Using simple accessible videos one doctor is on a mission to increase health literacy
Dr. Lisa Fitzpatrick has spent her entire adult life (and not just as a doctor) fielding questions about health care.
After visiting the doctor, “my family, [my] friends would leave the office and then text me: “Here’s what he said.” The question is, “What does that even mean?” The comment was made by Fitzpatrick.
She has spent decades working in government, academia, and hospital medicine, and she has seen the effects of people in her community not trusting or understanding their health care provider. Black people report higher levels of mistrust in the health care system than White Americans, and as a result, they have worse outcomes in areas ranging from maternal mortality to mental health to life expectancy.
Fitzpatrick has long held the belief that these inequalities could be reduced if the health care community did a better job of communicating health information in understandable ways and using credible messengers.
Fitzpatrick’s friends and family often trusted her more than their typically White doctors because of her race and the fact that she had a knack for simplifying complicated health care concepts, something she discovered early in her career.
In other words, I was constantly asking myself, “How can I reach more people?” Simply put, it’s natural to feel threatened by what you don’t fully comprehend. The fear causes you to put things off. And as Fitzpatrick so aptly put it, “that leads to worse health outcomes; it leads to death.”
As a result, she launched Grapevine Health, a startup aimed at educating the public about health. Grapevine produces brief videos in which doctors of colour discuss topics like kidney disease and Medicaid enrollment.
Grapevine has secured contracts with two Medicaid managed care plans and one public employee health plan in the Washington, DC area in the past 20 months, and Fitzpatrick is in negotiations with four national insurers.
With Grapevine, “we can introduce it as a bridge between the member and the health plan,” Fitzpatrick said. People can be helped by our explanations. There are questions we can answer. We can make people feel safer.”
Unexpectadly sourced source of inspiration
As a medical epidemiologist at the CDC and a professor at Howard University College of Medicine, Fitzpatrick has been considering how to expand access to clear, dependable health information for over 15 years.
But in 2013 while working as an administrator for a hospital in Washington, D.C., she realised how it could be done. Like many innovative approaches to healthcare, the concept originated in the realm of late-night comedy.
The other day I was watching Jay Leno Jaywalking,” Fitzpatrick said.
It was a staple of the show when Leno would hit the streets of Los Angeles and ask random people questions about the city’s history, government, and geography, all of which they would inevitably get wrong.
It was informative and fun at the same time. And I wondered, ‘What if I can do that with health?'” she said.
A cameraman she’d met at a local bike club joined Fitzpatrick a few months later on the National Mall, where they began interviewing and educating passers-by about the flu. They cut together some clips and uploaded them to YouTube. They treated the human body the same way by discussing diabetes with a medical professional.
It was well received by the locals, according to Fitzpatrick. To paraphrase: “They demanded more. Someone suggested, “Can you make a video about this or that?”
Fitzpatrick never made her interviewees the punchline of a joke like Jay Leno did. Not a single joke was told; instead, someone took the time to explain things in a straightforward, non-condemnatory manner.
While filming near a hospital, Fitzpatrick recalls a woman hovering nearby. She had just gotten out of the hospital after being treated for a blood clot in her lung, but she told Fitzpatrick that she was having trouble breathing and didn’t know what to do next.
She was scared, but there were no further instructions in her discharge paperwork, Fitzpatrick said. Like a total stranger on the street, she turned to me and asked, “What do I do now?”
Thirty minutes passed between Fitzpatrick and the woman, and when she finally left, he was confused and disoriented.
She said, “I felt profoundly sad.” I was infuriated by the fact that, despite all the talk about wanting to help those in need, many people still feel ignored. They think they’re completely alone and isolated. And I don’t think there’s any justification for that, considering how much money we’re putting into health care.
The health care system was failing to provide people, especially Black people, with the information they needed, and that was a part of the reason why people were suffering. That woman and the others Fitzpatrick met on the street helped crystallise this fundamental but often invisible problem.
Until March 2019, “Dr. Lisa on the Street” was just a side project that she fit in between board meetings and grand rounds.
I just made the decision to jump,” Fitzpatrick explained.
It’s clear that she’s familiar with the setting in which we find ourselves.
After serving as the chief medical officer for the Medicaid programme in Washington, D.C., Fitzpatrick decided to start her own company, Grapevine Health. She uprooted from her posh downtown Washington condo to settle in Congress Heights, one of the city’s most impoverished communities. Her understanding of the hardships endured by the people she had hoped to aid deepened as she lived among them.
This constant barrage of traumatic stress is having a devastating effect on [them]. And I’m not just referring to robberies and shootings. She explained, “I’m talking about the trauma of poverty, of living in scarcity, of having to fight for everything.” If your health isn’t bothering you at the moment, there’s no reason to make it a top priority.
Fitzpatrick was better able to craft messages she hoped could cut through all that stress and trauma, and they rang true for people like Yvonne Smith, who is now 70 years old.
Smith, who resides only a few minutes away from where Fitzpatrick now resides, claims that “Grapevine Health and Dr. Lisa are the best kept secret that I wish everyone knew about.”
Smith met Fitzpatrick in the early 2020s, when Grapevine Health was still a scrappy startup trying to break through. However, Grapevine was able to capitalise on the growing COVID-19 epidemic.
Fitzpatrick shared videos about COVID on Grapevine’s social media accounts and held online information sessions for local groups like the senior centre Smith frequented. Smith valued Fitzpatrick’s practical advice and straightforward explanations.
She is familiar with the setting in which we find ourselves. Smith remarked, “She knows we don’t have a single supermarket. As a result, she recognises that it may be challenging for you to obtain the resources necessary to maintain your health. Plus, her advice was practical and based on common sense.
Smith says the videos from Fitzpatrick and Grapevine were instrumental in lowering her blood sugar below diabetic levels, learning that she was at risk for heart failure, and altering her relationship with her medical providers.
There are typically three questions I pose to medical professionals. The question arises, “What is wrong with me?” Which brings us to the question: what exactly is our strategy? And what else is it that I need to know that you didn’t tell me? “I actually imagined her voice in my head,” Smith explained.
Companies that provide insurance coverage are starting to
In her attempts to convince insurance companies to take a chance on her young company, Fitzpatrick cites the positive effect Grapevine has had on Smith’s health. Medicaid managed care companies, private health plans that states pay to cover roughly 70% of Medicaid beneficiaries nationwide, are her primary area of research.
It was found in a recent report that only 30-60% of Medicaid managed care plan members actually receive regular contact from the plans. A patient’s health can deteriorate over time if they are not actively involved in their care, such as by failing to attend regular checkups, receive necessary screenings, or manage chronic conditions.
In Washington, DC, Blacks make up 80% of the Medicaid population; they have a 7x higher risk of developing diabetes and a >2x higher risk of dying from cardiovascular disease compared to their White counterparts.
AmeriHealth Caritas DC’s director of marketing Keith Maccannon admitted, “Frankly, many of the things that we’ve been doing haven’t been working.” The company serves 120,000 people on Washington, D.C.’s Medicaid programme. Maccannon said that only about one-quarter of members they call to remind about medical appointments actually answer.
In addition to encouraging healthy behaviours, health insurers stand to benefit monetarily from increased member participation. Plans may be penalised if insufficient numbers of their members undergo specified screenings or if an excessive number of their members require hospitalisation.
AmeriHealth Caritas DC was the first health insurance provider to partner with Grapevine Health in 2021 in an effort to better serve their members.
Executive Director of AmeriHealth, Karen Dale, stated that she and Fitzpatrick “connected like kindred spirits” after their initial meeting. She was basically telling me to change my perspective and method of doing things. I’ll be glad to lend a hand with that.
Working with diabetic AmeriHealth members is Grapevine’s first task. The researchers spoke with both patients who voluntarily comply with the insurer’s recommendations (such as having regular eye exams to prevent blindness) and those who do not. The data was then used by Fitzpatrick and her colleagues to create videos that they hope will encourage more people to take preventative measures. The final step will be to send the videos via text message to AmeriHealth members and evaluate the effect on engagement, outcomes, and savings.
According to Fitzpatrick, it’s not assumed that everyone who watches a Grapevine video will immediately make the healthiest choice for themselves. Grapevine isn’t enough to get past obstacles like a lack of transportation, child care, or a doctor who accepts Medicaid.
Fitzpatrick will have more evidence to present to other health plans if these videos improve people’s health and reduce costs for AmeriHealth. She claims that she has approached 20 insurance companies, and that most of them have declined to work with the startup due to its infancy and lack of track record.
To her, “all roads lead to trusted health information and understanding health and health care,” she said. But the difficulty lies in making it clear to everyone else.
Side Effects Public Media’s partnered health policy podcast Tradeoffs is the source for this report. Tradeoffs’ executive editor, Dan Gorenstein, and reporter/producer, Ryan Levi, aired a version of this story on their show on February 2. Collaboration with WHYY’s The Pulse and funding from the Commonwealth Fund allowed for the reporting of this story. The National Institute for Health Care Management Foundation also made a contribution.