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Getting People to Act
The document discusses leveraging behavioral science to drive engagement in healthcare through the Altarum Consumer Engagement (ACE) measure, which assesses patient engagement based on three domains: commitment, informed choice, and navigation. It presents case studies demonstrating the impact of tailored health coaching and incentive programs on improving health outcomes and reducing costs. The key focus is on identifying actionable insights and timely interventions to enhance patient engagement and adherence in healthcare settings.
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Getting People to Act
- 1. Insight. Action. Measure. Getting Peopleto Act: Driving Engagement through insight, personalization, and behavioral science August 19, 2015 © Medullan, Inc.
- 2. 2page Your Guides Today RyanRossier VP, Product Innovation Ryan leads the product innovation team at Medullan. His expertise includes market research and analysis, program management, agile delivery excellence, and lean start up. Josh is the Chief Behavioral Scientist at ChipRewards. Dr. Klapow is a licensed clinical psychologist and works extensively to communicate the role of behavioral science in a wide range health and wellness topics. Josh Klapow, PhD Chief Behavioral Scientist Chris Duke, PhD Director, Center for Consumer Choice in Health Care Dr. Duke is the Director of Altarum Institute’s Center for Consumer Choice in Health Care, and conducts research into how patients can make decisions to get maximum value out of their health care.
- 3. 3page Today’s topics Recap andbackground: Insight. Action. Measure ACE Measure: increase the probability for action The science of behavior change Applying the science to achieve outcomes Q&A 1 2 3 4 5
- 4. 4page MEDULLAN ACTIVATE Insight. Action.Measure. INSIGHT OUTCOME & LEARNING RIGHT PEOPLE RIGHT INTERVENTION, RIGHT TIME RIGHT REFINEMENTS 1 2 3 ACTION MEASURE
- 5. 5page MEDULLAN ACTIVATE Insight. Action.Measure. INSIGHT OUTCOME & LEARNING RIGHT PEOPLE RIGHT INTERVENTION, RIGHT TIME RIGHT REFINEMENTS 1 2 3 ACTION MEASURE Actionable insights identify the right opportunities and the right people to target
- 6. 6page MEDULLAN ACTIVATE Insight. Action.Measure. INSIGHT OUTCOME & LEARNING RIGHT PEOPLE RIGHT INTERVENTION, RIGHT TIME RIGHT REFINEMENTS 1 2 3 ACTION MEASURE Get people to take action with the right intervention at the right time (relevant and receptive)
- 7. 7page© Medullan Inc. TheAltarum Consumer Engagement (ACE) Measure Chris Duke PhD Director, Center for Consumer Choice in Health Care Altarum Institute
- 8. 8page How can weleverage engagement? When we understand an individual’s personal level of engagement, there are many opportunities for intervention. We can segment similar people to understand: – Who is more or less likely to have health problems? – How can we message to different segments appropriately? – How can we provide self-awareness to each segment? – How can we set appropriate health goals? But how can we identify individuals’ level of engagement?
- 9. 9page • Altarum Institutedeveloped the ACE Measure in 2014. – Survey of 3 primary domains and 12 questions. – Validated against many health outcomes and behaviors. – Published manuscript available here: http://link.springer.com/article/10.1007%2Fs40271-015-0131-2 • ACE was developed with several goals: – Scientifically validate a measure of engagement – Capture modern forms of engagement, like web resources – Capture complexity of engagement with multiple domains – Licensing agreement does not require financial payment Introducing the ACE Measure
- 10. 10page ACE Measure Domains •Commitment: Everyday health behaviors – Highly predictive of health outcomes and medical adherence. • Informed Choice: Preference for learning about health – Highly predictive of researching health, shared decision-making. • Navigation: Experience and savvy using healthcare – Highly predictive of comparing cost and quality information. • Individuals’ may be high on one domain and low in another.
- 11. 11page 0 .2.4.6.8 5 10 1520 25 Commitment Commitment also predicts healthy control of: • Cholesterol • Blood pressure • Smoking • Glucose 5 10 15 20 25 Commitment Score 80% 60% 40% 20% 0% Likelihood of not being clinically obese. Commitment & Healthy Outcomes © 2014 Altarum Institute
- 12. 12page How are weusing ACE? • A healthcare organization is customizing patient messaging based on patient ACE scores. – Understand who needs help in specific areas – Set appropriate goals for engagement and health • A hospital has providers talk patient through ACE scores in the hospital. – Understand patient strengths and weaknesses – Assign extra resources for specific patient deficits – Set appropriate goals for engagement and health © 2014 Altarum Institute
- 13. 13page • Patients tookan engagement survey and were called by a health coach following a hospitalization. • Coaching message was segmented into four levels to be achievable to each level of engagement. • Results? – Survey engagement increased – Medical adherence increased – Readmissions declined, saving an average of $1872 per person Full study: http://www.ncbi.nlm.nih.gov/pubmed/19514801 Case study: Tailored health coaching
- 14. 14page© Medullan Inc. TheBusiness of Behavior Change When success depends on doing Josh Klapow Ph.D Chief Behavioral Scientist ChipRewards
- 15. 15page Proprietary & Confidential •The individual becomes the center of the “universe” • Individual actions drive engagement across markets • What someone does or doesn’t do on any given day is quantified • How can this be unified? Source: Oliver Wyman Healthcare: A Personalized Marketplace
- 16. 16page Proprietary & Confidential TheCommon Denominator
- 17. 17page Proprietary & Confidential BEHAVIOR TheCommon Denominator
- 18. 18page Proprietary & Confidential BehavioralScience: An empirical approach to understanding, evaluating and changing human behavior. What is Behavioral Science?
- 19. 19page Proprietary & Confidential BehavioralScience: An empirical approach to understanding, evaluating and changing human behavior. What is Behavioral Science?
- 20. 20page Proprietary & Confidential •Learning Theories (Skinner/Pavlov) • Health Belief Model (Rosenstock) • Theory of Reasoned Action (Ajzen & Fishbein) • Social Cognitive Theory (Bandura) • Transtheoretical Model (Prochaska & DiClemente) • Information/Motivation/Behavioral Skills Model (Fisher & Fisher) Models of Behavior Change
- 21. 21page Proprietary & Confidential Probability ofBehavior Change (likelihood, not guarantee) Heuristic
- 22. 22page Proprietary & Confidential TheApplication
- 23. 23page Proprietary & Confidential -PTO days - Charity donations - Company merchandise - Payroll deposits - Merchandise - Gift cards - Real-time travel - Activities & events - Notifications - Virtual badges - Achievements - Discounts - Special offers - Savings & benefits - Premium reduction - HRA / HSA / FSA contributions - Annual exams - Preventive screens - Condition management - Generic conversion - Rx compliance - Mail-order Rx - Eligibility changes - EMR system data - DM/Wellness vendors - Onsite health events - Remote participation - Medical purchases - Grocery purchases - Self-reported activity - Quiz completion - Evaluator reporting Actions Data Sources Consequences Consequence Rules Behavior Change at Scale
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- 25. 25page Proprietary & Confidential Targeted segment of 745 eligible employees from large, national employer. Self-insured health benefit plan with historical cost increases ≥10% annually 10 year history of wellness initiatives with limited ROI On-site fitness and gym memberships HRA’s and biometrics with incentives Annual physical with PCP with incentives * Reeves, J., Kapp, B. (2013). Improved Cost, Health, and Satisfaction With a Health Home Benefit Plan for Self-Insured Employers and Small Physician Practices, Journal of Ambulatory Care Management Vol. 36, No. 2, pp. 108–120.
- 26. 26page Proprietary & Confidential Patient Health Information Registryand Cost Management Systems ChipRewards PCP Delivery System – P4P Medical Homes Care Plan - Patient Guidelines / Incentives Care Coordination Team- Coaches, Case Managers, M.D. Medical Director ChipRewards Role Connected to all sources of information Automated tracking behavior and processing rules Communicate consequences to plan administrator 12 Compliance Rules Selected examples: Complete Health Risk Assessment Establish care with PCP Follow PCP Treatment Plan (Specialist Referral, Laboratory/Medication) Report Emergency Room (ER) / Urgent Care Visit Timely Report of Inpatient Discharge to PCP Participate in Health Management Program Member Consequences 1st violation: written warning issued. 2nd violation: 100% increase in the employee contribution to premium 3rd violation: Termination of participation in preferred plan Platform
- 27. 27page Proprietary & Confidential HedisMeasures % Measures Improved % A1C in past year 84.4% A1C 90.1% BP in past year 92.6% BP 94.2% LDL C in past year 75.6% LDL C 88.1% T C in past year 76.4% T C 89.5% Disease Controlled % Utilization Improvement % Diabetes Mellitus 64.5% Hypertension 81.8% Lower ER Visits/1,000 -7% Hyperlipidemia: LDL-C 75.6% Lower Hospital Days/1,000 -48% Hyperlipidemia: T C 76.4% After 24 months, total medical costs were 23% lower than the baseline year.
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- 29. 29page Proprietary & Confidential Incented stair usage promotion was one component of a larger health and wellness incentive program Program to increase stair usage among 216 employees in a single 8 floor building Employees swiped their employee ID cards at readers on the doors at the entrance and exit of the stairwells which automatically awarded points to individual reward accounts *Schumacher et al. (2013). Boosting workplace stair utilization: A study of incremental reinforcement. Rehabilitation Psychology, 58(1), 81-86.
- 30. 30page Proprietary & Confidential Stair-taking behavior increased by over 600% New stair-takers increased by 66.4% Substantial overall gains were immediate and sustained over a 6-month period 0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00% Percentage of Employees Using Stairs 0 50 100 150 200 250 300 350 Average Number of Times Stairs Used Per Day 39 301 Baseline With Incentives Baseline With Incentives
- 31. 31page© Medullan Inc. FinalThoughts
- 32. 32page MEDULLAN ACTIVATE Insight. Action.Measure. INSIGHT OUTCOME & LEARNING RIGHT PEOPLE RIGHT INTERVENTION, RIGHT TIME RIGHT REFINEMENTS 1 2 3 ACTION MEASURE
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- 34. 34page Join us forthe next in our 3 part series #1 INSIGHT Finding Actionable Insights Aug 5, 2pm #2 ACTION #3 MEASURE Getting Members to Act Aug 19, 2pm Measuring Effectiveness Sep 9, 2pm See info.medullan.com/webinars for more details.
- 35. 35page© Medullan Inc. Thankyou! Chris Duke chris.duke@altarum.org Josh Klapow josh.klapow@chiprewards.com Ryan Rossier rrossier@medullan.com
- 36. 36page Better Lives I NN O V A T I O N F O R We improve the healthcare experience through human-centered digital solutions
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- 38. 38page www.chiprewards.com ChipRewards | WhatWe Do A configurable solution that merges science, technology, people and processes to optimize the probability that targeted behaviors occur. Behavioral Science Enhanced Utilization & Outcomes User Experience Engagement & Loyalty