Eliza’s thought leaders weigh in on the latest developments from Eliza, our clients, and the healthcare industry at large.

It's Flu Season! What's Up with the Vaccine Controversy?


It’s 2017. New controversies abound in America, but one that has persisted over time, even after being scientifically debunked over and over again, is the vaccine controversy. Unfortunately for herd immunity and individual health and wellness, the vaccine controversy extends well past childhood vaccines and into vaccines that recommended for adults, such as influenza (flu) vaccine. This post shows how behavioral economic concepts and decision theory play a role in what’s often referred to as “vaccine-hesitancy,” but I first want to draw your attention to the health and economic costs the nation incurs when people don't get vaccinated against the flu.  

Flu Facts

Herd immunity” protects infants and people who are too sick to be vaccinated against preventable diseases. It occurs when a significant proportion of the population is immune to a contagious condition because they have been vaccinated against it. When this occurs, infants and people whose immune systems are compromised have a much smaller risk of coming into contact with the illness in question because much of the community is already protected.  Influenza vaccination is important enough to individual and public health that multiple HEDIS measures track the percentage of health plan members who are vaccinated.

Reduced flu vaccination rates, also known as reduced vaccination coverage, can even present a problem for those who have been vaccinated against the flu. Due to the challenges of predicting which strains of flu will affect the nation in a particular flu season, flu vaccines vary in their effectiveness from year-to-year. The Centers for Disease Control and Prevention (CDC) estimates the overall effectiveness of the influenza vaccine in the U.S. to vary between 10% and 60% between 2004 and last year’s flu season. That means that in any given year, even if you get vaccinated, you may still contract the flu.

During the 2015-2016 flu season, nearly 42% of U.S. adults were vaccinated. That’s a drop of 2% from the previous season, and it means that 58% of the U.S. adult population was unvaccinated. That could include your neighbors and coworkers, who could [G6] come down with the flu and pass it along to you. That's a form of sharing that no one is really interested in engaging in. “But it’s just the flu,” you say. “No big deal.” Ah, that is where you are incorrect, my dear reader. The flu kills.

The CDC estimates that up to 56,000 people have died each year in the U.S. since 2010. And you know how you keep hearing about high hospital bills that are bankrupting Americans? Well, the flu sends up to 710,000 to the hospital each year. That means some big medical bills and lost income for something that could have been prevented with a flu shot. And the cost to the national economy? Nearly $6 billion in 2015, topping the economic cost of all other vaccine-preventable illnesses examined in one study. The researchers found that most of the economic burden caused by vaccine-preventable illness is caused by people who chose not to get vaccinated (about 79% of the total burden). When people make a decision not to get vaccinated, they’re making a decision that affects us all, and in multiple ways. So if the influenza vaccine can prevent all of this physical and financial suffering, what gives?

The Vaccine Controversy

The term “vaccine-hesitancy” is relatively new. Think of it as the middle section of a continuum that ranges from people who demand vaccines to those who totally refuse all vaccines. But a simpler definition that better aligns with the public’s understanding of the term is “an active desire to defer or omit any of the vaccines routinely recommended…” In the U.S., the controversy over vaccines[G9]  dates back to the 1850s, and today is driven by a number of factors, from the sources Americans often consult for health information, to increasing societal distrust in the nation’s institutions (e.g., business, media, and governmental institutions). Let’s face it – the internet is a platform for misinformation. One study, published in 2013, found that vaccine-hesitant people are more likely to use the internet as an information source than those who either get vaccinated or report that they are undecided about flu vaccination. Another driver of vaccine-hesitancy is the historical exploitation of minority communities in medical research which generated mistrust of the healthcare system that has been handed down through generations. This mistrust leads some to question medical guidelines and avoid engaging with the system.

But the Big Fish in this story is a discredited British researcher who published a study that claimed there was a link between the childhood MMR vaccine and autism (the paper has since been retracted). The author of that 1998 study, Dr. Andrew Wakefield, subsequently had his medical license revoked and a prominent medical journal reported that Wakefield’s research was fraudulent. The study’s co-authors no longer want anything to do with the work after learning that Wakefield was being paid by a law firm that was preparing to sue vaccine companies when he published his study. Dr. Wakefield had omitted this important detail from the report. In fact, the British Medical Journal (BMJ) reported that the researcher received the equivalent of more than a half-million dollars from the firm. But before the BMJ investigation broke the case open, the damage was done. Vaccination rates fell in the U.K and the U.S. The discredited Wakefield study, which BMJ calls “an elaborate fraud,” tarnished the image of life-saving vaccines.

Another issue implicated in the vaccine controversy is the inconvenient fact that new scientific findings are released all the time, and they sometimes conflict with each other. This cannot be helped — it's the nature of science. But the public can find it confusing, and confusion can lead to inaction. In 2012, researchers reported a paradox – people who are regularly vaccinated against the flu were less protected than those who don’t. That is exactly the type of scientific finding that leads to internal conflict and anticipated regret for people who are making decisions about whether to get vaccinated. As another example, some people fear that flu vaccines actually cause flu (they do not).[2] So what’s the average American supposed to think when combined with the fact that vaccination does not translate into 100% protection?

Cognitive Biases at Play

Well, I’m not here to tell you what to think, but I can tell you about some of the cognitive biases that affect the way people make decisions about vaccinations. Cognitive biases are tricksters that can cause people to make poor decisions. They’re studied in multiple disciplines that have a common theme – the study of how people process information and behave. They’re very useful for explaining why people make irrational decisions and fail to select the options we hope they will select.

Confirmation Bias

There are many types of heuristics and cognitive biases I could tell you about here, but I’m going to focus on three that are particularly relevant to the decision not to get vaccinated against the flu. The first is confirmation bias. Confirmation bias likely impacts most of our daily lives whether we like it or not. It occurs, in part, when you notice or seek out information that confirms your own beliefs while dismissing information that contradicts your beliefs. For example, if you have strong feelings about climate change or another hot-button topic, information that confirms your beliefs is going to stand out when you see it, while you may choose to disregard stories that present alternative viewpoints, believing that they have little credence. Perhaps, if you have strong political views, you seek out information on websites that align with your political views and actively avoid websites that are on the other side of the political spectrum. Or, in the case of vaccines, if you are vaccine-hesitant, information that asserts that there is an association between vaccination and autism may stand out to you more readily than information about vaccines saving lives. We all entertain our own confirmation bias from time-to-time. It takes active monitoring of your thought processes to avoid doing it, and it's hard to keep up with that monitoring 24 hours a day! Researchers from Yale and UCLA have posited that this type of bias, along with other defensive biases, are adaptive and serve to help you maintain a sense of individual self-worth.[3]  

Bandwagon Effect

The bandwagon effect is especially relevant now that social media is so pervasive in our society. You’ve heard of things “going viral,” of course. The bandwagon effect on vaccine hesitancy occurs when society begins to adopt the views of those who are vaccine-hesitant, increasing the probability that additional people will adopt vaccine-hesitant viewpoints. The bandwagon effect provides some explanation for social trends, like the use of Twitter and Facebook. Human beings are influenced by others around them. When they hear about people refusing vaccines, some will jump to a conclusion that must mean there is something bad about vaccines. Fortunately, there are ways of addressing this form of bias. Member outreach that uses social norming techniques and works to improve member self-efficacy can counteract the bandwagon effect.

Availability Heuristic

Finally, the availability heuristic is a mental shortcut. When you weigh the pros and cons before making a decision, if you find yourself placing more emphasis on the cons because past examples are more memorable than examples of the pros, you’re using the availability heuristic. It’s easier to remember the bad than it is to remember the good! A lot of times, the good just seems like the status quo, so it doesn’t stand out in your memory. For example, you may remember a time when you went and got your flu shot, but you contracted the flu anyway and lived in misery for a week. On the other hand, the years when you received a flu shot and remained healthy all season probably go unnoticed and fade from memory.

Heuristics help people make decisions under uncertain conditions, but they can lead to errors in logic that result in poor decision-making.

We at Eliza have the expertise and experience required to successfully tackle heuristics and biases head-on! Using a principle from decision science and behavioral economics, called “loss aversion,” Eliza crafts messages that use loss aversion to health plans’ advantage. For example, we can let members know that skipping the flu shot can dramatically increase the chance of getting the flu (by 400%)![4]

Theory Ties It Together

The use of the loss aversion concept dovetails nicely with our use of the Health Belief Model (HBM), a well-regarded theory frequently used in behavior change communication. The HBM is made up of five key factors that can be used to understand and predict health behaviors. The first of these is “perceived susceptibility,” or the degree to which a member believes that he or she is likely to come down with the flu. Perceived severity, another key piece of the HBM, ties-in here, as well. Using a conversational tone and simple-to-understand language, rather than providing a litany of statistics that aren’t very meaningful or impactful for the average person, we can also remind members that the flu is very unpleasant by invoking memories of members’ previous flu experiences. The final three pieces of the model are perceived benefits, perceived barriers, and cues-to-action. Previous studies have found that the perceived benefits portion of the HBM is the most important predictor of influenza vaccination (e.g., belief that getting vaccinated protects the member’s family and that the flu shot is safe). Eliza’s messaging serves as a cue-to-action and we explain the benefits of vaccination. We can also assess member barriers so that plans can evaluate whether additional intervention is warranted.

The HBM is just one of several health communication theories Eliza employs, in combination with decision theory and behavioral economic concepts, to drive member behavior change. Our designers have advanced degrees in health communication and know how to tackle cognitive biases and identify barriers that can prevent members from closing HEDIS gaps. Our outreaches get results for a reason — they’re scientifically-based!

Did you get your flu shot yet? It’s getting late in the season, but there’s still time



Dr. Gaiser holds a Ph.D. and MA in Health Policy, both from Brandeis University, an MPH with a concentration in Health Communication from Tufts University School of Medicine, and a BA in Journalistic Communication from Purdue University. Her doctoral research examined shared medical decision-making (SDM) for antidepressant treatment. It also examined how SDM and patient-provider trust affect treatment acceptance for three chronic conditions. Melanie has additional content expertise in behavioral health and healthcare cultural competence. Her work in broadcast and print journalism spanned more than a decade in the local (Boston), national, and international arenas.

In her role as Manager of Engagement Research and Strategy at Eliza, Melanie focuses on strategic research and development with a home base in Eliza’s Data Science group. She combines her diverse experience in research methodology, sales, and communication to serve as a boundary spanner, facilitating collaborative partnerships between Eliza’s technical, science, and creative groups.

A dog-obsessed Francophile, Melanie enjoys gardening, traveling, writing, making (and eating) cheese, and hiking in search of alpine waterfalls. She geeks out by reading about food policy issues and behavioral economics.

[1] Brownlee, S., & Lenzer, J. (2009, November). Does the vaccine matter? The Atlantic. Retrieved from https://www.theatlantic.com/magazine/archive/2009/11/does-the-vaccine-matter/307723  

[2] Mayo, A.M., & Cobler, S. (2004). Flu vaccines and patient decision making: What we need to know. Journal of the American Association of Nurse Practitioners, 16(9), 402-410. doi: 10.1111/j.1745-7599.2004.tb00390.x

[3] Sherman, D.K., & Cohen, G.L. (2002). Accepting threatening information: Self-affirmation and the reduction of defensive biases. Current Directions in Psychological Science, 11(4), 119-123. doi: 10.1111/1467-8721.00182

[4] Chen, F., & Stevens, R. (2016). Applying lessons from behavioral economics to increase flu vaccination rates. Health Promotion International, 32(6), 1067-1073. doi: 10.1093/heapro/daw031

Image Source: "Flu Shot Advertising" by Whoisjohngalt is licensed under CC BY 2.0

It’s 2017. New controversies abound in America, but one that has persisted over time, even after being scientifically debunked over and over again, is the vaccine controversy. Unfortunately for herd immunity and individual health and wellness, the vaccine controversy extends well past childhood vaccines and into vaccines that recommended for adults, such as influenza (flu) vaccine. This post shows how behavioral economic concepts and decision theory play a role in what’s often referred to as “vaccine-hesitancy,” but I first want to draw your attention to the health and economic costs the nation incurs when people don't get vaccinated against the flu.

Identifying & Addressing Social Determinants of Health

Social determinants of health (SDOH) are “the structural determinants and conditions in which people are born, grow, live, work and age.”[2] They include factors like socioeconomic status, education, the physical environment, employment, and social support networks, as well as access to healthcare.


Socioeconomic Barriers to Care

Consider, for a moment, some statistics[3]:

  • 28% of US adults reported that they had at least two chronic conditions
  • 26% of US adults said that they had experienced emotional distress in the past year that was difficult to cope with alone.
  • US adults were more likely than adults in all other countries to report that they were “always” or “usually” worrying about having enough money to buy nutritious meals and to pay their rent or mortgage.
  • 33% of US adults reported that they had had a cost-related access problem in the past year. US adults are the most likely to report financial barriers to health care compared to other countries.

Healthcare providers tend to think that people care about the same things they do – getting and staying healthy through a range of preventive care activities including annual well visits, chronic condition management, medication adherence programs and health education. However, we need to acknowledge that the same things aren’t often on the minds of the typical healthcare consumer. For them, healthcare is one of many competing priorities, and it is often put on the back burner when compared with the long list of things that is really on their mind

It is now widely recognized that the health outcomes of populations often are determined more by social factors than by medical care. 3

We’ve passed the point where more evidence is needed to prove the relationship between socioeconomic factors and health outcomes and are now at the point where early identification, screening and effective interventions and services are needed.

Health plans and providers need to assess members' access to healthy food, safe and stable housing, and healthcare, as these things are influenced by income and racial disparities and are related to poor health outcomes. Socioeconomic factors also contribute to chronic stress, which negatively impacts physical and mental health. But too often, socioeconomic barriers fall outside the benefit structure of health plans. One could argue that effective care cannot be delivered when we ignore life factors that have such an enormous impact on the health of members. It is critical for healthcare organizations to direct efforts and resources towards addressing issues of social inequities, diagnose problems, and remove barriers that negatively impact the health status and quality of life of their members. But how to do this when this type of information doesn’t come in on a claim? 

Know Your Members

Go beyond claims data and have conversations to identify life beyond the models.

Eliza develops strategies to assess and address social determinants of health in order to promote the health and wellness of health plan members. We do this by having a direct and open dialogue with members, with the intention of better understanding individual needs and barriers to care, and connecting members to valuable plan and community resources. 

An Eliza program assessing social determinants of health for Marketplace members revealed that people who report concerns about life necessities (food, shelter, safety) are:

  • 5x more likely to report having poor health
  • 2.5x more likely to report their health negatively impacting their work
  • 8x more likely to report high emotional stress
  • 40% reported having difficulty getting to the doctor

Our Social Determinants of Health module can be added to any Eliza outreach, from a welcome call with an HRA to a flu immunization reminder. The following topics are covered:

  • Life necessities (food, shelter, safety)
  • Mental and physical health changes
  • Health impact on taking care of others and employment
  • Money/financial worries
  • Caretaker stress
  • Housing stability over time
  • Access to transportation
  • Perceived ability to overcome problems and seek help

In order to get the most out of this activity, we recommend you follow these general guidelines:

  • Use multiple opportunities to collect Social Determinants of Health responses from members throughout their tenure
  • Monitor changes in responses over time
  • Offer immediate assistance to members reporting issues for which health plans have resources to address
  • Analyze member health behaviors in light of their responses




Eliza took this approach when partnering with Gateway Health to evaluate their Medicaid and Medicare population for socioeconomic barriers to care. Once barriers were identified, members were connected with a care manager who was able to provide support and plan or community resources. Over 30% of respondents said they were ‘moderately’ or ‘severely’ concerned with life necessities. These members are 2-3 times more likely to also report fair or poor health, compared to those with little or no concern for life necessities. 

Eliza Insights

We’ve found that the dually-eligible population is most likely to report high concerns about life necessities, followed by the Medicaid population and then Marketplace members (of which, about 85% are below 400% the federal poverty level).

It makes sense that those who are low income and older and/or disabled are most likely to experience socioeconomic barriers to health.

We also found that those who report high concerns about life necessities are 2-9% less likely to close clinical gaps than those who were neutral or had no concerns about food, shelter or safety. 


Those with concerns for life necessities are more likely to report that physical and emotional health problems affect their productivity, or their ability to do a good job at work, at home, or when caring for others. Not surprisingly, dually-eligible members are slightly more affected than Medicaid members, as age and disability status play a larger role in one’s ability to be “productive,” (as we define it). 

Emotional Health Impact on Productivity and Concerns About Life Necessities


Physical Health Impact on Productivity and Concerns About Life Necessities


How are you addressing social determinants of health for your low-income populations? Are you confident in your ability to catch members who don’t have access to life’s necessities? How can you leverage technology to identify and address social determinants of health? For more information on how Eliza can support you in answering these difficult questions, email or call us at 1-844-343-1441. 


[1]   "Community Healthcare Network Closeup" by jonny goldstein is licensed under CC BY 2.0

[3] Health Affairs, November 16, 2016

4 Taylor, L., Hyatt, A., Sandel, M. (2016, November 16). Defining The Health Care System’s Role In Addressing Social Determinants And Population Health. Health Affairs Blog. http://healthaffairs.org/blog/2016/11/17/defining-the-health-care-systems-role-in-addressing-social-determinants-and-population-health/



Eliza ‘Walks the Talk’ with Special Olympics Massachusetts

At Eliza, we envision a world where everyone is engaged in their health and the management of their care. Eliza’s ‘Walk the Talk’ wellness team recently kicked off its ongoing partnership and sponsorship with Special Olympics Massachusetts for 2018. 

During the standing-room-only launch event, Eliza employees heard about Special Olympics’ mission from its regional representatives and from inspiring keynote speaker/athlete Melissa Reilly.

Melissa, a Special Olympics athlete with Down Syndrome, represented the United States at the 2005 and 2013 World Games in alpine skiing. She also has competed in aquatics and cycling for 15 years and was inducted into the Special Olympics Hall of Fame in 2010.  Currently, Melissa is a college student and working part-time in a Massachusetts State Senator’s office.

Eliza’s employees reacted with cheers and some tears to Melissa’s dynamic talk about her accomplishments and challenges, including crowd-pleasing photos of Melissa doing slalom runs down mountains and arm-in-arm with New England Patriots’ quarterback, Tom Brady!

Eliza looks forward to sponsoring several upcoming events in partnership with Special Olympics Massachusetts:

  • The annual ‘Ho. Ho. Holiday Torch Run’ in early December is a fun holiday 5K run/1 mile walk. Please consider making a donation to Eliza’s team, the Mistletoes, to benefit Special Olympics.
  • In May of 2018, Eliza will be the main sponsor of the local Special Olympics Danvers School Day Games, at which Special Olympics athletes team up with area high school students. Eliza employees will volunteer to coordinate team activities for this event.
  • In August of 2018, Eliza will host an on-site bocce tournament with inclusive teams of employees and Special Olympics athletes. Bocce is a long-standing tradition at Eliza and is taken very seriously (in a fun, competitive way). This will be the first time that Eliza and Special Olympics will partner for this event that will also kick off Eliza’s Annual Employee Bocce Tournament.

At Eliza, we are driven by our vision of a world where everyone is engaged in their health and the management of their care, we deliver outcomes that make a difference — for our colleagues, our clients, and the people we serve. The ‘Walk the Talk’ team at Eliza frequently plans activities to engage employees at Eliza in their own health and the health of its community.

To learn more about working at Eliza, please visit our careers page.  

8 Reasons to Pre-Board your Members Before the New Year

Have you ever thought about “pre-boarding” your members?  Why not reach out early to engage members before their effective date, especially if it means you can identify transition of care needs.

Pre-boarding new healthcare members before January 1 preps them for a smooth transition to their health plan in the new year. Timely, personalized outreach goes a long way in the minds of your members.  Behavioral research demonstrates that little things make a big difference when it comes to social interaction.[i] Let them know that you are thinking of them and are ready to take care of them in the New Year.  A warm welcome can help ease any anxiety and supports them into new benefits.

Don’t wait until January to educate members on plan benefits, collect critical contact and consent information or identify transition of care needs when you can do it now. Pre-boarding can reduce costs, improve satisfaction and retention in the long run.

Here are eight reasons to pre-broad your members:

  1. Identify transition of care needs  
  2. Collect critical contact and consent information including email addresses, cell phone numbers and permission to contact via text and email
  3. Ease anxiety for new members by reassuring them they have coverage starting the first of the year
  4. Educate members on their plan benefits
  5. Remind members to be on the lookout for their new ID cards
  6. If applicable, make sure members understand how to make premium payments
    {15% of Marketplace enrollees fail to make their first premium payment and never effectuate their enrollment. Get ahead of this problem by welcoming members to the plan before their benefit year starts and remind them to make that first payment to ensure they’re covered on January 1.}
  7. Reduce the burden on your call center's anticipated January 1 volume
  8. Member loyalty and retention starts with your welcome message 

Contact us today at eliza@hms.com, 844.343.1441, so we can create your pre-boarding program so you can successfully onboard your members for a healthy 2018.  

Contact us

[i] Psychology Today, Mar 06, 2012, Sam Sommers PhD. https://www.psychologytoday.com/blog/science-small-talk/201203/the-power-hello


Fall Priorities to Better Engage Healthcare Consumers and Prepare for a Healthy 2018

Happy Fall! Autumn is a time for closing those last quarter gaps in care, encouraging flu immunizations, and planning for the health plan 2018 benefit year. Here are some quickly-deployable Eliza health engagement management solutions that can reduce costs and improve outcomes and the member experience that you might find valuable this fall.

Welcome and Onboarding – First impressions are lasting. Timely and relevant conversations are designed to get to know your members and capture critical information to make the healthcare journey successful while building loyalty and enhancing satisfaction. The welcome outreach is also an optimal time to conduct a Health Risk Assessment and connect members to plan resources. Some results delivered to clients include:

  • 4x improvement in HRA completion
  • $625,000 in savings by using email instead of mail

Marketplace plans – don’t wait until January to start outreaching to new members. 15% of Marketplace enrollees fail to make their first premium payment and never effectuate their enrollment. Get ahead of this problem by welcoming members to the plan before their benefit year starts and remind them to make that first payment to ensure they’re covered on January 1. For more information on the importance of Marketplace Payment Reminders, check out this blog post.

Flu Shot Reminders – This preventive health reminder is a quick and effective way to drive behavior and address barriers around the vaccination. One client increased its CAHPS scores 12% over the previous year thanks to increased flu shot rates. Another client reported increasing flu shot rates by 34% over a control group. Eliza’s approach allows you to:

  • Debunk some persistent myths about the flu shot (46% of people asked believe the flu shot causes the flu).
  • Point members to appropriate resources, whether it’s their provider, a local drug store, or an on-site flu clinic.

Risk Surveys – Eliza offers off-cycle HOS and CAHPS surveys to support health plan interventions and member-specific information to create targeted actions for improvement. Some Medicare Advantage plans have seen 15 - 20% increases in HOS and CAHPS scores, and Star measure improvements by 2-3 Stars.

Year-end Gap Closure – Eliza’s year-end gap closure programs provide a last-minute push to close critical gaps in care and improve quality ratings. Members are notified of any care gaps and educated on the importance of health screenings. If they need help scheduling an appointment they can be transferred to plan resources or Eliza’s live agents. In just two months, Eliza assigned 162 members to PCPs and scheduled over 1,700 appointments to close care gaps.

For more information on these solutions or for help with any of your other health engagement management needs, contact us at eliza@hms.com or 1.844.343.1441.

Mobilizing to Help Health Plan Members in Times of Crisis

Like many people who choose a career in healthcare, the prospect of helping people while working in a dynamic industry appeals to me immensely. And these past few weeks have given me the opportunity to realize the satisfaction of making a difference in people’s lives through our work at Eliza.

Being part of the solutions management team at Eliza enables me to partner with health plans to provide beneficial information to their members. On a daily basis, we engage healthcare consumers to motivate them to take action, on a range of topics— preventive screenings, access to plan resources to manage their condition, finding a provider, accessing prescriptions, and more. I consider our work to be an essential part of the healthcare ecosystem, as we facilitate member engagement that can lead to improved health outcomes and ultimately better quality of life. The impact of Eliza health engagement management’s contribution to member health has become clearer and more immediate in the weeks leading up to and during a series of powerful hurricanes.

Hurricanes Harvey and Irma caused enormous stress for many residents of Texas, Florida, and the surrounding states; and our health plan clients wanted to ensure they were doing everything they could to minimize the concerns of their members during these trying times. Eliza mobilized quickly to assist (in most cases within 24 hours). Here are just some of the actions we undertook on behalf of our health plan clients’ members:

Making sure members get life-sustaining meds. When it became clear that Irma was going to be a powerful storm that would hit U.S. southern states, we stood up an emergency call center campaign to contact health plan members in affected states who were at risk of running out of life-sustaining medications during the hurricane. We were able to get the campaign up and running in 24 hours and reached 490,000 members over a two-day period to provide information on how members could get their critical medications on time.

Hurricane preparedness for Florida members. As Hurricane Irma drew near, we launched a hurricane preparedness campaign for one Florida health plan in less than 24 hours. The campaign involved reaching 175,000 plan members to provide information about accessing providers, ordering medical equipment and general health preparedness during a hurricane.

Halting unnecessary outreach so that important ones can get through. Sometimes the communications you don’t get are as important as the ones you do. One Eliza client was concerned about non-essential communications going to members who were planning for the hurricanes or in the process of evacuating. Eliza identified phone, text and email campaigns in five impacted states that could be halted during the weeks leading up to and directly after the hurricanes were scheduled to hit. More than 30,000 outreaches were halted so that more critical communications and activity could take place.

There’s something very satisfying about knowing that my company and team can mobilize so quickly to help our clients and their members in a time of need. 

Chris Flieger is VP Client Solutions Management at Eliza, an HMS company that provides communications and analytics solutions to improve patient engagement and outcomes.

Mental Health and the Weight of Depression

May is Mental Health Month and since psychiatric conditions affect one in every five U.S. adults and teenagers, every opportunity to build awareness and reduce the stigma that still surrounds them can be helpful.1,2 In this post, we focus on major depression, which affects nearly 7% of adults each year in the U.S., making it one of the most common psychiatric conditions in the country.3,4  

Depression is so widespread that its outsized economic impact hits the national wallet hard. One study found that depression costs society $210 billion each year when disorders associated with it are included in the calculation.5 About half of that amount is attributable to workplace costs, like presenteeism.5 Presenteeism occurs when a depressed employee goes to work, but has limited productivity due to his or her depression symptoms. Given that depression symptoms can make it difficult to stay motivated and can harm a person’s ability to maintain relationships, its workplace impacts are not surprising. Depression-related presenteeism causes a loss of about 32 annual workdays for the average person suffering from the condition.5 It represents more than a third of the economic burden of people who have major depression.5

The healthcare system also struggles under the weight of depression in the U.S. The supply of psychiatrists and inpatient psychiatric beds has been shrinking for years, even as the population of people with psychiatric disorders has grown.6 A study published last year found that from 2003 to 2013, the number of practicing psychiatrists in the U.S. declined by more than 10-percent.7 Between 2010 and 2016, the number of inpatient psychiatric beds available in the United States fell by around 17-percent.8 This translates into reduced access to mental healthcare even when barriers like cost, uninsurance, and a lack of transportation are adequately addressed.

The challenges don’t end there. When people are able to access the care they need, they often struggle to adhere to their treatment plans. About 50-percent of patients receiving antidepressant therapy discontinue treatment prematurely for a variety of reasons.9 And there are some unique treatment adherence hurdles associated with depression that aren’t generally issues in the treatment of physical conditions in the absence of psychiatric comorbidities. For example, depression can (although does not always) negatively affect a patient’s decision-making abilities and cognition. Stigma is a factor that can affect the way a patient perceives his or her condition. It can also impact whether patients believe medication could be useful to them. Fear that antidepressants are addictive or can alter personality adds additional potential for treatment nonadherence.10

Nonadherence in psychiatry is associated with poorer outcomes, such as suicide and costly inpatient hospital stays.11 The challenge is to help members improve their adherence to antidepressant treatment by attending to the distinctive challenges presented by stigma and the negative effects depression can have on motivation, cognition, and decision-making. While a trusting patient-provider relationship can protect against nonadherence,11,12 there are effective outreach strategies that can help close adherence gaps once they occur. Eliza’s health engagement management strategies and multi-channel solutions have proven to be successful in closing HEDIS antidepressant medication management gaps.  

Using theory- and focus group-informed, targeted outreach, an Eliza solution achieved a 13-percent increase in antidepressant adherence for a payer with a large Medicaid population by delivering the right message to the right members at the right time.

Antidepressant medication management is just one of Eliza’s behavioral health solutions that helps payers improve outcomes and engage members. For more information on Eliza’s behavioral health programs, contact us at info@elizacorp.com or 1.844.343.1441.

Dr. Gaiser holds a PhD and MA in Health Policy, both from Brandeis University, an MPH with a concentration in Health Communication from Tufts University School of Medicine, and a BA in Journalistic Communication from Purdue University. Her doctoral research examined shared medical decision-making (SDM) for antidepressant treatment. The study also examined how SDM and patient-provider trust affect treatment acceptance for 3 chronic conditions. Melanie has additional content expertise in behavioral health and healthcare cultural competence. Her work in broadcast and print journalism spanned more than a decade in the local (Boston), national, and international arenas.

In her role as Manager of Engagement Research and Strategy at Eliza, Melanie focuses on strategic research and development for Eliza’s Health Engagement Design group. She combines her diverse experience in research methodology, sales, and communication to serve as a boundary spanner, facilitating collaborative partnerships between Eliza’s technical, science, and creative groups.

A dog-obsessed Francophile, Melanie enjoys gardening, traveling, writing, and hiking in search of alpine waterfalls. She geeks out by reading about food policy issues and behavioral economics.



  1. National Institute of Mental Health. (n.d.). Any mental illness (AMI) among U.S. adults. Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-us-adults.shtml
  2. National Institute of Mental Health. (n.d.). Any disorder among children. Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/any-disorder-among-children.shtml
  3. National Institute of Mental Health. (n.d.). Major depression among adults. Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml
  4. National Institute of Mental Health. (n.d.). Depression. Retrieved from https://www.nimh.nih.gov/health/topics/depression/index.shtml
  5. Greenberg, P., Fournier, A., Sisitsky, T., Pike, C., & Kessler, R. (2015). The economic burden of adults with major depressive disorder in the United States (2005 and 2010). Journal of Clinical Psychiatry, 76(2), 155-162. doi: 10.4088/JCP.14m09298
  6. American Hospital Association. (2012). Trendwatch – Bringing behavioral health into the care continuum: Opportunities to improve quality, costs and outcomes. Washington, DC: author.
  7. Bishop, T., Seirup, J., Pincus, H., & Ross, J. (2016). Population of US practicing psychiatrists declined, 2003-2013, which may help explain poor access to mental health care. Health Affairs, 35(7), 1271-1277. doi: 10.1377/hlthaff.2015.1643
  8. Fuller, D., Sinclair, E., Geller, J., Quanbeck, C., & Snook, J. (2016). Going, going, gone: Trends and consequences of eliminating state psychiatric beds, 2016. Arlington, VA: Treatment Advocacy Center. Retrieved from http://www.treatmentadvocacycenter.org/storage/documents/going-going-gone.pdf
  9. Sansone, R., & Sansone, L. (2012). Antidepressant adherence: Are patients taking their medications? Innovations in Clinical Neuroscience, 9(5-6), 41-46. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398686/
  10. Chakraborty, K., Avasthi, A., Kumar, S., & Grover, S. (2009). Attitudes and beliefs of patients of first episode depression towards antidepressants and their adherence to treatment. Social Psychiatry and Psychiatric Epidemiology, 44(6), 482-488. doi: 10.1007/s00127-008-0468-0
  11. Chapman, S., & Horne, R. (2013). Medication nonadherence and psychiatry. Current Opinion in Psychiatry, 26(5), 446-452. doi: 10.1097/YCO.0b013e3283642da4
  12. de las Cuevas, C., de Leon, J., Penate, W., & Betancort, M. (2017). Factors influencing adherence to psychopharmacological medications in psychiatric patients: A structural equation modeling approach. Patient Preference and Adherence, 11, 681-690. doi: 10.2147/PPA.S133513

Is Patient Engagement an Unnatural Act?

Nearly five years ago, a healthcare tech pundit called patient engagement “the blockbuster drug of the 21st century.” [https://www.forbes.com/sites/davechase/2012/09/09/patient-engagement-is-the-blockbuster-drug-of-the-century/#52bd29525638] The enthusiasm and excitement are understandable: patients who are more actively engaged in their care appear to have better outcomes and improved healthcare experiences. [http://content.healthaffairs.org/content/32/2/207.abstract]

But if patient engagement is such a good thing, why haven’t we seen the “blockbuster” outcomes that should come along with it? The answer is that in many ways, patient engagement is akin to levitating: it sounds good, but it’s awfully hard to do. That’s because when we try to increase patient engagement, we’re fighting millions of years of evolution.

Of the 10 million bits of information the human brain processes each second, a skimpy fifty bits are under our control. This means that we point our scant fifty bits at issues that are either pressing or pleasurable.

In other words, almost everything our brains do is automatic, happening below the radar and beyond our grasp. This leads to lots of inattention and inertia, often keeping us from engaging in better behaviors and decisions.

Fortunately, there are a number of proven strategies for activating patients’ pre-existing good intentions. We can use these strategies to craft interactions designed to address this “fifty bits” limitation.

None of this means that patient engagement is hopeless, or that it’s a bad thing. But it does mean that we should all appreciate the serious challenge that we’re taking when we call for greater patient engagement. And it absolutely suggests that we should thoroughly investigate other strategies for activating the good intentions that most people already have – whether that requires engagement or not.

Join me at the 3rd Annual Eliza Client Summit – Outcomes2017 where I will deliver the day one keynote and share proven strategies that can lead to better health outcomes. 

Dr. Bob Nease is an Eliza Engage blog guest writer, keynote speaker at Outcomes2017, chief scientist emeritus at ESI and author of The Power of Fifty Bits: The New Science of Turning Good Intentions into Positive Results

Cultural Intelligence: When knowing a language does not translate to knowing a culture

By: Mara Jimenez, Health Engagement Designer and Hispanic Approach Lead; and Marirosa Goetz, Certified Spanish Translator at Eliza

Let’s imagine you go to a restaurant with your friends. It’s your first time there. You open the menu and you quickly realize that none of the dishes seem familiar to you. Your eyes glance at the “Baked Alaska.” You’re craving fish, so you confidently order it. Your friends look at you a little strangely but you ignore it. Then, your meal arrives and... Surprise!  It’s a piece of cake!  You’ve just experienced a time when knowing a language does not mean knowing a culture. In this case you knew what the word “baked” meant and what “Alaska” meant, but you didn’t realize that together they meant something else. Now imagine if this happened to you every day, whether at the supermarket or at the hospital. You would be feeling lost, confused and stressed most of the time. This is the reality that many people face when they are trying to adapt to a new culture.     

Consider communicating in the context of healthcare. No matter which language you speak, healthcare has a culture all of its own – a series of phrases, euphemisms, and acronyms that even the most fluent can struggle with at times. For instance, what if a doctor diagnosed you with synchronous diaphragmatic flutter? Sounds scary and complicated... But it merely means that you have the hiccups. So try to picture a Hispanic patient who just mastered the concept that ‘hipo’ means ‘hiccups’ and how confused they’d be by this diagnosis? Entering the American healthcare space requires yet another complex layer of communications skills. The challenge of this undertaking often results in barriers that may seem impossible to overcome for a non-English speaker.

This is where communicating with cultural intelligence, defined as “the ability to cross boundaries and thrive in multiple cultures”1, plays a key role in effective communication. Here’s an analogy – if knowing a language allows you to talk and listen to somebody, having cultural intelligence allows you establish a relationship. This learning asset has become an essential element in the field of intercultural communication and is a necessary skill to develop in the growing global economy. It is particularly helpful in healthcare – when adapting campaigns about behavior change require so much more than simple ‘word-for-word’ translation. In a recent article in the Cleveland Clinic Journal of Medicine addressing disparities in healthcare, co-authors Anita Misra-Herbet and J. Harry Isaacson note that barriers to good outcomes go beyond language, and include issues involving authority, physical contact, communication styles, gender, sexuality and family – just to name a few.  

It’s essential to understand its cultural context In order to engage a Hispanic population and inspire action in healthcare. Where many communicators fail is in the notion that every English message can be simply translated to Spanish word-for-word and have the same impact. Enter Eliza. Eliza’s Health Engagement Management solution and our culturally adapted approach helps healthcare organizations overcome barriers to engaging the Hispanic Population to improve overall health, reduce costs and improve member satisfaction. This month, Population Health News released a Case Study written by both Mari and I, along with Michael Zagami, Eliza Vice President of Health Engagement Design that shares considerations and variations in the content that made a difference in the way Spanish speakers received well-child and diabetes care outreach. Download the case study and discover the impact a culturally adapted approach had for one client that resulted in a 3.2% higher nephropathy testing rate, a 4.7% higher HbA1c testing rate (based on HEDIS methodology) and a 16.6% higher annual well-child HEDIS rate among those choosing Spanish outreach.

Contact Eliza today so we can start the conversation to help you overcome barriers in engaging with your Hispanic members. Email info@elizacorp.com or call 844.343.1441

1 http://commonpurpose.org/knowledge-hub/all-articles/what-is-cultural-intelligence/


Health Motivation: Tips for Sticking with your Resolutions

Health Motivation: Weight loss/Healthy Eating

Tips for Sticking with your Resolutions

At Eliza we are passionate about helping engage and motivate healthcare consumers to participate in their healthcare. We also help support our employees in their pursuit of healthy living. We plan to regularly offer tips, on the Eliza Engage blog, to help motivate you to engage in your health. 

We thought it was quite timely to check in on your health and fitness goals for 2017.  According to Statistic Brain, only 21.4% of people stick with their weight loss/ healthier eating New Year's resolution.  That is a huge drop-off rate – let’s try to help you not become a statistic.   

Spring is a great time to renew your goals and rejuvenate your motivation to get healthy in 2017.

Here are some simple tips to help you maintain your motivation if you have been consistently following your plan, and get back on track if you have slowed your pace or outright given up.

1.  "Wow, this is a lot of work, I don't think I can do it". 

Setting a goal over 12 months can be daunting. The remedy? Believe you can do it!  Keep your end goal in mind and set a schedule for success. An organized plan and a positive mental attitude is what will get you to your goal.

Break up your goals into smaller achievable increments. Focusing on a 1 – 6 week goal will give you a greater sense of continuous accomplishment. Set a small reward for yourself when you reach each milestone. That way you can celebrate yourself for small and large victories.

2. "Ugh - When will I feel better, see the scale go down, start to like my nutrition plan, etc., etc.,”

When you are feeling frustrated, not making enough progress or just outright sick of the plan you are on - rethink your strategy. If the chosen routine isn't working then look for other alternatives. The main goal is to keep going! Change is hard, and sometimes the first choice is not always the best or the last.  

To alleviate your frustration and empower yourself on your journey, try changing the time of your workout, research new/better nutrition plans (there are thousands available), hire a trainer or health coach, or phone a friend for support.  Making healthy change should be fun.  If it is too much work or overwhelming, then it may not be the best choice for you. The good news is that you can always change your course for something that works.  

3.  "That's it, I am done - where is the wine?" 

If you have stopped all-together, forgive yourself and get going again. During your restart, evaluate why you stopped.  Make some adjustments based on what you learned when you first set out and get going again! Every day is a new day and a fresh start. 


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