say at least having it available in 14 languages, you know, so Okay. So that’s, that’s a big challenge. And if it has to be in print, that’s also a big challenge. So being able to open this up, for example, making it available to the community for free, on a on a platform that people can use, so that they can have it in their language, or their cultural backgrounds, or kind of topics that they’re interested in, or they want to share with someone else. This just opens, it changes the game completely for us.
Fred Goldstein 12:41
Right. And I think back today, we did a program where people spoke 65 different primary languages, when we looked at the, at our AT use of the ATT medical language line service.
Seth Serxner 12:50
Yeah there you go,
Fred Goldstein 12:51
And wow it just gets unbelievably complex. But then when you start thinking about these ideas of educating, say, around nutrition, and you have different cultural norms, what people eat and their diets and things like that, it really can get complex, but I can see where, you know, the data and the technology could lead us to develop really unique solutions that ultimately do get to that N of one of personalizing the message to the individual.
Seth Serxner 13:16
Yeah, I think what we have to remember as many people use themselves as the point of reference, but we’re not the point of reference. Everybody it’s such a diverse world. And for example, on this Edlogics platform, they really use kind of the scratch off and the Lotos. And a lot of those games, that millions and millions and millions of people play, all the time. And they use TV show formats, like Who Wants to Be a Millionaire, they use that kind of Health Champion network, or they use different game show, Jeopardy things. These are people that can everybody can relate to? Why wouldn’t we have done this in education, let alone health education. So now you start to get things that people can relate to? might seem a little corny, but by the way, we all do it. So
Fred Goldstein 14:06
right,
Seth Serxner 14:06
we can all figure it out. There’s no instruction manual.
Fred Goldstein 14:10
Yeah. And, you know, this whole idea of gamification has been talked about for a number of years now, bring this into healthcare. We see how powerful and the number of individuals playing games all the time on their cell phones. So you said so where are we in this journey? You know, you talked about Edlogiocs and other companies, how close are we to getting this to where it really needs to go? Obviously, we’ve moved beyond the old school.
Seth Serxner 14:35
Yeah, you know, it’s really interesting to me, Fred, I was at a conference a couple of weeks ago, and it was primarily health professionals, benefit professionals, employers, and some universities, etc. And I asked, I asked people what comes to mind when I say health literacy? Because I said, this seems so boring. Like why aren’t people more interested to me? This is a linchpin, how come we’re not excited? And the word cloud came up? Confusing, not that interesting. You know, complicated, boring, it was really interesting. So where we are, I think is we need a bit of a mind shift. And you started out talking about health equity. And in my mind, health equity is a function of, you know, its health disparities. So people get different levels of services, we’ve got to even that out, it’s social determinants, there’s many things that people basic needs that people need. And then it’s health literacy. And for me, people are really genuinely looking for solutions to health equity. And while getting people food and housing and transportation is really important. That’s a huge lift and an expensive lift. Health Disparities, that’s a training of the health care system, you know, that world much better than I. But health literacy is something that we can do at scale, at low cost now, and we have the technology, there’s Edlogicss, there’s one or two other players out there, there’s interest at the government level, there’s interest at the Health Insurance level. So I feel like it’s a turning point, but it may be because I’m just very close to it.
Gregg Masters 16:18
And if you’re just tuning in, you’re listening to PopHealth Week on HealthcareNOW Radio, our guest is Dr. Seth Serxner the Chief Health Officer for Edlogics, a digital communications and engagement company dedicated to improving health literacy and empowering individuals to make better health care decisions.
Fred Goldstein 16:40
And as you think about that, well, you know, you you came out of the health plan world. What is there thinking? What do you hear just in general, from health plans as you talk to them around this issue? And what are they looking for?
Seth Serxner 16:54
Yeah, so you know, health plans are, you know, think about it in terms of Medicare, Medicaid, and commercial populations, meaning employers, when they think about Medicaid, they’ve really been ahead of the game there in terms of thinking about how does the community environment affect those members, and they’ve tried to do things, and there’s many, many health plans that make contributions and try to address that. But now they’re saying we need to do more. And so we are hearing from them about this health literacy piece as one of the keys to whether it’s addressing health equity itself, or social determinants. So we see it there. We see it in the Medicare population. Of course, seniors have a lot of complicated issues, they have caregivers. So they’re starting to ask. And then to me, where I spent a lot of my career, the employers are saying, our employees don’t understand this information. We’re, we’re, we’re really working hard to have all these services to help them explain it. So I think one of the other reasons it’s attractive is because of an engagement factor. People are, they talk about, I have all these programs and services, but nobody uses them. When you have a fun, engaging platform, and things that people want to learn about, you can say. And by the way, did you know you have this pharmacy plan? You want to learn more about it? Here’s a little game that will tell you about that? Or did you know that there’s a food bank down the street from you, let me move you that way. So this could become kind of the front door engagement platform. And that’s what I’m seeing some of the health plans looking for.
Fred Goldstein 18:37
And you raise a great point here. And I think, you know, the employers should consider this, you’re we’ve talked about personalizing this for the individual, right. But you also can in essence, personalize it for the employer group, to use the product to better explain their benefits and services to their employees.
Seth Serxner 18:57
Absolutely. And even to the point where it can be very specific to what plan they have. But again, we’re asking everyone to do more know what a primary care person is, know what a specialist is, know what, you know, quality is no what in network is all these terms are so complicated and so, so embedded, that we almost forget to explain them or you explain them upfront, there’s a glossary the deal and then it’s, it’s gone. So we really need to help people. And I’m going to get dinged on my plan if I don’t do something first. So it really does behoove employers to help their members, those families understand the benefits as well. So we’re seeing some interest in that.
Fred Goldstein 19:44
I think back to the days and still now of trying to read through the benefits package and understand what that whole thing means, you know, 20, 30, 40 pages of using use your primary care doctor this way and this net and obviously if you can take that information and put it in to something useful, something fun, people probably get it.
Seth Serxner 20:03
Exactly right. And because again, that information goes to the family too, right? So if you have a partner or if you have dependents, they all need to understand it. So who got that mailer? And kind of threw it in the trash and filing cabinet. Right? It was pretty complicated. So this this, you know, again, what we kind of recommend is that if you’re out there, as an employer, partner with current vendors, and ask about this, raise the bar a little bit say, hey, what, what are you guys doing in this space? Have you thought about this? Work with health literacy partners Edlogics is out there. There are some other really interesting players out there. Look around, maybe this is missing from your portfolio, maybe this could be the horizontal across all the verticals. Even in the consultants out there, think about this as requirements in your RFP? Are people doing health literacy 2.0 level of work and develop some baseline. So this is early days, we understand that? Take some metrics, find out how many people you do employee surveys, you do member surveys, ask them? Or do you understand the information we send you? Are you able to navigate? There are kind of standard questions, but it’s not that hard to ask them questions, get some pre post to find out what the level of issue is in your population.
Fred Goldstein 21:30
One of the other areas that’s interesting, Seth, that we’re seeing some movement into, is this whole idea of not just looking at it from an employer or health plan perspective, but how do you create health literacy in the community? So talk a little bit about that.
Seth Serxner 21:45
Yeah, I think it is so interesting, what we’re seeing. And we’ve got a big test called Healthier 757 in in the Virginia area. But what we’ve seen is the community come together to say we need a healthier , health literacy population. And that’s going to improve the health of the population, it’s going to improve, frankly, the employee pool for businesses to come. And so what we’ve seen is health health systems come together, government organizations come together, religious and organizations of faith come together, other nonprofits all come together, nonprofits and foundations to fund a free platform for everyone to go on, tell raise all boats, and it’s been quite successful. And we think it’s a model that will also be able to scale around the country.
Fred Goldstein 22:37
So when you talk about this model, it’s actually a platform that people within the community, anyone in the community can access, play, the games educate themselves,
Seth Serxner 22:46
you got it. And it’s been advertised on kind of Good Morning Today in Virginia, and governor talks about it, and all kinds of people are promoting it. And as we said, some of these, you know, faith leaders are explaining in their churches and temples and all over the place. So it’s been really interesting to see a community come together to drive this issue.
Fred Goldstein 23:11
Yeah, one of the things that you mentioned that I think it’s important to touch on because we kind of lost a lot of this thinking, I think, going through COVID, because it really, we had to focus on that we really did. But was this idea that in the long run, healthier communities will be able to entice businesses to come to their community to set up shop, because they won’t be exposed to these potentially higher health care costs? So this is a great economic builder, in a sense.
Seth Serxner 23:36
Absolutely. So that’s what the businesses are seeing. That’s what the public health officials are seeing. So now they have a vehicle by which to say, hey, there’s a you know, here’s COVID, ‘s out there, or here’s what a vaccine is. So again, this information during COVID was a perfect example of how complicated am I supposed to weigh the risks and the side effects? And when do I do this? And when do I test and how do I protect myself and who’s vulnerable? What if our community just had that platform at that time to go on and learn about COVID and communicable diseases and protection? So the businesses are saying, Yeah, you just took that load off my back, I’m still going to do the right thing. But I know my community now understands it. I’m going to push everybody to that. So to your point, businesses are seeing the value in this. Absolutely.
Fred Goldstein 24:28
Yeah. And I think the other issue raised with that Seth is this idea of helping people to understand how to measure risk. It’s, it’s it’s really been shown, you know, with the COVID epidemic, about how that can be discussed in certain ways or manipulated in other ways to create the feeling that something’s one way or the other, because we really do need to raise our literacy level in terms of understanding risk.
Seth Serxner 24:51
It’s very complicated. Translating population risk to individual risk is really complicated stuff we talked about earlier. numeracy. So, you know, a lot of people again, and there’s this is no judgment, a lot of people aren’t great with math great with percentages, in general, you know, doing numbers in the top of their head. So now how do you expect them to understand is? Is it scary that three out of 1000 people get it or not? I mean, three people got it. I don’t want to be that person, or is that like, Oh, that’s a really low number, millions of people did the vaccine, a couple people had a side effect. It’s worth it compared to the disease. So again, to your point, it would be really helpful to translate risk into 2.0 language.
Fred Goldstein 25:40
Yeah. And then when you think about BID, QID. And you start putting that on top of it, you know, really becomes difficult. So we’ve got about two minutes left here, Seth, what, what excites you about this area?
Seth Serxner 25:55
You know, what excites me about it is that it creates accessibility to everyone. It really opens the door, and it levels, the playing field for everybody out there. So I get excited to try to help people in general to improve their lifestyles and their overall well being. And, you know, I’ve been trying to get people to eat better and exercise and stress and all this. That’s a hard road. This is easy road, because people are asking for the information. They want the information. It’s fun and easy. And by the way, then they start learning about the other things. So for me, it’s very exciting as a real opportunity to drive health equity and overall engagement in the system.
Fred Goldstein 26:37
Yeah, I think it’s really a fantastic area to be working in. And we’ll definitely have to get you back on in the in the future to discuss, you know, where it’s gone. What what what do you what do you see now, because I do think we’re at an inflection point with it. So thanks so much, Seth, for coming on PopHealth Week.
Seth Serxner 26:52
Yeah, I appreciate it. Fred. It’s been great. And I look forward to sharing the data. There’s a lot of good information out there.
Fred Goldstein 26:59
Fantastic. And back to you, Gregg.
Gregg Masters 27:01
And thank you for that is the last word on today’s broadcast. I want to thank Dr. Seth Serxner the Chief Health Officer for Edlogics for his time and generous insights today, and for more information, follow Ed ogics on Twitter via @Edlogics and on the web via www.edlogics.com. And finally, if you’re enjoying our work at PopHealth Week, please like the show and the podcast platform of your choice. Share with your colleagues and do consider subscribing to keep up with new episodes as they’re released. We stream live on HealthcareNOW Radio weekdays at 5:30am 1:30pm and 9:30pm. Eastern and for you left coasters 2:30am 10:30am and 6:30pm. For PopHealth Week, my co-host Fred Goldstein. This is Gregg Masters saying please stay safe everyone. Bye now.