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 or call 844.343.1441



Webinar Recap: Social Determinants of Health


Eliza Corporation recently hosted a webinar on, “Identifying and Addressing Socioeconomic Barriers to Care". Our guest presenter was Betsy Mazzoni, Manager of Quality Improvement at Gateway Health, a valued partner of Eliza since 2013. Gateway expanded its partnership with Eliza this year and launched an integrated, multi-channel health engagement solution, focused on improving health outcomes. 

Access the ‘Social Determinants of Health’ webinar on-demand here.

Betsy noted, “Many plans and providers can fall into the trap of presuming that our interests around health promotion align with the priorities of our members.” Too often, socioeconomic barriers fall outside the benefit structure of health plans. The reality is that life factors have an enormous impact on health and wellbeing. 

This is why Gateway Health has taken a comprehensive, proactive approach to identifying and addressing social determinants of health. Betsy spoke about the tools Gateway uses, including ensuring member materials promote health literacy, risk stratification, and Prospective Care Management™. They have also enhanced the ways in which consumers can interact with the plan, including Eliza-led, multi-channel outreach such as email and text messaging. 

Each personalized, automated outreach that Eliza conducts on behalf of Gateway Health, whether it’s a flu shot reminder or a check-in after being discharged from the hospital, integrates a social determinants of health module. Creating a direct and open personal dialogue assessing socioeconomic risk allows Eliza to connect members in need with valuable health plan and community resources. 

Aimee Delorey, Eliza’s Senior Director of Data Science and Analytics concluded the webinar by reviewing best practices when engaging healthcare consumers on social determinants of health and presented some results from Gateway’s program. 30% of those asked, reported significant concerns about life necessities, such as food, shelter and safety, and were 2-3 times more likely to report fair or poor health.  

Through these interactions, we were able to help Gateway identify and engage members who could use some extra help that otherwise may have slipped through the cracks. After all, things like access to food, shelter, and safety, can’t be found on claims. 

To hear more best practices to identify and address social determinants of health, watch and listen to the webinar on-demand or contact us at or 1-844-343-1441.


Understanding and Addressing Social Determinants of Health to Achieve Health Equity and Improve Outcomes

According to the Centers for Medicare and Medicaid services, as a share of the nation’s Gross Domestic Product (GDP), health spending accounted for 17.5%. While this represents a significant portion of our GDP, as a whole, our nation’s health outcomes are not representative of that investment and in many ways lag behind many other industrialized nations. Even more concerning is when you start to peel back the reasons behind these outcomes, and an alarming number of disparities become apparent:

  • African-American women are 10% less likely to be diagnosed with breast cancer, and over 40% more likely to die from the disease, compared to non-Hispanic white women
  • Hispanic adults are 7 times more likely to have been diagnosed with diabetes than non-Hispanic white adults
  • Asian/Pacific Islander adults are more than 2 times more likely to have liver and bile duct cancer than non-Hispanic white adults

These are just a few of the health disparities that disproportionately affect racial and ethnic groups in the United States. Social determinants, including barriers to care – such as language and culture, lack of access to preventive and urgent care, lack of health insurance, and fear of deportation – often mean that these population groups are also less likely to receive the quality preventive care they need.

To begin to impact health outcomes, we need to ensure that the communications and services we provide are culturally and linguistically tailored to specific population groups. Understanding the unique socio-demographic characteristics of the individual patients and individuals we are engaging, as well as the best ways to reach them, are critical success factors.

In order to yield greater results, Eliza works with our clients to create tailored, culturally appropriate approaches to member engagement. For some ideas on how you can engage your Hispanic member populations in their health and healthcare, take a look at the recent blog post written by Mara Jimenez, Eliza’s Bilingual Health Engagement Designer. –Or, if you prefer, read it in Spanish!

To learn more about Eliza’s tailored approach to member engagement, please contact us

 About the Author:

Sarah McLaughlin, MPH brings 15 years of experience working in health and human services on program planning, strategic and organizational planning, and population analysis. Sarah joined Eliza in 2014 as a Consultant on the Consulting Services team. In her role, Sarah is primarily responsible for leading comprehensive, health engagement projects and working with clients on strategic business solutions across the healthcare space – payers, providers and PBMs – to design, develop, and implement integrated, technology-enabled solutions that more effectively engage consumers and improve outcomes.

Prior to joining Eliza, Sarah was a consultant working with local, state, and federal health and human services agencies on projects utilizing behavioral economics and population analysis to drive outreach and engagement strategies through targeted behavior-change interventions. Areas of expertise include chronic disease, preventive health, as well as maternal and child health. Sarah has a Master of Public Health degree from Boston University and a BA from
Bryn Mawr College.

CMS and AHIP agree on new quality measures for physicians - ‘HOW DO WE IMPLEMENT?’

The Core Quality Measures Collaborative made up of the Centers for Medicare & Medicaid Services (CMS) and major commercial health plans, in conjunction with medical associations and employer and consumer groups, released on Tuesday, February 16 the first set of "core measures" that the government and private payers plan to use for value-based payments. Participating health insurers include members of America's Health Insurance Plans (AHIP), as well as Aetna and UnitedHealth Group.

Following 18 months of consensus work, the group produced seven sets of clinical quality measures, a total of 37 measures, believed to support multi-payer alignment for physician, group practice and health system quality program in the following seven sets:

  • Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMH), and Primary Care
  • Cardiology
  • Gastroenterology
  • HIV and Hepatitis C
  • Medical Oncology
  • Obstetrics and Gynecology
  • Orthopedics

The majority of the 37 quality measures are consistent with or drawn from NCQA, HEDIS and PCMH measures already in use, including readmission rates, diabetic measures, etc.

The goal of this work was to focus on broadly agreed upon quality improvement actions, simplify quality reporting for healthcare providers, make actionable information available to consumers to inform care choices and most importantly, to create a consistent platform to support the necessary shift from fee-for-service to value-based payments and alternative payment models. Achieving consensus is a tremendous step in the right direction for meaningful healthcare transformation.

ACOs under the Medicare Shared Savings Programs have been accountable to report against a similar set of quality measures. These new proposed measures would replace the measures for the current period, which started in 2015. Quality measure reporting requirements have only applied to Medicare ACO-engaged providers, and ACO organizations have invested significant time and resources to meet the reporting requirements. Absent the ACO requirements and incentives, the transition will be slow and challenging for smaller, independent physician groups.

Today, commercial payers independently contract with physicians and health systems, absent any standards, and have established custom and varied quality measure sets that have created a significant burden for management, measurement, and reporting. The application of the newly defined core measure set by commercial payers will be voluntary, using these measures as the quality gate in alternative payment models or ACO-like risk contracting. This cannot happen overnight. Commercial payers will have to phase in these measures as providers contract renewals and new program negotiations roll out.

Whether payers choose to adopt a set standard or a custom measure set, in the end, the goal is the same – to help engage individuals and close gaps in care in order to improve measurements and results. Eliza Corporation has been working with the HEDIS, STARS and NCQA quality standards for over 15 years and realized positive member outcomes, raised HEDIS scores and STAR ratings, enhanced medication adherence and refill rates, and increased member retention. The fist step is using behavior-driven healthcare analytics to identify actionable data and then applying a multi-channel communications plan that make interventions more efficient and effective. Healthcare i complicated, but Eliza is here to help. For more information on Eliza’s provider and payer solutions, contact us at or 844.343.1441.


Medicaid goes mainstream

1 in 5 (or 70 million) Americans now get their health coverage through Medicaid. I think it’s safe to say this is no longer the welfare program it once was. Medicaid is going mainstream.

According to the Kaiser Family Foundation, there was a net increase of nearly 11.2 million people enrolled in Medicaid programs between Summer 2013 and January 2015. This influx of beneficiaries is mostly due to a 25% increase in enrollment in the 29 states that expanded coverage to low-income adults under the ACA, although non-expansion states saw enrollment increases as well (albeit smaller at 7.34%).

The ACA, and Medicaid expansion in particular, has resulted in reduced uncompensated care, increased access to care, better health, and in some states, more jobs. More individuals have access to preventive care, which has resulted in an uptick in the number of diagnosed conditions, such as diabetes. The New York Times recently reported that the states that expanded Medicaid have experienced a 23% rise in diabetes cases. According to the CDC, 29.1 million people in the United States have diabetes, but 27.8%, or 8.1 million people, are undiagnosed. Luckily, we seem to be closing that gap, and getting people the care they need to manage their condition. Not only does this improve their quality of life, but it reduces the long term burden on the health system.

While the benefits of Medicaid expansion appears to far outweigh the costs, some states are struggling with the unanticipated overhead of administering this program with its sudden influx of members and the cost of many years’ worth of unmanaged care. Nationwide, Medicaid partners and stakeholders such as Medicaid Managed Care Organizations (MMCOs), hospitals, practitioners and Pharmacy Benefit Managers, are being called upon to reduce costs while increasing quality and improving the member experience.

MMCOs are putting more and more emphasis on the “member experience.” If it isn't already, I would wager that Medicaid will be more member-focused than its commercial cousins very soon. Why? Because Medicaid beneficiaries aren't at the mercy of their employer’s insurance choices and have the option of voting with their feet. Upon enrollment, most beneficiaries have a choice of at least two plans, and then must reapply (and choose a plan again) at the end of their benefit year. Some states allow beneficiaries to switch plans at any point, for any reason, throughout the year. It’s more important than ever for MMCOs to provide their members with the best care and service if they want to retain and grow their membership.

At Eliza, we've been helping Medicaid plans for the last 15 years engage, activate and empower this growing, unique population and drive outcomes that make a difference. Through a combination of Eliza’s multi-channel technology, advanced analytics, and consultative services, Eliza for Medicaid is partnering with savvy MMCOs to:

  • efficiently engage their members early and throughout the year;
  • build brand recognition and loyalty; and
  • ensure that their members feel supported and engaged in their health care.

To learn more about Eliza’s Medicaid solutions, please contact  And join us for our next World Congress Webinar: "How Gateway Health is Influencing Medicaid Health Outcomes Through Member Engagement"

About the Author: Jennifer Forster joined Eliza in the summer of 2014 as the Director of Medicaid Strategy. Before Eliza, Jennifer was at Network Health, a Medicaid Managed Care Organization and division of Tufts Health Plan. She served as the key operational and product contact with state and federal agencies and managed staff to support contract management activities such as compliance, reporting, communications, and negotiations.

Jennifer attended Syracuse University where she earned a B.S. in Marketing from the Whitman School of Management and a Masters in Public Administration from the Maxwell School of Citizenship and Public Affairs.

February is Peak Flu Season. Are Flu Shots Better Late Than Never?

While many think about getting their flu shot, or their children’s flu shot, during the fall, January through May is still an active time for the flu -- and the flu hits the hardest in February when the nation-wide rates are nearly double than any other month of the year.

According to Dr. Wendy Sue Swanson, “When you get a flu vaccine, you stimulate the immune system to create protection against the strains of the virus in the vaccine. That immunity (the antibodies that are created) tends to fade and wane in your bloodstream after about 6-12 months. Therefore, even if you got the flu vaccine last year, you really want your family to have it again this year so it protects you through the winter influenza season, which can continue late into the springtime, but tends to peak in February or March.”

   The CDC released historical data on the flu season from 1982-2014. The “peak month of flu activity” is the month with the highest percentage of respiratory specimens testing positive for influenza virus infection. As seen above, February is when 
 the flu is at its peak.

“More than 100 children died from flu-related complications last year (2013-2014).” said Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention. Click here to read more from the CDC on the impact of flu on children’s health.

Considering that the flu shot is covered as preventative care by most health plans - including Medicare and Medicaid, members need to more informed by their plans and encouraged to get the latest flu shot.

Eliza’s flu programs do exactly this - engage people through education, and the ever-challenging barrier of care navigation (e.g., finding a primary care physician (PCP), where the closest clinic is in relation to a members home). One way to remind people to get their annual flu shot is a flu text messaging program. Below is an example of the difference a health plan can make by reaching out to its flu-vulnerable populations:

“A study in Pediatrics revealed parents who received a text reminder were more likely than those who did not to bring their children for a second influenza vaccine. About 57% of those who received the paper reminder returned for the second shot, 67% of those receiving the basic text reminder returned and nearly 75% of those who received educational information as well as a text reminder brought their children back for the second dose, the researchers reported.”

When it comes to preventative care, especially for children, reminding and persuading care givers and parents to get children vaccinated is critical. For those in the Medicaid population in particular where parents may be dealing with other issues such as finding safe housing, or working to find their families next meal, a text reminder, or phone call could go a long way as they may not have the capacity to be as proactive as other populations.

To learn more about who should get the flu shot, and more reasons why parents shouldn’t wait to get their children vaccinated for the flu, check out Dr. Wendy Sue Swanson of Seattle Children’s Hospital and her nationally acclaimed parenting blog, Seattle Mama Doc, as she talks to the Huff Post Parenting Blog about just how easy and imperative the flu shot is for kids here. To learn how Eliza can help clients inform their plan members on the importance of getting their flu shot, click here.

Julie Viola joined Eliza’s Product Marketing team in the fall of 2014.  Prior to Eliza, Julie was at Philips Healthcare for 9 years where she honed her expertise in ER utilization, Patient Safety, and emerging Population Health Management topics such as Community Paramedicine, Care Coordination, and Condition Management.

Julie has a Bachelor’s of Fine Art from the University of Massachusetts at Amherst. She serves on several non-profit board of directors and advisory boards including the Trustees of Reservations and The Massachusetts Oyster Project.

Let's Connect