Helen: Welcome to Health Literacy Out Loud. I’m Helen Osborne, president of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.

In these podcasts, you get to listen in on my conversations with some really remarkable people, hearing what health literacy is, why it matters and ways we all can help improve health understanding.

Today I’m talking with Meg Poag, the executive director of the Literacy Coalition of Central Texas. With her training as a social worker in health and human services, Meg has worked in the areas of housing, substance abuse, mental health and literacy. Now Meg focuses on the design and delivery of specialized health literacy interventions.

What impresses me most about the work that Meg and others are doing is how they’re using a business model to fund their health literacy programs in a sustainable way. Welcome to Health Literacy Out Loud, Meg.

Meg: Thanks, Helen. I’m glad to be here.

Helen: I’m intrigued. First of all, let’s put this into context. Tell us about those health literacy interventions that you are doing in the Literacy Coalition of Central Texas.

Meg: We have two prongs to our health literacy initiative. One is that we have developed training and materials for adult literacy instructors to infuse health literacy instruction and health content into the adult literacy classroom.

That has actually been very difficult to find funding for. As we shifted our focus to the healthcare arena, we were hoping to get better and more stable funding by offering interventions in healthcare.

Our focus for Health Literacy Forward has been to train direct care staff, doctors, nurses and really anyone who comes in contact with patients to be able to use better communication to help patients understand and to make sure that there is the understanding on the patient’s side to make good decisions about their health.

Helen: I’m intrigued, Meg, that you thought there was better funding if you went the clinical or healthcare route rather than the adult literacy route.

Meg: That’s right. Nationally, there is a huge lack of funding for adult literacy programs, particularly with the goal of my organization of supporting a bunch of nonprofit adult literacy programs that are very volunteer driven and underfunded. That network of programs has zero to no funding.

Helen: Listeners know that my world has always been in healthcare, and we’re always thinking that there is no funding either. Is it even worse when we get to adult education?

Meg: That’s been our experience, yes.

Helen: What a sorry state of affairs. You’re still going at this in two ways. You’re working in your literacy programs, but now you have these health literacy interventions. You’re working to train and help the providers. Is that right?

Meg: Yes. That’s been one aspect of Health Literacy Forward. It’s offering interactive trainings for direct care staff to help them use promising practices, best practices and communication with their patients who are likely to be low health literate.

We’ve also started to offer more assessment services for hospitals to be able to identify where they’re having more strategic challenges in interacting with low literate and low health literate populations, and then being able to offer policy-level solutions to them and providing training and oversight for all the staff in the hospital.

Helen: That’s great. You’re doing the skills, strategies, assessments and policies. What intrigues me is the business part. How did you put this together in a business way?

Meg: It has definitely been a learning process for this social worker. We have a local foundation that wanted to give us a grant to hire a business strategist or consultant. They felt like we had a product that we could probably sell to hospitals and clinics and receive earned income to stabilize our funding.

In applying for foundation grants, we were getting rejected left and right. I don’t know if the philanthropic world is just not interested in health literacy yet or if it ever will be.

Helen: Tell us more about that because I think a lot of listeners are probably trying to get grants. There are little grants, local grants and bigger grants, and then there are great big national grants. You were saying that you weren’t having great success going that route.

Meg: We really weren’t. We found that in order to get the big national grants, you have to be a big player. We are a small nonprofit. We tried doing collaborative grants and none of those were funded.

We shifted our focus to foundations and really tried to convince them of this need to improve health literacy levels, and also the responsibility of the healthcare system to change the way they’re interacting with patients.

What I heard from some foundations was that if this was really an issue in healthcare, then the healthcare providers needed to pick up the bill. They weren’t interested in funding and providing grants where there was probably funding within that system.

Helen: I’m rather appalled. That’s really upsetting to hear about all of that push back. Foundations would be groups that have a philanthropic arm, or is that more of a business or a corporation?

Meg: I’m referring mostly to private family foundations, but also there were some corporate foundations.

Helen: There were family foundations and corporate, so you were getting push back all around. I just want to clarify that yours is a not-for-profit organization. Is that correct?

Meg: Yes.

Helen: Now this local foundation comes along and says, “Maybe you should get a business consultant.” Then what?

Meg: We hired this business consultant, formed a committee of folks who had a lot of experience in the entrepreneurial and business world, and started doing a business plan.

We also did a market analysis. It was a clumsy market analysis because there just isn’t a lot of precedence for this type of service. As you know, the field is still fairly young as far as what we’re trying to do in the healthcare setting. There weren’t a lot of people that we could survey and find out what they were doing or if there was a really a market for this.

Helen: Can I take you back just a little bit? I do a business plan in my business, but I’m a business of one. Yours is a little bit bigger than that. We’ve both been down that route, but for listeners who don’t know about a market analysis or a business plan, can you just give some of the high spots that you need to include in a plan?

Meg: Sure. The consultant told us that we needed to look at what she called the pain point of the healthcare provider or whatever the source of funding would be.

She said, “Is there a market for this kind of a program because there is some sort of pain point with them?” That’s their bottom line, unless the hospital is really mission driven like the nonprofit hospital that actually wants to improve care.

On the flip side of that, there are hospitals that are completely bottom-line focused. We had to analyze whether our service could impact their bottom line positively, avoid costs or help their profit in some way. We had to analyze that and see whether people were willing to pay for this because it was in their interest.

Helen: I know from doing a business plan that they are hard to do. They might just end up being a few sheets of paper, but it takes a lot of work to do. Did you find that it was a hard road to get the facts that you needed for this plan?

Meg: Absolutely. It took us months of working on this really diligently with a whole crew of volunteers. If would have known what I was getting into, I don’t know if I would have done it. It was very extensive.

Helen: You stuck with it and did it. Now you have a plan. Then what?

Meg: What we realized in our research is that there were a couple of things happening nationally that we felt were really going to pick up business for health literacy intervention. One was that the Joint Commission was changing their standards for accredited hospitals and basically mandating hospitals to start paying attention to how they were communicating with vulnerable populations.

The other thing was healthcare reform. There were some health literacy and clear communication principles peppered throughout. We felt that those hospitals that didn’t care before were going to have to care. We were right on the cusp of this, so we felt really positive about the potential.

What we learned was that hospitals sometimes aren’t very proactive when it comes to the Joint Commission accreditation standards. Even though they went into place, hospitals in Texas weren’t paying attention to what they needed to do to adapt to those because often they’re reactive rather than proactive. There was a time lag.

Helen: What you were doing was just the opposite of being reactive. You were being proactive. It’s a very different way of looking at it. Rather than looking back, you’re looking ahead. You’re asking, “What can we do? How can we keep this going?”

Now you have your plan in place. I assume this means it’s the pain points and, like it or not, organizations need to pay attention to health literacy.

Meg: Yes. The pain point that we landed on was readmission. We knew that that was going to be a bottom-line factor and there was plenty of research out there showing that there were a lot of avoidable readmissions.

In most of those, the majority of folks were admitted because of communication problems and a lack of understanding. We started marketing using that because everybody was talking about readmissions.

Helen: Take us forward. Then what? Now you have your plan. You’ve found your pain point. Tell us how you got the funding in place.

Meg: We thought that people were going to jump at this because everyone was worried about readmissions. We have a couple of hospitals here in Austin that said, “If you can really reduce our readmission rate even by 3%, we would love to invest in that. Where is the research showing that your intervention will reduce readmissions?”

That was a barrier. We really didn’t have research showing that doing the health literacy intervention strategies we were promoting actually impacted readmission rates.

Helen: That’s a painful point that I find over and over. I’m so glad we’re talking about that. Just today I got an email from somebody else who is passionate about health literacy and doing research on it.

She’s actually from a literacy program on the other side of the world. She just said, “I want to do research and show how this impacts how women get their mammograms.” I said, “Whoa! That’s a big leap. I’m not sure that research is out there.” You’re saying that too. You’re not finding the research.

Meg: We’re not. We’re finding that when we’re competing for all of these other change efforts that are happening in a hospital system, they’re not ready to jump on board with something that they’re not 100% sure will work.

They’re being offered all kinds of other consulting services. At the same time, a lot of hospitals are shifting their philosophical models to accountable care. They’re going through these massive transformations and we are just a little bug buzzing around the perimeter trying to get them to care about this intervention.

Helen: You phrased that so well. Yes, we are a little bug. This little health literacy bug is buzzing around, but I think all of us who do this work know that it really matters and affects all components of healthcare. It’s not the only solution, but it’s part of the equation. What I said in this email is that we know intuitively it’s the right thing to do.

We’re there, we’re part of it, and we know there’s a lot of other competing and equally worthy priorities, but somehow you’re figuring this out even knowing these barriers and the resistance. What did you do next?

Meg: We shifted gears once again. The thing that really put us over the edge was that we became a vendor consultant for the American Medical Association to administer what’s called a CCAT.

It’s the Communication Climate Assessment Tool that was designed for us to go into a hospital and use a scientifically validated tool with national norms and benchmarks to evaluate hospitals on how well they’re communicating at all levels. It’s a 360-degree assessment with nine domains that we’re assessing.

Helen: It sounds like a worthy tool. It’s a new tool to me. I was not aware of this. Is that giving you the entry into doing what you need to be doing?

Meg: Yes. We were always able to sell a training for $500 or $1,000, but when you run the numbers, you can’t have a sustainable business doing that. It’s not enough money, and it’s a lot of work to go and do these live, in-person trainings everywhere.

We really wanted to push for larger packages where we conducted an assessment and then offered them interventions based on what came out in the CCAT assessment. We have two contracts right now. It was the CCAT that really hooked them in.

Helen: Let’s just divert a little bit. Tell us again what the CCAT stands for.

Meg: It is the Communication Climate Assessment Tool, and it has nine domains that are assessed. There are surveys that are done for staff, patients and executives, and there’s also an analysis of their policies.

The nine domains measure things like health literacy, cultural competency, plain language and how well the workforce is trained in these kinds of things, but it all centers around communication and the climate of the hospital.

Helen: That’s really great. We’ll have a link on the Health Literacy Out Loudwebsite so people can learn more about that tool.

You hit some bumps along the road but it sounds like you figured out your way to navigate around them, whether it’s entry, funding or that pain point. Now what? Fast forward to what you’re doing now. Is it working?

Meg: Right now it’s working. We have two hospitals that signed contracts that I personally think are a great price. We have a $75,000 contract and a $60,000 contract. That’s good in my world.

Helen: That’s good in probably all of our worlds.

Meg: We are in those hospitals conducting these CCATs and giving the reports to the hospitals. We’re writing one report this week and offering specific interventions that we will then conduct in the hospital after they look at the assessment and agree strategically to the most important things they want to address.

The funding for these has come from a process here in Texas called the 1115 Waiver. It’s a waiver process for Medicaid where hospitals are able to apply to do some interventions that would help the Medicaid population and appropriate use of care and better health outcomes.

The hospitals got a big infusion of money and they’re using those dollars to work with us, so that makes me a little nervous about our long-term revenue.

Helen: For now, it’s working. Looking ahead, if everything worked the way you wanted it to, what would that be like?

Meg: We’re going to use this opportunity to prove ourselves and really get good testimonials and impact these hospitals. I think that’s really going to help us to be able to sell our interventions in other hospitals.

I am encouraged by what’s going on in healthcare with healthcare reform. Hopefully it continues. In Texas, we’re getting to the proportion where the number of low-income folks and people with literacy barriers is just massive. Hospitals are realizing they can’t ignore it anymore.

I really feel like we’re going to prove ourselves right now with these contracts and interventions and be able to go to other hospitals and say, “Here’s what we did that was successful here. It was really meaningful to them.”

I still feel like we’re going to have this model where we go and sell these larger consulting packages to hospitals. We are less willing to do one-pop, small, $1,000 trainings. We really want to get these bigger interventions, but there needs to be a top-down buy in to do that.

Helen: I’m hearing some lessons learned. There’s the top-down buy in, the packages, putting them together and finding that pain point. You started in the beginning saying that you needed good outcome research because it wasn’t there. Will you be adding to our body of knowledge so we can all be learning by this?

Meg: We certainly hope to. We have been in conversation with a very large hospital here about applying for grants for the Agency for Healthcare Research & Quality on NIH. We’re trying to look for collaborative funding to actually just test that and how our health literacy interventions have impacted readmissions. Hopefully at some point in the future we’ll get there.

Helen: It seems to have come full circle. Your story is such an inspiring one about how you’ve seen the problems and bumps and used all of your organizational know-how to make a difference today and be looking ahead for what you’re doing. That’s great. How can people learn more about your program?

Meg: Our website is really easy to remember. It’s www.WillRead.org, and we have a health literacy page.

Helen: That’s terrific. We’ll have that on the Health Literacy Out Loudwebsite. Thank you so much for sharing candidly what works, what didn’t work and your ideas for what’s ahead with us on Health Literacy Out Loud.

Meg: Thank you. It’s been a pleasure.

Helen: I learned so much about funding health literacy programs from Meg Poag. I thank her for being a guest of Health Literacy Out Loud.

I also want to thank Mike Mackert, who introduced us. Mike is a college professor and a longtime Health Literacy Out Loudlistener. He also was a guest on Health Literacy Out Loud talking about using advertising principles in public health campaigns. Thanks to you both.

For listeners, is there somebody you think I should be interviewing on Health Literacy Out Loud? If so, please email me at Helen@HealthLiteracy.com.

NewHealth Literacy Out Loud podcasts come out every few weeks. Subscribe for free to hear them all. You can find us on iTunes, Stitcher Radio and the Health Literacy Out Loud website at www.HealthLiteracyOutLoud.com.

To learn more about health literacy please, visit my health literacy consulting website at www.HealthLiteracy.com.

Did you like this podcast? Did you learn something new? If so, tell you colleagues and friends. Together let’s, let the whole world know why health literacy matters. Until next time, I’m Helen Osborne.