Enabling Healthy Decisions

While I didn’t get to meet Victor at the World Healthcare Congress in DC, I got a chance to do a phone interview with him last week. For those of you that don’t know who he is, here’s a quick bio:

My key takeaways from the conversation were:

1. We have to focus on intrinsic motivators in healthcare.
2. A little help at the right time is a lot better than a lot of help at the wrong time.
3. Selecting physicians based on organic chemistry scores without weighing empathy may be a issue.
4. You have to listen to the patient, assess their needs, and provide them with tailored information.
5. Social media has to embrace “collaborative filtering”.
6. Most behavior change companies are hitchhikers while some like PBMs are tollbooths. It’s better to be a tollbooth.
7. Choice has to expand over time.

Intrigued? You should be. Dr. Strecher was a fascinating person to talk with (see some of his insights). We only spent 30 minutes together, but I could easily imagine sitting with him in at my alma mater (University of Michigan) and talking for hours about healthcare communications and how this can impact the country and our outcomes.

We started off by talking about the shift in focus to the consumer over the past decade and how even while this has happened we (healthcare companies) have been guilty of seeing the patient from our perspective not from their perspective. This took us down the path of talking about motivation and what gets people to take action. We focused on the fact that health (in and of itself) isn’t a big motivator, but being healthy to see your kids or grandkids certainly is. We talked about how financial rewards aren’t the right (or only answer) and how there is a need to really understand and articulate intrinsic motives (see write-up on Drive by Daniel Pink).

We talked about his company HealthMedia (owned by Johnson & Johnson) and what they do to collect information on motivation. We talked about the use of stories (a topic that keeps coming up) and providing the right amount of help at the right time. He talked about how HealthMedia monitors consumers, provides them with coaching, and continuously evaluates their goals. He also talked about how they use online technology and mobile technology to get the right connection at the right time.

This led us into a discussion about how important behavior is in health outcomes. He mentioned that 70% of cancers are related to behavior – scary. But, at the same time, we don’t chose candidates for medical school based on their abilities to engage patients or show empathy. We choose them based on their organic chemistry scores. (As a physician, he could say that while I’d probably get tomatoes thrown at me for that comment.)

At this point, I really wanted to understand what HealthMedia has learned to get people off the couch and engaged. It all sounded a little too theoretical to me. He talked about their core process:

1. Listen to the issues. Assess the patient using branching technology and feedback to them.
2. Try to figure out what they need using a software algorithm.
3. Tailor information to them based on what you’ve learned (e.g., if they are concerned about gaining weight when quiting smoking, help them with that). And, I thought a key point here was to help them prioritize their actions rather than giving them a laundry list of things to do.

But, one of the keys in getting them to engage is to work through their intermediaries – employers and payers. For example, while you might encourage consumers to take an HRA for a financial reward, you may need a “health champion” at the employer site to really motivate people at a personal level. Or in another example, he talked about how Kaiser uses Epic and how HealthMedia integrates there. This creates an opportunity for “information therapy” which can be given to the consumer as a follow-up action from their encounter.

We went on to talk about social media which is one of those big topics in healthcare today. Obviously, there is lots of research that talks about the “peer pressure” effect on weight and smoking and other topics. (He mentioned the book Connected here.) But, how to you build trust (see recent post on this) and route consumers to the relevant information. He brought up a concept which was new to me called “collaborative filtering”. My interpretation of this is essentially having an expert monitor and guide consumers to relevant information within the social media realm. You want to find relevance in the data which means it has to be from “friends” who have experience with the topic.

I was asking him about the challenge of building trust given how many companies are out there and the amount of information which consumers are bombarded with. This is when he created the great visual of most companies as being hitchhikers in the behavior change world while others like PBMs are tollbooths. The tollbooths create a pause in the process which is triggered around an event. This event is an opportunity to get the consumer engaged. Of course, in general, these “golden moments” (my phrase) aren’t taken advantage of as much as they could be.

But, if they were, consumers would understand what they want and how a particular behavior maps to those desires. This would lead to improvements in adherence and other outcomes.

We wrapped up by talking about preference-based marketing and the impact of choice. He had some great points here which is an area of interest for me since there’s not much research. He pointed out that choice is instrumental since it appeals to autonomy. BUT, not everyone wants autonomy. Too much choice can be overwhelming. In summary, he suggested that less choice is best early on when the consumer is overwhelmed (e.g., newly diagnosed), but as they become more of an engaged patient over time, more choice is better.