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Is Healthcare Consumerism a Solution for Lack of Patient Engagement?


Next month, many in the healthcare industry will converge on Las Vegas to attend HIMSS 2018. What will be the hot topics? While much of the focus will be on trends in healthcare information and technology, healthcare consumerism is also on the agenda.

Preston Gee, VP of strategic marketing at Christus Health, who will be presenting at HIMSS, told MobiHealthNews, “Consumerism is all the rage, so it’s not like it’s a revelation to anybody, but in a way it’s been a long time coming.”

He went on to explain: “And it’s a challenge for a lot of folks in the healthcare sector because we have not been very consumer-driven historically, so we have to shift our way of thinking.” Part of the required shift is understanding how to use healthcare consumerism to influence patient engagement.

This isn’t the first time we’ve tackled the subject. Several years ago, we noted that organizations — from hospitals and employers to private insurers, pharmacies and the Centers for Medicare and Medicaid Services (CMS) — were looking for an edge to improve personal engagement in health and wellness. Such organizations particularly want to manage high utilizers who, according to CMS data, represent only 5 percent of Medicaid beneficiaries, but account for 54 percent of Medicaid spending.

Carrot or Stick: Which Will Motivate Healthcare Consumers?

Back in 2014, we cited a program offering reduced premiums and other incentives for Michigan Medicaid beneficiaries who participate in an annual health risk assessment with their regular physician and work to quit smoking or lose weight. Michigan wasn’t alone. Other states, private health insurers and employers put programs in place in hopes of driving higher engagement in healthy behaviors.

But as we mentioned previously, a KHN poll warned that while a “carrot” might help to incentivize patients to engage in the desired behaviors, 75 percent of Americans were opposed to financial penalties related to employer wellness programs and were likely to have a similar response to government wellness initiatives.  

The  c2b Consumer Diagnostic, a national study of healthcare consumers’ attitudes and behaviors, found similar results, in which only 36 percent of consumers agreed that health insurance companies should penalize members for unhealthy behaviors (e.g., increased premiums or copays).

How have such programs fared in the past few years? The Center for Budget and Policy Priorities, a nonpartisan research and policy institute, reviewed data last year and found mixed results. The research looked at incentive programs through government and private sector organizations including:

  • Rewards for one-time activities such as keeping primary care appointments, calling a smoking cessation hotline or participating in cancer screenings; and
  • Rewards for long-term activities such weight or diabetes management programs.Penalties for not getting preventive care or visiting an emergency department for a health concern that could have been treated in a primary care office.

The results showed very little difference in hospitalizations or emergency department use for participating patients. An incentivized smoking cessation program in California did report better 30-day compliance than a control group that did not receive incentives.

In addition, the Center for Budget and Policy Priorities found that penalties actually did more harm than good. Programs that limited healthcare access or required cost-sharing as “sticks” to incentivize healthier behaviors—such as those in West Virginia, Indiana and Kentucky—led to higher emergency department usage.

In West Virginia, for example, the Center found that, “Among all Medicaid beneficiaries in the counties offering the program, the likelihood that an individual would go to the ED rose by an average of 6 percent, and the likelihood that they would go to the ED for a non-emergency rose by 12 percent.”

Wearable Technology as Healthy Lifestyle Incentive

What of the burgeoning number of health and fitness technologies available to healthcare consumers? Healthcare providers, insurers and employers have embraced using wearable technology as an incentive. That’s just what software company Autodesk hoped when it began offering the wearable technology to employees in 2011. And it worked with 50 percent of their employees.

According to an article in Fortune, among employees who accepted the activity-tracking device, awareness about the number of steps taken each day led to some “friendly competition” and behavior changes such as parking further from the office or taking the longer route to meetings. Oil giant BP is also using the FitBit for its Million Step Challenge, part of the company’s overall wellness program.

But, Dr. David Asch, executive director of Penn Medicine's Center for Health Care Innovation and upcoming speaker at HIMSS 2018, suggests that technology isn’t a cure-all on its own. He told MobiHealthNews that, “Fitbits and pedometers don't make you walk more. Weight loss apps don't make you lose weight. They're just facilitators. Unless they're paired with some insight into human behavior, they're the sound of one hand clapping.”

Insurance companies and employers – and hospitals, for that matter – need to find other methods to encourage healthier lifestyles based on unique motivators among their audiences. That means appealing to the factors behind these consumer motivations:

  • Values
  • Principles
  • Beliefs
  • Emotions
  • Personality
  • Interests
  • Lifestyle

This more detailed perspective allows organizations to develop multi-faceted wellness programs that effectively engage a higher percentage of the targeted consumers.

Healthcare Consumerism Demands Patient-Centric Approaches

A one-size-fits-all approach to healthcare marketing or disease management will see limited success. Why? For the same reason that retailers know so well: consumers have different goals, concerns, and motivations – even within the same demographic. We already know that a standardized approach to all diabetes patients, for example, does not lead to better outcomes for all patients.

As healthcare consumerism increases, providers, along with private and public insurers, need deeper insights into the individual variances in order to craft meaningful patient engagements that positively influence behavior. As MobiHealthNews reported, “The key is to not just rely on technology, not just rely on educational tools, but to really work to gain insights into the motivations behind what makes patients tick.”

Psychographic segmentation offers organizations those insights to craft more engaging, effective communications to inspire and empower individuals to take control of personal wellness. c2b solutions has identified five, distinct psychographic segments in their approach to health and wellness:

  • Self Achievers:  The most proactive, wellness-oriented segment; Invests in health and appearance; Prioritizes physician engagement; Goals and measure-driven; Competitive
  • Balance Seekers:  The next most wellness-oriented; Self-directed and does not rely on healthcare professionals; High vitamins/minerals/supplements and alternative medicine use.
  • Priority Jugglers:  Prioritizes family and responsibilities over own health and wellness.  Thus, they ensure others get the care they need, but often ignore their own needs until they have to address them.
  • Direction Takers:  Reactive and need prescriptive guidance from healthcare professionals.  Once they receive this direction, they typically follow it.
  • Willful Endurers:  The least wellness-oriented; Lives for the moment and has a difficult time changing habits; Least compliant and very independent.

Each segment has its own motivations and preferences for education and communications. It takes a different proposition to drive patient activation for each of these consumer types.

How does this translate to an incentive, such as a FitBit? Self Achievers are the natural segment to target for early adoption, and Balance Seekers are more than likely to discover it as they do their own research on these options.

Those two segments make up 42 percent of the population, close to the 50 percent of Autodesk employees who adopted the FitBit. Now, it is more than likely that all five segments are represented among the 50 percent of Autodesk FitBit adopters, but it’s also likely there is a heavy weighting toward the most proactive segments.

So what about the more reactive segments, or the other 58 percent of consumers who are more difficult to activate?  It is more challenging, but it can certainly be done.  c2b solutions has experience successfully activating Willful Endurers toward health interventions.

The key is framing engagement tactics — from traditional doctor-patient communications to innovative incentive programs — in terms that resonate with the patient’s priorities and motivations.  Granted, excellent medical care, habit change and sustained results require many variables and considerations, but engaging patients in a consumer-centric way is a good start to transformative healthcare.

Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change


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