© 2016 Enroll America | StateOfEnrollment.org
COVER MISSOURI COALITION | 05.12.16
Beyond Awareness: Using Audience Insights to
Facilitate Behavior Change Among Late Adopters

Who We Are

Audience insights
Changing behavior
Building a responsive
communications plan
CAC story: Removing barriers for the
Hispanic/Latino community
Health insurance literacy
and motivation
Agenda

Audience
insights

State of Enrollment – The Challenges We Face
AUDIENCE INSIGHTS
Shift from general awareness to targeted outreach
Complexity of audience backgrounds
Fluctuating state of healthcare (real and perceived)
Conflicting messages
Potential uncertainty, need for clarity

Remaining uninsured
AUDIENCE INSIGHTS
Percentage of Uninsured U.S. Adults, by Subgroup
(Q1, 2016 – Gallup-Healthways Well-Being Index)
Q4 2013
%
Q1 2016
%
Change
%
National adults 17.1 11.0  6.1
18 to 25 23.5 14.8  8.7
26 to 34 28.2 18.5  9.7
35 to 64 18.0 10.7  7.3
65+ 2.0 1.6  .4
Whites 11.9 6.4  5.5
Blacks 20.9 11.4  9.5
Hispanics 38.7 28.3  10.4
Less than $36,000 30.7 20.0  10.7
$36,000 to $89,999 11.7 8.2  3.5
$90,000+ 5.8 2.9  2.9

The uninsured and eligible for Medicaid or CHIP are
likely to be poor, a person of color and working
AUDIENCE INSIGHTS
NOTES: Numbers may not sum to subtotals or 100% due to rounding.
SOURCE: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect
state Medicaid expansion decisions as of January 2016 and 2015 Current Population Survey data.
Distribution
by Income:
Distribution
by Race / Ethnicity:
Distribution
by Family Worker Status:
Uninsured and Eligible for Medicaid and CHIP = 8.8 Million
200%+
FPL 18%
100-199%
FPL 32% Below
Poverty
51%
Hispanic
31%
White
43%
Black
16%
Other Non-Hispanic
10%
At least one
Full-Time
Worker in
Family 57%
Only Part-Time
Workers In
Family 17%
No Workers
in Family
26%

Reasons For Being
Uninsured Among
Uninsured Adults,
Fall 2014
AUDIENCE INSIGHTS
NOTES: Includes uninsured adults ages 19-64.
SOURCE: 2014 Kaiser Survey of Low-Income Americans and the ACA.
When asked in their own words, the
remaining uninsured said that the main
reason they were without insurance was…
48%
6%
3%
3%
7%
6%
12%
4%
12%
Too expensive
Don’t need it
Opposed to the ACA/Prefer to pay penalty
Don’t know how to get it
Immigration Status
Told they were ineligible
Unemployed/Work doesn’t
offer/Not eligible at work
Don’t know/refused
Other reason

Why uninsured?
AUDIENCE INSIGHTS
Fine can be cheaper than premiums
At some point told they were ineligible
Opposed to the “mandate”
Fear about submitting application due to mixed immigration status

Changing
behavior

Using audience insights
in building a responsive
communications plan
CHANGING BEHAVIOR
Now, it’s about more
than awareness – it’s
about facilitating
change in behavior

CHANGING BEHAVIOR
Behavior happens when three elements come
together at the same moment.
B =
BEHAVIOR
Desire or
willingness to
do something
M
MOTIVATION
Having the
means or skill to
do something
A
ABILITY
Influence
which causes
an action
T
TRIGGER
Based on the work of Dr. BJ Fogg, Stanford University

Were you
prompted to
do it at the
right time
and in the
right way?
CHANGING BEHAVIOR
In other words,
B =
BEHAVIOR
Do you want
to do it?
M
MOTIVATION
Do you have
the ability to
do it?
ABILITY
T
TRIGGER
A

CHANGING BEHAVIOR
B =
BEHAVIOR
M
MOTIVATION ABILITY
T
TRIGGER
All three must be present to create
a desired behavior.
A

Building a responsive
communications plan

BUILDING A RESPONSIVE COMMUNICATIONS PLAN
Triggers
Also known as:
cues, prompts,
calls to action,
requests
Triggers can lead to a chain
of desired behaviors
Heavily dependent upon timing –
right place, right time

Motivation curve
TRIGGERS
SUCCEED
TRIGGERS
FAIL
MOTIVATION
ABILITY
LOWHIGH
HARD EASY

Motivation curve
MOTIVATION
ABILITY
LOWHIGH
HARD EASY
1
2
3
FACILITATOR
High motivation,
Low ability
SPARK
Low motivation,
High ability
SIGNAL
High motivation,
High ability

For example…
MOTIVATION
ABILITY
LOWHIGH
HARD EASY
TACTIC:
Instead of creating your own event that she has to find time to
attend, seek to meet her where she is. Attend a presentation with
a group she meets with regularly already (playgroup, booster club,
etc.) with assisters on hand to answer questions.
DESIRED BEHAVIOR:
Will a 34-year old mom come
to my enrollment event?
M
A
T
She knows she is required to have
insurance and has a lot of questions
HIGH
Her schedule is hectic and she feels
it’s one more thing she has to try
and fit in
LOW
TYPE OF TRIGGER: FACILITATOR
Seek to increase ability by making
the task simpler

For example…
MOTIVATION
ABILITY
LOWHIGH
HARD EASY
TACTIC:
Provide free food to entice him to the event; Partner with
educators and advisers to offer incentives for attending
the event and learning more
Is healthy and thinks he doesn’t
need health insurance
LOW
An event is taking place on campus
to educate and enroll graduate
students
HIGH
TYPE OF TRIGGER: SPARK
Increase motivation by prompting people
to take actions that they wouldn’t otherwise
intend to take
DESIRED BEHAVIOR:
Will a 26-year old graduate student
come to my enrollment event?
M
A
T

Take baby steps
Effective triggers for a small behavior can
lead people to perform harder behaviors.
What triggers can you put in the
consumer’s path to get to the next step?
Step
2
Step
3
Step
1
MEETING
Learns about Marketplace,
has immediate access to
assister to ask questions
APPOINTMENT
Schedules appointment
with assister to look at
options when it’s
convenient for her
SIGN UP
Schedules follow-up
session with assister to
sign up and GETS
COVERED!

Step
2
Step
3
Step
1
BEHAVIOR CHANGE EXERCISE
Let’s practice!
Activity
Break into groups of 3-4
5 minutes to discuss
5 minutes to report
Define desired behavior.
Remember – think in
baby steps!
Assess consumer’s
motivation and ability.
List triggers you can use
to increase low
motivation or ability and
prompt them to do
desired behavior.
What tells them to “do it
now”?

ID best times
and places to
reach them
Define the
behavior you
want your
audience to do
CHANGING BEHAVIOR
B =
BEHAVIOR
M
MOTIVATION
A
ABILITY
Reach
people when
motivation
is high
Make target
behavior easier
to do
Offer the right
resources;
Connect people
to in-person help;
Follow up
ID steps they
need to take
to get there
T
TRIGGER
Offer ways for
consumers to
easily perform
desired behavior
Plan outreach
activities that
are responsive
to motivation
and ability
Putting it all together

CHANGING BEHAVIOR
Remember…
Learn how much they can save? ► Cost calculator (via healthcare.gov)
Find/schedule in-person help?
► Searchable database by ZIP code (via healthcare.gov)
► Bringing assisters to presentations/outreach events
Find information?
► Multichannel presence online and offline (social media, community
partnerships, mix of paid and earned media)
Attend a meeting? ► Go where they are instead of creating standalone events
Share information?
► One-click social share buttons
► Having extra printed materials
► Connecting with network of community partners
THINK IN BABY STEPS:
Big leaps almost always fail. What triggers can
you put in the consumer’s path to get to the next step?
SEEK TO SIMPLIFY:
Easier to affect ability than motivation. Focus first on making tasks easier.
Is it easy for consumers to:
DEFINE YOUR AUDIENCE AND WEAR THEIR SHOES:
Know who you need to reach and think about the barriers they
face to get covered. Decide how to remove those barriers.

Removing barriers for
Hispanics & Latinos

HISPANIC/LATINO BARRIERS TO GETTING COVERED
BARRIERS AFFECTING ABILITYA
BARRIERS AFFECTING MOTIVATIONM
Language
Lower levels of education and literacy
Limited time because of work, family
Decreased emphasis on preventive care
Fear because of mixed immigration statuses
Unfamiliarity and misinformation

REMOVING BARRIERS LIMITING ABILITY
For example…
MOTIVATION
ABILITY
LOWHIGH
HARD EASY
What tactics would you use to overcome these barriers
and increase ability to connect to reliable information?
DESIRED BEHAVIOR:
Get reliable information so they can
understand what’s required, the benefits of
being covered and where they can go for help.
T
TYPE OF TRIGGER: FACILITATOR
Seek to increase ability by making
the task simpler
A
Low or no ability to speak, understand
English
Lower levels of education and literacy
Time is limited because they tend to work a
lot and spend free time with family

REMOVING BARRIERS LIMITING MOTIVATION
For example…
MOTIVATION
ABILITY
LOWHIGH
HARD EASY
What tactics would you use to overcome these barriers
and increase ability to connect to reliable information?
Decreased emphasis on preventive care
Fear because of mixed immigration statuses
TYPE OF TRIGGER: SPARK
Increase motivation by prompting people
to take actions that they wouldn’t otherwise
intend to take
M
T
DESIRED BEHAVIOR:
Get reliable information so they can
understand what’s required, the benefits of
being covered and where they can go for help.

OUR TRIGGER: WEEKLY RADIO SHOW EN ESPAÑOL
Boletín de Acción Comunitaria
(Community Action Bulletin)
• Meet them where they are
• Speak in their native language
• Share timely information in a
culturally relevant way
• Speak peer-to-peer

Language
Entirely in Spanish; On Spanish
language station
Lower levels of education and
literacy
Certified assister is host of the
program.
Limited time because of work, family
Can listen wherever they are, even
at work
Decreased emphasis on preventive
care
Focus on benefits, unforeseen costs
Fear because of mixed immigration
statuses
Clarity provided by peer
Weekly timing provides info on
ongoing basis
BROADCASTING TO REMOVE BARRIERS
A
A
A
M
M
M

Health insurance
literacy and motivation

HEALTH INSURANCE LITERACY AND MOTIVATION
Your role as an assister
People are better persuaded by the reasons
they themselves discovered, than those that come
from the minds of others.
‒ Blaise Pascal

Your role as an assister
Create a supportive
environment:
You can create an environment
where change can occur ‒ helping
consumers realize their motivation
and achieve their goals
Be an
advocate:
You can empower
consumers to make positive
decisions about health and
health insurance

Strategies to create health-literate messages
70%
use
“HealthCare.gov”
instead of “Health
Insurance
Marketplace”
50%
use “fee” instead
of “penalty” or
“individual shared
responsibility
payment”
100%
use “doctor”
instead of “primary
care provider” or
“health care
professional”
70%
use “financial
help” instead
of “tax credits”
Use consumers’ words:
Use simple, everyday language
Explain need-to-know words

Instructions
1. Replace each
difficult word with
a common word.
2. Give a simple
explanation for
need-to-know
words that can’t
easily be replaced.
Difficult word Common word or explanation
Annually
Eligible
Co-payment
Reimburse
Utilize
Specialist
Excluded
services
Yearly, each year
Qualify, able
A fixed amount you pay at the time
you get a health care service
A doctor who gives health care
for a specific medical problem
Use
Pay back, refund
Health care services that are not
covered and not paid for by your
insurance plan

Give clear action steps
Focus on what the consumer needs to do
Example: is my doctor in-network?
1 Get your
insurance card
2 Call your
insurance company
at the number on
your card
3 Ask if your doctor is
in your network

Strategies to motivate consumers
To be an advocate: Be accepting
Help clarify goals
Avoid arguing and confrontation
Support their ability to change
Affirm strengths, accomplishments,
and efforts to change

To motivate someone to action,
find out what motivates them

What do you know
about HealthCare.gov?
How are you currently
getting health care?
You know your situation
best. What do you see
as your biggest barrier?
To get consumers to
talk, ask open-ended
questions, which:
Usually start with “what,” “who,” or “how”
Invite descriptive, informational answers

It sounds like you
are feeling…Reflect their feelings
Listen to what the consumer is saying
Identify the underlying emotion
Verbally reflect the emotion
Reinforce any statements they made
about taking a positive health behavior
I understand you are
having trouble with…

I can tell you really care
about your health.Examples of reflecting feelings:
“I go for long walks everyday. I eat my
fruits and vegetables. I feel like I’m doing
everything right, so I don’t need health
insurance. I’m not happy about having
to pay for health insurance or pay a fee!”
“There’s just so much to think about.
I’m afraid I’ll make the wrong decision.”
It’s clear to me that this
is hard for you but also
very important to you.

What I’m hearing is…
Summarize what the
consumer has said
Gather together what has already
been said
Make sure you understand their
thoughts and actions
Prepare the consumer to move on
It sounds like
you’re saying…

It sounds like you’re
having some trouble
with your application.
Example of summarizing
Consumer:
“I’ve tried to enroll on HealthCare.gov
on my own and kept getting an error
message. The call center didn’t
help me.”
Let’s see how I can
help you.

Step
2
Step
3
Step
1
Let’s practice!
Activity
Break into groups of 3
1 assister, 1 consumer, and 1 observer
Assister: Asks an open-
ended question to get
the consumer to talk about
a problem
Consumer: Talks for
1 minute to answer
the question
Observer: Keeps time
for 1 minute
Assister: Reflects
feelings using statements,
not questions
Consumer: Clarifies if
the assister didn’t reflect
your message correctly
Observer: Checks to
make sure the assister
only reflects – no
questions are asked
Assister: Summarizes
what was said and
prepares to move on

Final thoughts

FINAL THOUGHTS
Tips to remember…
Always know your consumer and
think about the process of
getting covered from their POV
Plan your communications
activities around identifying and
removing or reducing barriers
Ask what you can do to make
each step in the process easier
Focus on baby steps
for long-term change
Guide people in creating
structured behavior – they
rarely know how or what to
do without help
Trust that tiny habits grow
naturally – one success leads
to another success

FINAL THOUGHTS
Tips to remember…
Next time you work
with a consumer:
Use everyday words
Give clear action steps
Ask open-ended questions
Reflect feelings to acknowledge
the consumer’s emotions
Summarize what the consumer said

2 31
TO LEARN MORE
Resources
BJ FOGG’S BEHAVIOR
CHANGE MODEL
http://www.behaviormodel.org/
COVER MISSOURI
ASSISTER GUIDE
COVER MISSOURI
YOUTUBE
https://www.youtube.com/
CoverMissouri

U
Contact Us
Tony Zagora, FleishmanHillard
tony.zagora@fleishman.com
Brandy Geers, FleishmanHillard
brandy.geers@fleishman.com
Diane Webb, Health Literacy Missouri
dwebb@healthliteracymissouri.org
Gustavo Valdez, CAASTLC
gvaldez@caastlc.org

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