Human relationships are complicated, dynamic, and also extremely powerful when it comes to influencing both behavior and health outcomes. Books have been written about it. Dave Chase eloquently describes the issue in health care with some analogies:
“With chronic disease, a service-based, cognitive approach is necessary to effect behavioral change. In a manufacturing setting, with enough practice a machine will do what it is intended to do and doesn’t have a mind of its own. However, as anyone who has been in a service-based business knows, human interaction and a partnership-oriented approach leads to the best outcomes.
“Think about throwing a rock at a target. Like a manufacturing scenario, with enough practice a well trained professional can hone their craft and hit the target most of the time. Now imagine rather than throwing a rock, you are throwing a bird at a target. Perhaps you can impact 10-20% of whether that bird hits the target. However, the other 80-90% is going to be driven by understanding the motivations of the bird. Perhaps putting food or the bird’s babies at the target would be necessary to drive the bird’s behavior.”
Chase goes on to say that
“As one who has implemented traditional healthIT, the process is very involved with many months of planning before go-live. During that process, there is a ton of process planning and re-engineering before configuring the system to reflect what has been decided. Roughly speaking, process is weighted 80-90% toward pre go-live with 10-20% focused on post go-live to deal with go-live issues and some further training.”
Chase is underscoring two key concepts that MUST be a part of a successful patient engagement and outcomes strategy.
- Understanding in affecting people’s motivations and what drives attention.
- Taking an iterative, learning-based (some might say Bayesian) approach. It will take time.
And these are related. We need to take an iterative approach because we just don’t know what works best. While I gave some suggestions based on motivational theory as to which patient populations might be most receptive to engagement in my last post, this is mostly uncharted territory, working with complex interactions. Where might the path lead?
Motivation: The $150 Toothbrush As Successful Engagement
My colleague Nate DiNiro recently made the case that Philips’ success at selling a $150 toothbrush (with $15 replacement heads), Sonicare, wasn’t necessarily easy. But it’s a good example of how patient and consumer engagement can work when the value proposition is clear and you meet people where they are with their own internal motivations. People want clean teeth for just about every level of Maslow’s hierarchy, physical, safety, belonging, esteem and self-actualization. Patient engagement needs a clearly articulated value proposition for many different motivations – like any product. Sonicare shows that people will engage in preventative care on a daily basis, and even pay for it, as long as the case can be made for how it might improve their lives.
It will even help more if a trusted doctor recommends it. It’s no surprise that Philips had creative agencies involved in both the development of Sonicare and the data-driven marketing strategy targeted to the dentists who support the product.
Patient engagement is conceivably not much different. Armed with enough data and marketing dollars there could be an effective campaign to educate doctors and patients on the power of patient engagement, but we’ll need both the dollars and the data.
Advertise Engagement Like We Advertise Drugs
If drug companies can spend millions on TV asking us to “ask our doctor” about a medication, couldn’t the same be done to promote the power of engagement nationwide? If engagement really is a “blockbuster drug,” why don’t we advertise it like one?
I hope we soon will. If patient engagement continues to be shown to be many times more effective at influencing outcomes than even the best drugs – if it really is a blockbuster drug for many conditions – then at some point we’ll need to generate public awareness and advertise results to physicians and consumers like a drug or a toothbrush.
Add to the long list of areas where better engagement and communication can help: a recent JAMA article showed that 80% of misdiagnoses were related to inadequate patient-physician communication. One could say both physicians and patients were “disengaged” from the communication and the relationship. The potential savings and public health benefits of engagement are too high not to promote.
To Dave Chase’s point above, the takeaway lesson for those implementing patient engagement is that it will be a journey of discovery to uncover what works for the patient populations you want to address. If results with engagement continue to show promise, more open communication and engagement with patients will become part of the standard of care, and we can’t afford to wait. The important thing is to get started.
It’s up to each participant in the system to discover, to learn what works and then teach others. Each patient context will have a unique path to success. It’s an adaptive process that, much like the best software design, remains flexible and iterative. It will likely require an agile approach and agile frameworks to find what works effectively in each unique situation.
The Missing Business Model of Engagement
Engagement also needs a business model. The incentive to sell engagement ultimately has to be as strong as the incentive to sell a $150 toothbrush.
Health care economist, JD Kleinke, mentioning patient engagement as a blockbuster drug, said “it’s too bad we can’t patent it.” Of course, sadly, he’s right. Sonicare might not cost $150 if they didn’t have it patent-protected. Philips’ marketing is selling outcomes (cleaner teeth), but the their financial path is though a product consumers will buy. On the other hand, it also means we might be able to get engagement for a lot less than a $150 toothbrush.
But he does raise larger questions. If it’s savings that we’re after, what’s the business model for engagement? What’s the product? What will it do for people? What’s the incentive to use it? How will all this be communicated most effectively and who will benefit from the communication?
Payment reform is a start, but how far can shared savings take the business model of engagement? Who else could provide the incentives and attention to appeal to each of the levels of Maslow’ hierarchy? Dave Chase recently likened the issue of how health care is packaged and productized to our generation’s World War III. Health care is eating up our GDP like a World War, but we’re having a hard time figuring out who the enemy is.
One thing Americans can get behind it is fighting the enemy. Yuck Mouth was around as a public service announcement long before there were $150 toothbrushes. Will similar campaigns get the ball rolling before we find the health care products? Is AliveCor just the beginning of this era’s $150 toothbrushes?
These are rhetorical questions. It will be iterative, but my sense is that social is what holds the motivation pyramid together, just as it does when selling clean teeth.