A lack of patient engagement costs the public healthcare system mightily and leads to less healthy populations. The solution? Education rooted in behavioral science.
Consider that instead of seeking regular care from providers, many people rely on emergency department (ED) visits for care, costing the system upwards of $8 billion per year. When Miami’s Jackson Health System undertook a study to understand why, researchers found that repeat visitors were typically grappling with other major challenges: homelessness, lack of a primary care provider, or no access to reliable transportation. That insight led to focused, innovative solutions that have, so far, saved the system about $3 million.
When individuals can’t access regular care, they miss out on preventive healthcare opportunities, which leads to the overutilization of the ED. A heavier focus on preventive healthcare can help payers and providers save money and create better healthcare outcomes overall. Payers should look to enable more preventive healthcare through increased patient engagement strategies and education rooted in behavioral science to help members better adhere to care plans.
The engagement problem
Most members are assigned a health insurance plan through their employer or the state rather than choosing their own. From the beginning, there’s a lack of relationship between members and plans. The lack of individualistic programming and communication results in members feeling as though payers are working in parallel instead of in concert with them.
I frequently care for patients who don’t know what’s covered or where to go for treatment. Most members don’t know their health plans are valuable partners in finding providers and specialists in their network, managing chronic conditions, and improving overall health. They often seem surprised that their health plans are willing and able to provide access to health resources. Without this knowledge, on the occasions they do need medical help, they head straight to the ED, the last bastion of care when patients are scared and unsure of what to do or where to go.
When patients aren’t engaged, everyone loses: Costs for patients and providers creep up, populations become less healthy as people manage conditions independently, and the system becomes more burdened. At a macro level, payers and systems are handed ever growing populations with ever increasing health risks. Here are three engagement fixes.
1. Offer whole-health coverage.
Instead of just treating sick patients, the system should focus on keeping members healthy. The expansion of supplemental benefit coverage, like vision and dental, could help.
One-third of Medicaid members prefer a health plan that includes dental and vision. Plus, when members have whole-health coverage, navigating the healthcare system becomes easier. When obstacles to care are removed and patient-centered care is in focus, they’ll become empowered to make regular appointments and maintain healthy habits. Preventive healthcare can help catch ailments early, leading to more effective treatment and affordable care.
Routine dental exams, for example, can help to identify signs of diabetes, kidney disease, heart disease, and even some cancers, in addition to the assistance provided in curbing progressive dental disease.
2. Motivate members by understanding their values.
One thing that keeps people from seeking preventive healthcare is not understanding how a preventable condition could negatively impact the aspects of life they value most. Assessing what matters most to a patient is a great place to start improving engagement.
I do this through motivational interviewing. Providers and health coaches can conduct interviews to learn about what members value and their biggest obstacles to changing their minds or habits. Once we have a better understanding, we can develop realistic plans to achieve their goals — by encouraging them to eat better, exercise regularly, quit smoking, or get preventive healthcare screenings, for instance.
The bottom line is that providers do best for their patients when they can communicate the need for preventive healthcare in a way that resonates on an emotional level. It all starts with listening well to truly understand a member’s values and challenges.
3. Use human behavior to make healthy habits feel achievable.
According to Dan Ariely, a professor of psychology and behavioral economics at Duke University, fatigue is one of the main roadblocks to engagement. One of the examples he shares is of lifting a 5-pound weight. Lift it a few times — no big deal. Lift it 100 times, and that weight feels much heavier. In the same vein, members feel fatigued when they face a long list of dos and don’ts or receive a barrage of repeated messages and reminders.
Imagine an overweight woman who has Type 2 diabetes and hypertension. She knows she should maintain a healthy diet, exercise, and take her medication correctly — on top of taking her daily glucose readings. But how do we begin to encourage and build habit-forming behaviors? How do we assemble the musculature to lift a 5-pound weight more today than was possible yesterday?
Now, imagine that this member feels fine on a given day and decides not to take her prescribed medication. This singular decision could become a habit. But what if this patient’s health plan was focused on helping her tackle one achievable aspect at a time? Instead of a massive diet overhaul, what if her first step in her healthcare journey was logging 15 straight days of medication compliance? What if the next step was the completion of a yearly foot or eye exam?
By breaking her care plan into easily accomplished steps, she might be encouraged to sit down with a registered dietitian or attend a prolonged primary care visit to discuss broader activities such as an exercise or diet program.
To get a snowball going, you don’t start with something huge; you start small and add slowly. First, health plans can focus on enabling members to access the care they need to maintain whole-person health and the preventive healthcare required to keep them in top shape. They must also be active listeners to get a full view of members’ values and challenges. Then, they can educate and communicate in a highly curated manner, implementing behavioral science insights to help patients feel empowered rather than overwhelmed.