One doctor takes the fight for health literacy to the street : Shots

Dr. Lisa Fitzpatrick has spent her entire adult life answering people’s questions about health care — and not just for her patients.

“My family, [my] friends would leave the doctor’s office and then send me a text message: ‘Here’s what he said. Like, what does that mean?’ ” Fitzpatrick said.

Over her decades in government, academia and hospital medicine, she’s seen what happens when people don’t understand or trust their health care provider. The problem can be particularly striking, she says, among Black Americans, who report higher levels of mistrust in the medical system than whites and suffer worse outcomes in everything from maternal mortality to mental health to life expectancy.

Fitzpatrick has long believed those disparities could be narrowed if the health care community did a better job of explaining health information in everyday terms.

She found early in her career that she had a gift for breaking down complex health care ideas. And because she’s a Black physician, her friends and family often trusted her more than their own doctors, who were usually white.

“If you don’t understand something, it can be very scary,” Fitzpatrick said. “And when you’re afraid, you avoid, you delay. And that leads to worse health outcomes, it leads to death.”

Throughout those early years of training and medical practice, Fitzpatrick said, she was constantly thinking, “How can I reach more people?”

That’s why she founded Grapevine Health, a startup that creates short videos featuring Black physicians and other doctors of color, explaining everything from high blood pressure to kidney disease, to how to sign up for Medicaid, and not lose that coverage.

In the last 20 months, Grapevine has landed contracts with two Medicaid managed-care plans and one public employee health plan in the Washington D.C. area; Fitzpatrick is also in talks with four national insurers about creating content they can use.

“We can introduce Grapevine as a bridge between the member and the health plan,” Fitzpatrick said. “We can help people understand. We can answer questions. We can alleviate fear.”

Inspiration from an unlikely source

Fitzpatrick has been thinking about how to reach more people with plainspoken, trusted medical information for more than 15 years, going back to her time working as a medical epidemiologist at the Centers for Disease Control and Prevention and serving as a professor at Howard University College of Medicine.

But it was in 2013, while working as an administrator for a hospital in Washington D.C., that she figured out how it might work. It started as so many great health care ideas do: with late night TV comedy.

“One day, I was watching Jay Leno Jaywalking,” Fitzpatrick said.

The classic segment featured Leno taking to the streets of Los Angeles to ask people questions about geography, history and politics — questions they would inevitably fumble, to great comedic effect.

“It was educational, but it was also entertaining. And I thought, ‘What if I can do that with health?’ ” she said.

A few months later, Fitzpatrick went onto the National Mall in Washington with a cameraman she’d met at her local bike club and started asking and educating people about the flu. They edited the footage and put a short video up on YouTube. They did the same thing for the human body and diabetes, and did another video on where things can go wrong when talking with your doctor.

She called the episodes “Dr. Lisa on the Street.”

“People in the community loved it,” Fitzpatrick said. “They wanted more. They gave suggestions: Can you make a video about this and that?”

Unlike Jay Leno, Fitzpatrick never made fun of the people she interviewed. There were no punch lines, just someone taking the time to explain things in a clear and nonjudgmental way.

Fitzpatrick remembers one woman who was hovering nearby while they were filming near a hospital. She told Fitzpatrick she’d just been discharged from the hospital after having a blood clot in her lung, but was still feeling short of breath and unsure of what to do.

“She was scared,” Fitzpatrick said, “but [her discharge paperwork] didn’t give her any instructions. So she was asking me, like a stranger on the corner, ‘What do I do now?’ “

Fitzpatrick spent 30 minutes with the woman, and after she walked away, Fitzpatrick was left in a daze.

“I felt profoundly sad,” she said. “I felt angry that we have all of this lip service around helping people, yet people feel forgotten. They feel like they’re on their own, all alone. And with as many resources as we are pouring into health care, I think there’s no excuse for that.”

That woman and all the others Fitzpatrick met on the street helped crystalize this foundational but often invisible problem: The health care system was failing to give people — especially Black people — the information they needed, and that was part of why people were suffering.

So she kept making videos, but “Dr. Lisa on the Street” remained a side hustle — something squeezed between board meetings and grand rounds — until March 2019.

“I just decided to take a leap,” Fitzpatrick said.

‘She knows the environment we’re living in’

Fitzpatrick left her job as Chief Medical Officer for D.C.’s Medicaid program and founded Grapevine Health, which today creates and hosts “Ask a doctor” videos in English and Spanish with several different health providers of color, all taking questions from people on the street. Fitzpatrick moved from her swanky condo in downtown Washington to nearby Congress Heights, where incomes tended to be much lower. Living alongside the people she hoped to help opened her eyes even more to the struggles many faced.

“[They’re] being bombarded with chronic stress because of the trauma. And I’m not talking about gun violence necessarily, or carjackings. I’m talking about just the trauma associated with being poor, living in scarcity, having to fight for everything,” she said. “Why would you prioritize your health if it’s not bothering you right now?”

The experience made it easier for Fitzpatrick to craft messages she hoped could break through all that stress and trauma, and it resonated for people like 70-year-old Yvonne Smith.

“Grapevine Health and Dr. Lisa are the best kept secret that I wish everyone knew about,” said Smith, who lives just a few minutes from where Fitzpatrick moved.

When Smith first encountered Fitzpatrick in early 2020, Grapevine Health was still a scrappy startup looking for its big break. But the burgeoning COVID-19 pandemic gave Grapevine an opening.

Fitzpatrick posted COVID-related videos on Grapevine’s social media accounts and offered virtual information sessions to community groups, including the senior center Smith attended. Smith appreciated Fitzpatrick’s plainspoken explanations and actionable advice.

“She knows the environment we’re living in. She knows we don’t have one grocery store,” Smith said. “So she understands that it might be difficult for you to get the things you need to be healthy. And she would [suggest] common sense things that are doable.”

Smith credits Fitzpatrick and Grapevine’s videos for helping her cut her blood sugar to below diabetic levels, discovering she was at risk for heart failure and changing how she interacts with her doctors.

“I try to ask three questions for the doctors. I say, ‘What’s wrong with me? What’s our plan? And what else do I need to know that you didn’t tell me?’ So I could hear her voice in my head,” Smith said.

Insurers are taking an interest

Fitzpatrick points to the impact Grapevine has had on Smith’s health as she pitches insurance companies to take a chance on her young company. She’s particularly focused on Medicaid managed-care companies, the private health plans that states pay to cover around 70% of Medicaid beneficiaries nationwide.

A recent report found Medicaid managed-care plans regularly connect with just 30-60% of their members. That lack of engagement can lead to patients not attending regular check-ups, getting important screenings or managing chronic conditions, which can make them sicker over time.

In Washington D.C., 80% of people on Medicaid are Black, and they are seven times more likely to have diabetes and more than twice as likely to die from heart disease as their white neighbors.

“Frankly, many of the things that we’ve been doing haven’t been working,” said Keith Maccannon, director of marketing for AmeriHealth Caritas DC, which covers 120,000 Medicaid beneficiaries in Washington D.C. Maccannon said they’re lucky if, when they call to remind members to get needed care, one in four people pick up.

In addition to pushing good health practices, insurers have a financial incentive to improve engagement. Plans can face fines if too few of their members get certain screenings, or too many people end up in the hospital.

In 2021, AmeriHealth Caritas DC became the first health plan to bring Grapevine Health on to try to improve their connection with their members.

“Once we connected, it was like kindred spirits,” said AmeriHealth Caritas DC’s CEO, Karen Dale, about her first meeting with Fitzpatrick.”She was saying, ‘I want you to think differently, approach things differently. I can help you with that.’ “

Grapevine’s first assignment is working with AmeriHealth Caritas DC members who have diabetes. They interviewed patients who do things the insurer wants them to do — like get eye exams to prevent blindness — and those who don’t. Then, Fitzpatrick and her team used that information to make videos they believe will convince more people to take preventative steps. The last step will be texting the videos to AmeriHealth Caritas DC members and measuring the videos’ impact on engagement, outcomes and cost savings.

The expectation is not that every person who sees a Grapevine video will immediately do the best thing for their health, Fitzpatrick said. Other factors like a lack of transportation, lack of child care or not having access to a doctor who takes Medicaid present barriers that Grapevine alone can’t overcome.

But if these videos improve people’s well-being and save AmeriHealth Caritas DC money, Fitzpatrick will be able to take that evidence to more health plans. She said she’s pitched around 20 insurers, and most of them so far have said no, citing the company’s youth and lack of proven results.

“To me, it’s so clear all roads lead to trusted health information and understanding health and health care,” she said. “But the challenge is how to make it obvious to everybody else.”

This story comes from the health policy podcast Tradeoffs. Dan Gorenstein is Tradeoffs’ executive editor, and Ryan Levi is a reporter/producer for the show, where a version of this story first appeared.