Engagement is a Strategy IV: 10 Reasons Value-based Health Care Orgs Need A Social Strategy

“In the past man has been first. In the future the System will be first.” –Frederick Winslow Taylor

“Take two aspirin and call me in the morning.”

There was a time when engagement was the one-on-one relationship between a patient and physician and you could call your doctor on the phone. Do you remember that time?

Me neither.

The Problem: Industrialized Health Care Has Led to Disengagement

Although dated, taking two aspirin and calling in the morning is real engagement. We have a desired action (take a pill) and a follow-up (call me), and the baseline is essentially to do nothing (first, do no harm and less care is more).

But this kind of interaction is from a bygone era. It seems to be widely accepted that somewhere in the industrialization of health care, we’ve lost this one-on-one, relationship-based care with ongoing communication (truly a kind of Bayesian approach to health care). For better or for worse, health care is a system now, a network. Workflows, business models and reimbursements (for the most part) don’t support this kind of model.  Physicians aren’t going to get the time to make personal phone calls on a regular basis (without being reimbursed), but we need to find a way to encourage ongoing communication. It works.

Consistent Communication Means Better Outcomes

When ongoing communication is made available, even when it’s just increased office visits that are encouraged (hey, docs get paid for those), the results are staggering. Take a look at these results from Aetna in a Medicare Advantage Program in Maine:

  • 50 percent fewer inpatient hospital days

  • 45 percent fewer hospital admissions

  • 56 percent fewer readmissions than unmanaged Medicare populations statewide

  • Costs were 16.5% to 33% lower across all categories of medicare costs

As part of a collaboration strategy, a large part of the program seemed to be encouraging office visits, follow-up care and sharing information. In other words, ongoing communication and behavior change can have potent benefits. But why a social strategy?

We need scalable communications to fit our health care system.

We need to scale and improve patient-provider, provider-provider and patient-patient communication. We can’t go back to Marcus Welby days, we must find a scalable solution to the disengagement our industrialized system has created. If it works on the small scale of office visits, it makes sense to scale the relationships with social technologies. We have to. As we’ll see, it works.

1. A social strategy can make it easy, effective and low cost to keep up with patients.

The idea of engaging on a massive scale just wasn’t doable before now. To take the most familiar example, before Facebook you probably had no idea what most college and high school friends were up to. Who had the time to keep up? But with social technologies we do, it’s easy, effective and low cost.

And most health care institutions haven’t kept up with patients once they’ve left the office or the hospital. Who has the time or the resources?

Of course, value-based reimbursement strategies are making it much more valuable to keep up with patients than to keep up with high school friends. Pioneer ACOs recommend patients to become “part of the care team” to improve care and outcomes. Imagine just how many care teams each provider would need to be in to manage thousands of patients!

To make thousands of patients part of the care teams, a communications solution must be developed to match that scale, and that’s really what social media is. Quality-focused institutions must be thinking about their social strategy for this reason alone, but here are nine more:

2. A social strategy doesn’t mean doctors on Facebook

Having a social strategy doesn’t mean health care institutions must get doctors on Facebook. Facebook was built for sharing personal information and reforming old connections. The context for most of health care is, of course, very different.

There are and will continue to be solutions that fit healthcare. PatientsLikeMe is the most common successful example. Social technologies are about setting up ways to facilitate digital sharing and ongoing communication in health care for the context you are trying to address. A social strategy is a plan and set of tools, not any one tool.

3. Care measures improve with social interaction.

PatientsLikeMe has shown a dose-response curve with increased social interaction in epilepsy communities, similar to what you might see for a drug.

Look for more studies that provide similar findings in upcoming posts.

How might this work? What might be the sociokinetics of the “engagement drug”?

4. Crowdsourcing knowledge in care: Social networks provide valuable missing information, improving people’s ability to care for themselves.

We talk a lot about self-tracking in health care as a form of modern engagement, but in reality for chronic disease, self-tracking is not as fun or as easy as it should be. In a recent article in The Atlantic, The Diabetes Paradox, Thomas Goetz makes the point that, a lot of times, self-tracking isn’t fun or motivating – It’s a long slog with few rewards.

Still, a diabetes sufferer who commented on Thomas Goetz’s article said:

“To me the problem (with self-tracking) comes when education about the disease is limited and patients are sent away with little more than a user manual for their new glucometer. Add to that the fact the doctors spend less and less time with patients and/or don’t return phone calls, give out e-mail addresses, etc. Self-management is not the problem. It is the solution. People need help using these tools. I encourage all diabetics out there reading this to find yourself an online support group.”

The solution offered? Essentially a social network (“online support group”) to share valuable missing information. What’s being recommended is not really support in the traditional emotional sense, it’s information on how to perform the necessary self-tracking tasks because there’s nowhere else to go. It’s communication. People want reliable answers, and more and more they go to social networks to get them. As Susannah Fox, Pew Research Center’s Internet & American Life Project, has learned, “So many patient community leaders have told us: we are about science, not hugs.”

For caregivers concerned that patients might not get accurate answers, that’s even more of a reason to have a social strategy. Wouldn’t you rather be a part of the online community and be able to see what your patients see? Or provide a way for them to filter the best information?

Amazon’s recommendations have shown for a long time that the users of a service can add a lot of value by sharing. Many Twitter users, PatientsLikeMe members and the patient, above all, have discovered something very similar: the crowd is a good source of low-cost, high value information if it’s properly curated and filtered.

5. Social networks are potent influencers of behavior change

Motivation, ability and the triggers are the three things in the Fogg behavior model that influence behavior change. Intuitively, we know social networks have the potential to provide all three. Nicholas Christakis and James Fowler have shown just how deeply social networks influence behavior.

And saving health care is ultimately going to be about behavior change and how healthier, coordinated behaviors can be influenced on a massive scale.

It’s a well-worn fact that 70% of health care costs are a direct result of behavior. That means just about anyone in health care will eventually find themselves in the behavior change business.

Dan Munro’s Forbes article on Ernst & Young’s Patient-centric Vision of Healthcare quotes E&Y’s Glen Giovanetti:

“Almost every life sciences company, regardless of their product or offering, will soon be expected to help change behaviors and deliver better health outcomes.”

If you want to influence behavior (which you do or will), you really can’t ignore a social strategy. We’ll need to get really good at engagement and behavior change on a massive scale. Social media strategies may be our best bet at influencing behavior on a massive scale. Not to push behavior in a direction, but to provide systems that let behavior naturally migrate toward the health people already seek.

6. Social might be the key to promoting tracking and behavior change in chronic disease.

Chronic diseases like Diabetes are a tough area of engagement between the self-actualized, quantified selfers of Maslow’s pyramid and those at the other end who are concerned about not dying, which I described in the second part of this series. Social influences appear to be helpful for chronic diseases, where depression can be a problem.

7. People trust social communications over other forms of digital communication.

The following graph shows why you need a social strategy rather than just a digital communications strategy: to build trust.


The takeaway here is that you can’t fake an engagement strategy. By a factor of more than 2 to 1, people trust recommendations from friends over any other kind of digital communication.

8. For day-to-day health decisions, people seek answers from friends, family and social networks as much or more than they do from physicians.

Do they trust this information more than they trust advice from their physician? Not necessarily, but, according to Pew Research, it depends on the type (and timing) of information needs.


The opportunity to influence behavior and to reduce costs has to come from day-to day health situations, where doctors and social networks score about even.

9. It’s not just about patients.

Physicians need hugs, referrals and great curated content, too. Social can provide all of these and help avoid physician burnout.

From Orthopedic Surgeon Dr. Howard Luks’ recent post on Medicine and Social Media ROI:

“I derive an ENORMOUS amount of satisfaction simply from educating and interacting with the public, and helping them “clear the windshield of doubt”.  50+ thank you emails a day, a thank you from a happy reconstructed patient, seeing a new MD producing meaningful content appearing in a Google search, and helping people understand the complexities of our healthcare system and medical treatment decision making is the (Social) ROI I am ultimately searching for …and realizing. The rest is an added “bonus” .. and is quite real!

10. We all want hugs, too.

According to Susannah Fox, who studies consumer attitudes toward health and online behavior, in her great presentation Healthcare Out Loud:

“Love is the reason why people want to stay healthy. It’s why they want to stay well. It’s why people feel compelled to share, to give each other emotional support, to track observations of daily living, to track how a medication treats them as an individual so others can learn from it. Because of love. Because we want to help each other.”

Social communication strategies can help with that, too. Isn’t that why we call it “care”?

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Leonard is Principal and Co-Founder at VivaPhi, an agency that solves multi-disciplinary business problems involving data science, software, biomedical science, behavioral science, health care, product design, community development, marketing, consumer engagement and organizational design. He has been quoted in Forbes and other top-tier publications for thought leadership on patient and consumer engagement. In addition to his role at VivaPhi, he is Chair of the Marketing and Communications Group for the Collaborative Health Consortium. Prior to VivaPhi he held the position of Vice President of Operations at Capitis Healthcare International as well as executive positions with several startups. He started his career as a software requirements analyst on Qwest Communication’s highest priority IT project while earning a triad of advanced degrees from the University of Colorado. These included an MBA, a Master’s of Science in Information Systems and a Master’s in Biomedical Sciences (Thesis on System Dynamics in Parkinson’s Disease). Leonard earned a Bachelor’s in Zoology from Miami University in Oxford, Ohio. He’s interested in how systems evolve, and how to help them evolve, in a variety of unique contexts. Connect with Leonard: @leonardkish, LinkedIn and Google+