The concept of behavior change, previously a footnote at best in patient engagement conversations with healthcare stakeholders, increasingly represents a key theme in those talks. Providers, payers, employers, and health IT vendors all acknowledge the importance of helping patients take specific actions to improve clinical outcomes, lower healthcare costs, and improve overall quality of life. The topic even came up at HIMSS18.
That said, behavior change is hard. Fast-food burgers cost much less than salads. Modern America prioritizes cars over bicycles and pedestrians. Alcohol and prescription drug advertisements are everywhere. Treatment is easier to obtain, and pay for, than prevention. Phrases like “no pain, no gain” make exercise seem like a chore, not an enjoyable activity.
A recent New England Journal of Medicine Catalyst web event (available on demand here) discussed the challenges and opportunities associated with creating, scaling, and sustaining behavior change. Here we highlight five major points from the event’s speakers and offer our recommendations about where patient engagement solutions could help.
To best encourage behavior change, organizations must push as much as possible to patients – information, products, services, external programs, and so on – instead of expecting them to seek these things on their own.
Let patients be curious. Physicians often scowl at patients who bring their own research to medical appointments, then take another sip from their coffee mugs that read, “Please do not confuse your Google search with my medical degree.” But these patients want to engage, to understand their options, and to have a conversation. This is especially true for patients with chronic conditions, where the answer to a question is unlikely to emerge right away.
- Technology recommendations: Provide and “prescribe” educational resources within portals or apps that physicians trust and verify; offer tips to help patients determine the efficacy of other resources
Improve education. Amid 15-minute appointments, physicians tend to fall back on medical jargon, which only reinforces healthcare’s paternalistic power dynamic. Important details also get glossed over – the meaning of “1 in 5 chance,” for example, or the math behind calorie intake and weight loss. Finally, conversations may not include family members who unintentionally influence poor behavior through their own choices.
- Technology recommendations: Ask appropriately about and tailor educational resources to socioeconomic and demographic factors; give access for caregivers and surrogates; offer menu or activity suggestions based on patient-entered data
Use different language. Beyond stripping conversations with patients of jargon, medical professionals need to think about the words they use. Losing weight is not about willpower, discipline, and hard work. Eating chocolate is hardly the moral equivalent of cheating on an exam – and it’s an opportunity to learn, not scold. Meanwhile, admitted patients rarely have the wherewithal to describe pain in clinical terms such as localized, inflammatory, or chronic.
- Technology recommendations: Use common names for conditions, drugs, and procedures, and supportive language in care plans and condition management apps (especially for chatbots); map persona to determine what motivates individual patient behavior and tailor interventions accordingly
Embrace shared decision-making. If physicians and patients alike modify clinical relationships to accommodate shared decision-making when the stakes are low, then they will be more comfortable with the concept when the stakes are high. Shared decision-making also encourages a process that is less about dictating what patients must do and more about offering them guidance to discover what they should do, so that patients are better empowered to make their own decisions.
- Technology recommendations: Ask and record patient’s self-determined care plan goals; include patients and surrogates in clinical care teams; use telehealth to connect dispersed clinical teams; use telehealth or apps for check-ins between in-person care episodes
Remove barriers. Whether it’s enrolling in a 401(k), adding a tip to a restaurant takeout bill, or donating to the Red Cross via text message, people are more likely to take action when most of the work is done for them. To best encourage behavior change, organizations must push as much as possible to patients – information, products, services, external programs, and so on – instead of expecting them to seek these things on their own.
- Technology recommendations: Connect non-clinical resources, social services, and patient support groups that align with conditions and/or care plan goals; connect community programs, especially for patients in underserved areas – make it easy for patients to do the right thing
We recognize that many healthcare organizations are unlikely to address these five efforts until healthcare’s reimbursement models shift from volume to value. We also recognize that most vendors as well as provider/payer Innovation Centers are unlikely to build the tech to support these efforts until that shift. As far as the business of healthcare is concerned, helping patients change their behavior when it is medically beneficial to do so will only be viable when it pays better (and requires less administrative burden) than simply bringing patients in the door time and time again.
We also recognize that while change comes slowly to healthcare, it is coming. Providers, payers, and even employers are testing value-based care models. The vendors profiled in our previous condition management and patient relationship management reports offer technology to encourage effective patient engagement within VBC models.
Above all, the conversation about patient behavior change, and its larger role in supporting VBC, is getting louder. The recommendations discussed here will help stakeholders begin to explore their options for better empowering patients to make more informed decisions about their health and wellness, with the end goal of making behavior change a bit less difficult than it needs to be.