So many well-meaning patient engagement efforts are based on a fallacy. The logical assumption is that by connecting patients with technology – equipping them with access to their personal health data or the educational information relevant to their condition – they'll take a more active role in their care.
But all the portals, pedometers and Bluetooth-connected scales in the world will only make so much difference – and only on a certain portion of the patient population.
"The idea that we should educate people and help them make better decisions has only minimal effectiveness," says Dr. David Asch, executive director of Penn Medicine's Center for Health Care Innovation.
Despite massive public health campaigns and targeted physician interventions to educate them about the risks, "people still smoke, people still fail to put on a seatbelt," he said. Same too for patients who are told they need to lose weight or take their prescribed medications on time.
At the HIMSS and Healthcare IT News Patient Engagement & Experience Summit on March 5, Asch will offer some perspective on another tool that could help get patients more engaged and drive changes in their behavior: behavioral economics.
At its core, behavioral economics is the study of human psychology as it relates to people's decision-making processes. With the era of consumerism upon the healthcare industry, it's time to start adopting some of the innovative techniques other industries use to reach their consumers and influence their behavior.
"So much of what we do in everyday life is designed around an understanding of how people ought to behave," he said. "We create financial and performance incentives at work to make people try to increase their productivity and the quality of their work. We put nutrition labels on food so people can be informed about the things they're eating. And in healthcare, we give instructions to people about the importance of taking their medications.”
Behavioral economics has shown that consumers are not always rational, even when equipped with all that information – in fact, their decision-making is often quite irrational.
"But the key promise of behavioral economics is that we're irrational in highly predictable ways," said Asch.
That's an encouraging fact. Because once we understand the typical traps we fall into – the ones that fuel irrational and counterproductive decision-making – we're "not only better able to defend ourselves against them, but sometimes we're able to design the reality of our circumstances so that the same thing that used to be pitfalls are now opportunities," he said. "It's almost like a martial arts thing when you use your opponent's force as a weapon against him."
The ground is already well set for strategies like that to take root. The web has long since conditioned people to do their own research and educate themselves on any number of fronts. Consumers are "much more willing to take charge of activities and information in all domains of their lives, and healthcare is one of them," said Asch.
"But I don't think healthcare has made anywhere near the translation of using technology effectively to manage consumer behavior to in the way that financial services, retail, entertainment or travel has," he said. "That, to me, is an opportunity."
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.
"Fitbits and pedometers don't make you walk more," said Asch. “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."
Most efforts to shift healthcare consumer behavior so far have been along the lines of: "We just need to get information to people – we need to make it easier to understand calorie labeling, or we need to port information from people's cell phones to their primary care doctor," he said. "But that just takes us part way. The real question is how to sustain engagement with people so it's effective. It's not just cool technology. It has to be paired with behavioral insights."
But embracing such a fundamentally new way of thinking is arguably asking a lot of hospitals and clinicians that already have full plates. How do they do it? What are the tricks?
"It is easier said than done," Asch admitted. "But the most exciting thing about this field of behavioral economics is that we're getting better and better and better at developing tricks to keep people engaged long-term. Some of them are tricks that other industries have learned earlier, things like loyalty programs. American Airlines wants you to keep flying on American and not on United. And Starbucks doesn't want you to migrate to Peet's Coffee – and they want you to keep coming in. That's similar to the repeat engagement challenge of healthcare."
It's true that healthcare generally hasn't created good systems to consistently keep high blood pressure patients on their antihypertensives. But Starbucks has done a pretty good job of encouraging people to come $5 coffee drinks – often more than once a day. What are those companies doing right?
"I think we can generally learn from those industries," said Asch. "What are the buttons that help sustain engagement?"
At Penn Medicine, for instance, "we do lots of things that might be called gamification," he said. "They're things that keep people engaged and entertained but allow them to monitor their glucose better or stay sustained in a fitness or diet program. We use variable rewards, we use lottery incentives, we create loss aversion, we create regret aversion."
"All of these are part of the behavioral economic toolbox, which reflects how people actually make decisions," he added. "If we can find ways to connect with those behavioral patterns that people already have, that's our ticket to engagement."
Asch speaks from experience as a primary care physician: "If every time someone came in who wasn't taking their medicine, or they were still smoking or they weren't losing weight, and I just said, 'Here, let me give you the evidence again about why this is bad for you,' I'm not going to make progress with that patient. I'm going to have to jazz it up," he said.
The HIMSS and Healthcare IT News Patient Engagement & Experience Summit take place on March 5 at HIMSS18 in Las Vegas.
