Even though patients today are more empowered and informed than ever before, patients at large continue to struggle with awareness, understanding and willingness to act on their health information (health literacy). There is a compelling body of evidence linking sustained patient engagement with better health outcomes, improved patient care and lower overall costs of care (and references quoted therein). While the advent of digital tools has made patient outreach relatively seamless, the current hyperbole about the engagement these interventions end up creating remains unsubstantiated.
Providers’ ability to reach patients through digital platforms (texting, email and chat) does help extend the outreach, eliciting what seems like an early engagement, but it fizzles out relatively quickly without long-term behavior change. Consider another definition of patient engagement: “Patient engagement is the desire and capability to actively choose to participate in care in a way uniquely appropriate to the individual, in cooperation with a healthcare provider or institution, for the purposes of maximizing outcomes or improving experiences of care.” Most of the prevalent patient engagement solutions end up being mere outreach enablers due to their inability to address underlying behaviors that tend to act against the patient’s best interest.
Patient engagement solutions designed using principles from Behavioral Economics (“BE”) can help innovators and care teams to demystify what might seem like an irrational human behavior by:
- Understanding how people make decisions.
- Understanding the motivations behind the decisions taken.
- And finally, honing in on behaviors exhibited within the society or a group.
This approach can help create a reliable and predictable engagement framework, enabling personalized, patient-specific interventions and improved outcomes. Let us consider how the use of BE can help explain commonly witnessed irrational healthcare decisions.
Example 1
Patients often fail to maintain healthy lifestyles despite being well aware of the benefits and despite the recommendations of their care teams. Unhealthy lifestyles remain a major public health policy concern and require careful consideration in designing effective interventions that also recognize the importance of individual preferences.
In the example above, the exhibited behavior could be attributed to impatience or preference for immediate gratification; this is also known as present bias. This tendency could explain why some patients neglect further treatment if they don’t experience immediate improvements.
Example 2
Another counterintuitive behavior is patients not showing up for their scheduled physician appointments, which adversely affects patient outcomes, translates into delayed patient care, disrupts provider operations and increases stress for both providers and patients. It is estimated that the yearly cost to the providers of missed appointments in the U.S. is $150 billion.
With regards to example 2, it was shown that when patient reminders containing a specific set of words were used to inform patients of an upcoming appointment, no-show rates were reduced by 7%, and canceled appointments increased by 9%. This phenomenon of our choices being influenced by the way our messages are framed or worded is known as the Framing effect.
The removal of similar behavioral barriers could lead to a model that will infuse principles and interventional strategies from the field of Behavioral Economics into the patient journey. One such BE integrated engagement framework could be developed based on understanding individual patients’ awareness, ability and willingness (AAW) to participate meaningfully in their own healthcare decisions. Consider an example based on pricing transparency that will help further illustrate how the frameworks could be applied.
The removal of similar behavioral barriers could lead to a model that will infuse principles and interventional strategies from the field of Behavioral Economics into the patient journey. One such BE integrated engagement framework could be developed based on understanding individual patients’ awareness, ability and willingness (AAW) to participate meaningfully in their own healthcare decisions. Consider an example based on pricing transparency that will help further illustrate how the framework could be applied.
Problem Statement: Rising medical debt and lack of transparency about healthcare costs
Likely Solution Using AAW Framework:
Create individualized Awareness about out-of-pocket costs for the upcoming medical service. Understanding patient’s Ability to cover the potential costs Influence patients’ Willingness to engage using behaviorally segmented “Nudges.”
In conclusion, while the reasons behind such behaviors are complex, and sometimes circumstantial and beyond the patient’s control, behavioral biases play a major role in the observed outcomes. The ability to identify the reason driving the adverse behavior and mitigate it through interventions based on Behavioral Economics is the key to unlocking meaningful patient engagement.
Mayank Pant
SVP- Product and Innovation at IKS health
