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.


Health Engagement: One Size Doesn’t Fit All

If you spend more for something, you expect better quality, right?

According to the Commonwealth Fund’s latest view of Medicare spending per capita vs. overall quality score, the data says otherwise for many states.  For example:

  • Louisiana has 25% higher spending than the national average, but their quality is 14% lower than the average
  • In New Jersey, the per capita spending is $9,587 vs. Oregon is only $6,380

What about those states that score high (average 4-5 STARS) on Medicare Advantage STAR scores such as Michigan, Massachusetts, and Illinois?  Their overall numbers may not be as low as Texas, Louisiana, and Florida, but their costs are still high versus quality.

  • Michigan: $9,521 per capita spending with 11% higher in spending, for only 1% improvement in quality over the national average.

The overall view that combines hospitals, doctor’s offices, home health, and nursing home numbers is below.  You can see there is almost a slight tip to the south and east- a bit of a corridor. Blog - 7.16_1

It gets even more interesting when you look at the subgroups like home health.  Some of the states that had a normal rating overall, quickly slip when you look at home health on its own. See below: Blog - 7.16 (2)

When home health is viewed on its own a few staggering data points float to the top:

  • Texas: 182% higher spending and 2% lower quality
  • Florida: 148% higher spending for only 5% higher quality

How are payers, providers, and other healthcare entities changing the game?

Interestingly enough, PBS just published a series on a quiet revolution that has a goal of improving care while at the same time lowering cost.  In fact, the caregivers they highlighted focus on listening and putting the patient at the center of care from Maine to Mississippi, all the way to Alaska, and they are caring in the way that makes sense for their community.  This means house calls in small town Maine, a mixture of traditional and spiritual methodology in Alaska, and a hospitable approach in San Francisco.

Eliza takes a similar approach to solving client and patient problems.  Through conversations- whether on the phone, over email, or through a text, Eliza uncovers barriers to better quality, better outcomes, and improving costs.  We do this by tailoring our programs to meet the needs of our clients and the people they serve.

At Eliza, we know that one size does not fit all.

For example, in a recent preventive screening outreach to Medicare members, Eliza was able to not only improve completed screenings, but also uncover barriers such as transportation challenges, concerns about comfort, and even apathy.

Blog - 7.16 (2) 

By taking a conversational approach to healthcare, a laser-focus on peoples’ motivations, their concerns, and their reactions to the initiatives supported, Eliza knows what makes people “tick” – and the technology and content constantly are fine-tuned to honor consumers’ unique challenges and preferences to effect small changes in behavior across different populations. These small changes lead to better engagement and better outcomes. As a result, Eliza is uniquely qualified to deliver more granular data to clients about how people are behaving. Eliza also is able to refine recommendations and implement strategies that leverage this data in order to drive desired outcomes for clients.

To learn more about Eliza’s preventive screening solution, or any of our Eliza for Medicare solutions, please contact us at or 1.844.343.1441.


The Rise of the Provider-Owned Health Plan

Over the past few months, a lot of attention has been building around provider-owned health plans.  Many questions are emerging – for example:

  • Do provider-owned health plans have staying-power?
  • What do providers really know about running a health plan?
  • What about providers who previously have tried and lost millions?
  • Is this the next big move in healthcare as more organizations take a closer look at population health management?

Modern Healthcare recently published an article on the provider-owned health plan trends that considers some of these questions.

Below are a few of the highlights from this editorial:  

  1. Financially stable: Financially, provider-owned plans are doing as well as other health insurers or better. They had a 3.2% average profit margin in 2013, in comparison to the entire health insurance industry had a similar 3.2% profit margin in 2013
  2. The impact of Medicaid expansion: Presbyterian Health Plan, owned by Presbyterian Healthcare Services in Albuquerque, increased its Medicaid membership by 18% to 193,000 in 2014. It was one of four health plans selected to manage care for New Mexico's Medicaid population, which grew because that state expanded eligibility under the Affordable Care Act.
  3. Carving out a place in the market: This year, Premier Health Plan is moving beyond its employees. It now covers 7,100 Medicare Advantage members and 2,000 individuals and families, most of whom signed up through the federal insurance exchange in Ohio. “For us, the insurance business is just a vehicle to cover as many lives as we can in our service area with our population health initiatives,” Maiberger said. “We're not out to be one of the large national players in the insurance market.”
  4. Identifying the risk and cost: Paul Levy, former CEO of Boston-based Beth Israel Deaconess Medical Center, said hospitals are starting health plans because handling both sides of the premium dollar helps them better understand the enrollment risk pool and medical cost trends. They're also doing it to gain dominance in their market. “I just don't think most of them are thinking about getting into insurance for the sake of better patient care,” he said.
  5. The Revenue is real: The largest provider-owned health plans are listed below.

Provider Blog 2015            

As Levy describes, providers want to know what populations hold the most risk- how can they predict who will be non-adherent to their medications.  What part of the population want to improve their health but have barriers to bettering their care like transportation, affordability of care, education, etc.

Eliza leverages behavioral science to identify poor social, emotional and physical functioning and other barriers to improved outcomes.  These obstacles could be things such as- socioeconomic factors, certain health conditions, ability to cope with life stressors, a person’s ability to care for themselves, access to a PCP, etc. Ultimately, Eliza can implement solutions such as upfront screening assessments to identify those who could benefit from additional resources and then trigger the appropriate next steps to increase positive outcomes that improve care, reduce cost, and engage people in health.

To learn more about Eliza’s Health Risk Assessment solution and other health engagement management solutions, please email

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.

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.

Making a difference with STAR measure 13

In 2007, my 70-year old mother’s right hip joint imploded—an unusual form of bone loss that led to hip replacement surgery. In 2009, she stumbled on the stairs during a midnight trip to the bathroom, and fractured two lumbar vertebrae. Eight months later, she slipped on a patch of ice outside the front door while retrieving the newspaper, and broke her ankle.

Our family oversaw her recovery from these events with great concern—falls of this nature in the elderly female population so often are the first signal of the end of life’s journey.

According to the National Osteoporosis Foundation, 54 million Americans have osteoporosis and low bone mass. Studies suggest that approximately one in two women and up to one in four men age 50 and older will break a bone due to osteoporosis. Falls and fractures can result in chronic pain and loss of mobility which in turn can lead to isolation and depression. 20 percent of seniors who break a hip die within one year, and many of those who survive need long-term nursing care.

And it’s expensive. $19 billion in related costs every year—by 2025, predicted to reach $25.3 billion.

Centers for Medicare & Medicaid Services (CMS) STAR measure 13 is Osteoporosis Management, and measures female Medicare Advantage enrollees 67 and older who suffered a fracture and subsequently had either a bone mineral density test or were prescribed a drug to treat or prevent osteoporosis in the six months after their fracture.

Eliza for Medicare includes an Osteoporosis solution that reaches out to this newly vulnerable and fragile population, connecting them with the care and resources they need. We’ve proven that the outcomes achieved from Eliza solutions like this not only make a difference in CMS STAR measures, but in the lives of the people reached.

With her doctor’s excellent care and our family’s support, my mother, now 77, has fully recovered from her broken bones and surgeries. She swims three times a week at the local pool, strapping on light weights for her water aerobics class, and has joined a seniors weight lifting program at the local senior center. Osteoporosis was a speed bump for her, but thankfully, not the end of the road.

Melissa Palladino joined Eliza’s design team in 2009 as a web copy developer. Now, Palladino can be found at the forefront of new product design and implementation, client solution strategy, and well-crafted, impactful outreach creation. Her areas of subject matter expertise include Medicare, STAR gap-closure tactics, and medication adherence.

A perfectionist and achiever in her work, Palladino has applied that mindset successfully to other life arenas. Her walking tour business, Gloucester Guided Tours (2006-2009), was featured in Life Magazine, Boston Magazine, and Boston Business Journal. Melissa Cooks Gourmet, her cook-through blog featuring recipes of The Gourmet Cookbook, won attention in The Wall Street Journal. Real Simple and the Boston Globe featured her artwork. And as a fiction writer, Melissa is a two-time nominee for the Pushcart Prize. She holds a Bachelor of Arts in Psychology from Colby College and a Bachelor of Fine Arts in Sculpture from Maine College of Arts.

Learn more and request the Eliza for Medicare Case Study

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