Behavior Focused Care: The Next Frontier

The concept that behavioral science can play a role in protecting the health of the nation is not new. In 1988, the Institute of Medicine (the health arm of the National Academy of Sciences) published a ground-breaking paper recognizing the contribution that behavioral science can have on the health care ecosystem, specifically referencing “population-based health problems, including biological, environmental, and behavioral issues.” Fast-forward to today with the COVID-19 pandemic overwhelming health care systems around the world, and providers and insurers have received a crash course in the nation’s behavior.

Using a data-driven approach—similar in nature to the approach used by Amazon, Facebook, and Google—governments and health care providers are enabled to promote pandemic-geared societal behaviors like wearing masks, improved handwashing, and social distancing. Generally, people demonstrated they were willing to accept government recommendations if the mandates protected them, their loved ones, their communities, and large populations as a whole. But these behaviors were driven by stick—the threat of large fines and other penalties, not to mention the fear of catching COVID-19—rather than carrot.

Now, with the pandemic subsiding, behavioral scientists have the opportunity to use data-driven technology to take the next leap forward to keep—or make—our nation healthy through positive personalized communication, impacting the health of each individual in our population according to their specific health condition.    

Using Behavioral Science Beyond the Pandemic

We may have mastered the “what’ and the “how" of health care–what treatments are needed to cure patients and how to make those treatments most effective—but now with the emergence of new AI-powered behavioral science technologies, we have an opportunity to improve our understanding of the “why.” Why do people act in certain ways? Why do some people get vaccinated and others avoid vaccinations? Why do some stick to their treatment regimen and others give up?

The truth is, we currently find it hard to answer these questions, as each person has different considerations ranging from fear of treatment, to cost and many other factors. One way to understand personal motivation would be to have one-on-one conversations with individuals. But, realistically, talking to an entire population to obtain the data necessary to properly analyze them is just not feasible nor cost effective. Even if it was a possibility, would this enable us to automatically personalize the way we engage our target audience and cater to their individual needs to stimulate healthy behaviors? 

When Knowing Your Customer Can Save Lives

For example, there is an effective screening process recommended for people aged 50-75 to help prevent colorectal cancer (CRC)—the third most common cancer and cause of cancer related deaths in the US—and yet, less than 62% of people are getting tested even though early CRC detection can be the difference between life and death.

If health insurers and providers could understand what is driving the behavior of people avoiding colonoscopy tests, they could adjust their approach and achieve better cancer-prevention outcomes. It is not a question of one size fits all; each person will have their own legitimate reasons for a behavior. By understanding the psychology behind those behaviors, we could engage in a timely and motivational way, and address some of their concerns or fears.

By better understanding patient needs, health care professionals could persuade those at risk to get tested and reduce the likelihood of CRC complications and other related conditions. This would reduce the mortality rate, free up hospital beds, and reduce costs for the health insurers, which ultimately would reduce costs for all patients and increase patient satisfaction levels.

Improving Care Through Scalable Personalized Communications

With AI-powered behavioral science technology, it is now possible to understand the fears and motivations of large cohorts of people in a cost-effective way. This allows health insurers and providers to segment and personalize communications so that they truly resonate with the individual. Once organizations know more about their patients and members, their member risk assessment analysis will improve, and they can provide better care for members not just based on clinical results but also on clinical insights and psychological impact.

By using these technologies, members will be more enthusiastic and responsive to insurer and provider outreach, as well as more inclined to take preventative or immediate actions to improve their health status. With members taking more active roles to improve their care earlier on in their care journey, the entire healthcare system will benefit. Additionally, healthier members make happier members.

Member feedback, which is evaluated through Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, plays a crucial role in determining Medicare Advantage Star Rating scores for health plans. Higher rated plans are eligible for quality bonus payment reimbursement, which they are then required to use towards more consumer benefits, improving care potential and outcomes for all.

The next frontier in public health will be scalable personalized communication, and it will seismically change the interactions between payer, provider, and health care recipient. If we continue to develop the tools to understand people and communicate with them at scale—not only in a clinical but on a behavioral level—we can deliver better treatments and continuously improve health outcomes, creating healthier populations and increasing patient satisfaction.

Disclaimer: The views and opinions expressed are those of the author(s) and do not necessarily reflect the official policy or position of the Population Health Learning Network or HMP Global, their employees, and affiliates. Any content provided by our bloggers or authors are of their opinion and are not intended to malign any religion, ethnic group, club, association, organization, company, individual, or anyone or anything.