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Frictionless Healthcare: Fueling Behavior Change

Have you ever wondered why Amazon provides its recommendations or why Netflix tailors your movie menu? It’s not because they must, dear readers. It’s because they know the power of behavioral science.

They both have behavioral science and psychology marketing teams working on the user experience and are uniquely aware of the constant barrage of advertisements and marketing that their consumers are being hit with throughout the day. People, including members we are trying to reach, see between 4k and 10k ads and make about 35,000 decisions every day. To complicate things further, 87% of information is subconsciously filtered. So, most of the time it can be next to impossible to get through to members.

So, you might be asking yourself what is behavioral science? And why does it matter for health communication?

Behavioral science describes the study of behavior through experimentation and observation. Behavioral scientists’ study when and why individuals engage in specific behaviors by examining the impact of factors such as conscious thoughts, motivation, social influences, contextual effects, and habits.

Behavioral science research is diverse and expansive. There is an abundance of work showing that human reasoning does not conform to what common sense predicts. Behavioral scientists study why people sometimes behave in a way that may not maximize their own well-being, such as making choices in the present that do not maximize their happiness in the future; examining how seemingly arbitrary contextual factors influence our decisions, beliefs, and attitudes or test how different incentives affect people’s motivation and behavior.

Learn more about using behavioral science in health communications by viewing our on-demand webinar, Frictionless Healthcare: Fueling Behavior Change »

So, readers, you might be asking yourself how do you apply these ideas in healthcare or health behavior change? If we really want to drive behavior change, we need to understand how people behave. When it comes down to it, there’s a lot of human behavior that we can explain in terms of two simple forces: Friction and Fuel. A rocket ship is a helpful metaphor that Dan Ariely uses to describe behavior change. To get a rocket ship moving, you need to increase fuel and decrease friction. To change behavior, you need to increase fuel (increasing motivation) and decrease friction (removing barriers). And it turns out, these concepts play out quite well in healthcare, so let’s examine that.

The Friction

In healthcare, frictions are anything that get in the way of your member performing a positive health behavior. Friction is typically caused by uncertainty on the part of your member. They could be uncertain about how hard an action will be, how long it will take, or how much it will cost.

Technology can go a long way to uncover and decrease friction.

One way is to employ barrier messages to uncover challenges (the friction) a member may be facing. Barrier messages are specific questions posed based on research of top barriers for specific audiences with specific health actions. Barriers happen. Why not proactively create opportunities to uncover and address them?

Once the barrier is discovered, we can work to solve it then drive motivation using proven behavior science techniques. You can see examples of those barrier messages below and observe how in a short phone screen you can do a lot to try to reduce barriers and increase motivation.


The Fuel

Speaking of motivation, fuel is anything that makes a positive health behavior more appealing. This could be member testimonials that utilize people copy the actions of others in an attempt to undertake behavior in a given situation) or an offering using incentives to activate the concept of reciprocity. Or you could utilize the endowment effect in messaging (an emotional bias that causes individuals to value an owned object higher, often irrationally, than its market value) like The Behavior Change for Good Initiative (BCFG) did to boost flu vaccine rates by up to 11%. The most powerful of these vaccination texts simply used ‘reserved for you’ messaging.

One of the ways we use these concepts is in stories or fotonovelas. This format is something members are used to seeing on social media, are they are quick and viewable on-the-go.

The Big Picture

Behavioral science can be tricky, but you can use the concept of friction and fuel to make a big difference in behavior change. This post was just an introduction to friction and fuel in healthcare, but we’ll be following up with a lot more information around the specific concepts and examples of each, so stay tuned for part 2!

2023 Star Ratings: Experience Reigns Supreme as Equity Waits in the Wings

To say the events of the last two years had an unprecedented and unconventional impact on health plans would be an understatement. Fast forward from March of 2020 through the better of logic within The Extreme and Uncontrollable Circumstances Policy producing temporarily inflated 2022 Star Ratings to today. While we wait for either the end or extension of the current Public Health Emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) continues to work tirelessly to further its pledge to put patients first in all programs.

To truly put patients first, however, you have to address their needs and provide support to the plans, practitioners, and communities who care for our most vulnerable populations. Back to the traditionally timed release of the 2023 Medicare Advantage and Part D Advance Notice Part II, CMS provided plan sponsors with a sneak peek at its next sizeable agenda with an emphasis equity! This takes me back to when we first read about proposed weight increased for CAHPS® and the other member experience measures. Back when it felt nearly impossible and so much more difficult than managing numerator compliance for HEDIS® and Adherence measures. But we started taking better care of our members and alas, here we are looking at all of those 4s in the weight column of 16 separate experience measures and hoping it all shakes out in favor and balances the expected deflation in post-pandemic performance metrics.

CAHPS® and the Member Experience

CMS makes good on its promise to lend a bigger voice to the beneficiary as it proceeds with the increased weight of its member experience measures, including the Consumer Assessment of Health Plans and Systems (CAHPS®) survey. The 2022  MA-PD CAHPS survey fielding began last week and I’m sure teams are eagerly awaiting even the earliest peek at performance from their survey vendors ahead of Westat reports later this summer while the rest of us will have to wait until public data becomes available in early October. Even the best and most robust regulatory and off-cycle surveys will only represent a small percentage of members at one moment in time. Plans need more experiential and real time data around common and frequently used benefits that scales not only the entire member population, but the entire member year. mPulse Mobile has developed an event-based check-in program that not only gathers valuable member experience and sentiment data, but also has the ability to address dissatisfaction and solve common pain points in real time using its patented natural language understanding and conversational messaging.

The Extreme and Uncontrollable Circumstances Policy

As expected, The Extreme and Uncontrollable Circumstances Policy provided additional COVID-19 relief and over inflated performance numbers that will feel like a one-time get out of jail free card with the ‘better of logic’ that will not be in play for 2023 Star Ratings. This ‘better of’ method produced inflated performance numbers that will be difficult to sustain in future years. As experience continues to reign supreme, plans should prepare everyone from members to senior leadership for potential disruption and work to find ways to offset the potential loss of the one-time inflated bonus payments.

No new measures for 2023 and some moving to the display page

With no new measures for 2023 and some moving to the display page for a few years, plans will have the opportunity to continue efforts to close gaps, connect members to appropriate care, and review their data for another year. Controlling Blood Pressure makes its return to the active page with a 1x weight while Plan All Cause Readmission remains on display for one more year before returning with a 1x for 2024 Stars. Two key HOS measures, Improving or Maintaining Physical Health & Improving or Maintaining Mental Health will see their time on the display page for 2022 & 2023 as they were too disrupted by COVID-19.

HEDIS and Telehealth

HEDIS and Telehealth seem to be here to stay and work together. According to the American Journal of Managed Care, telehealth claim lines increased 3.060 percent nationally from October 2019 to October 2020. As members seek care outside of the traditional office setting, providers and payers still have a need and obligation to capture the full burden of illness and these updates include additional code sets to be allowed for measure inclusion or exclusion when captured via telehealth visits alone. This is just another example of how members, plans, and providers are embracing digital technologies. We’ll keep an eye on these flexibilities as the House recently extended virtual care flexibilities beyond the public health emergency.

Is Health Equity the new Experience?

CMS provided information on the potential development of five new equity related measures for Parts C and or D.

    • Driving Health Equity (Part C and D)
    • Stratified Reporting (Part C and D)
    • Health Equity Index (Part C and D)
    • Measure of Contract’s Assessment of Beneficiary Needs (Part C)
    • Screening and Referral to Services for Social Needs (Part C)

After two wild years of recycling data and rates due to COVID-19 to the temporarily over-inflated 2022 Part C & D Star Ratings due to the expansive extreme and uncontrollable circumstances policy, 2023 proposed changes seem to be minimal and mild in comparison. The last handful of years have had plans focusing heavily on improving their member experience with 2023 Stars rounding out the increased weights from 1.5x to 4x. Accounting for just over 50% of the plan’s overall Star Ratings weight, experience will remain top of focus for the foreseeable future. But no time to get comfortable because equity and social determinants are hot on experience’s heels with more than a handful of related measures and methodological enhancements. Proposed changes and new measure concepts must go through federal rulemaking and stabilize on the Display Page for a minimum of two years before becoming an active Star Ratings measure. mPulse Mobile has developed solutions to address and promote social determinants as well as stratify your member data within our engagement solutions to support and map to internal efforts.

It’s never too late to develop or enhance your member engagement strategy. How will you continue to wrap your arms around your members as we (hopefully) move from pandemic to endemic and beyond?

Activating Healthcare Consumer Behavior Change: Make it Personal

Key takeaways from our interview with Solome Tibebu

In the last decade, behavioral health has grown from an ancillary service offering to a critical component of health services and care delivery. According to an OPEN MINDS Market Intelligence Report, spending on mental health services totaled $225 billion in 2019, up 52% from 2009. Companies like Talkspace and BetterHelp, founded in 2012 and 2013, recognized this spike and made it their mission to increase the availability and accessibility of mental health services to those struggling to access and navigate care. Behavioral health has continued to evolve, and it is incumbent on all healthcare organizations to adopt new methods of providing care to vulnerable populations. Learning from innovative companies and forward-thinking leaders is vital to building an effective care strategy for the one in five U.S. adults living with a mental illness.  

mPulse sat down with Solome Tibebu, a pioneer in behavioral health technology and innovation, whose passion stems from the care gaps that have existed and still remain in mental healthcare. At the early age of 16 years old, Tibebu started a non-profit online resource, Anxiety in Teens, to offer education and support for teens and young adults who were struggling with anxiety and depression. After ten years, she began working in startups and consulting, continuing to advocate for the role of technology in advancing behavioral healthcare. 

This year in June, Tibebu will be putting on her third annual Going Digital: Behavioral Health Tech summit, a conference where health plans, providers, health systems, employers, investors and startups convene to discuss the evolving landscape of behavioral health. The virtual (for now) event is a great opportunity to share best practices for implementing digital resources and innovative technologies to improve access to mental health services. We are proud to be a sponsor for the second consecutive year, and we look forward to contributing to discussions around how healthcare organizations can implement solutions to tackle barriers and make mental healthcare more accessible for all.

Improving Access through Technology Innovation

COVID-19 created an array of challenges to advancing mental health access, but it also sparked a digital transformation that brought innovation to the center stage. With more consumers staying home, “tech has exploded as a response to the pandemic,” Tibebu prefaces. Technology plays an important role in understanding and addressing the social dynamics that affect each person living with mental illness. Some of the challenges that plague mental health accessibility require more than simple one-way consumer interactions, however. 

Talking about health plans, Tibebu emphasizes, “stigma is a huge barrier even after they’ve procured some kind of solution, so they need to have a strategy around how they’re gonna address stigma, and engagement of the member.” Stigma can produce feelings of worthlessness and lead to social isolation while social determinants of health (SDOH) like transportation access or income level can prevent consumers from seeking care. To tackle barriers like SDOH and stigma, it is necessary to utilize technology to understand consumer needs and preferences. 

Conversational AI and Natural Language Understanding power the capability to deploy behavioral science strategies at scale when communicating with vulnerable populations. For instance, incorporating a strategy like Affect ensures that messaging is based in empathy, increasing motivation to engage with sensitive healthcare outreach. Social Proof is an effective strategy that helps assure consumers that they are not alone and can help reduce social isolation caused by mental health stigma.  

Applying behavioral science and identifying SDOH in conversational outreach enables a deeper understanding of consumers. Once individual preferences are captured, healthcare organizations can efficiently tailor relevant content to each consumer and activate meaningful behavior change. 

Delivering Tailored Content at Scale

Incorporating clinically validated behavior change techniques helps with understanding the needs and preferences of consumers. Tibebu asks, “now all of these payers have implemented their telehealth solution but it’s the next level – how do we get something more customized, personalized to their respective populations?”  

Plans and providers can drive deeper engagement and self-efficacy by adopting tailored engagement strategies that lift utilization of the programs they’ve invested in. Conversational AI enables the orchestration of programs and resource delivery across preferred consumer channels. Natural Language Understanding helps capture important data from consumer responses to help route them to the appropriate digital resource. 

A one-size-fits-all care model fails to meet the needs of each consumer, while customization empowers healthcare organizations to intervene with meaningful content that drives behavior change. “How can you identify the consumer’s need and triage them to the right end solution?” Tibebu reiterates. Certain individuals who prefer a visual learning experience may benefit from a course like Living with Anxiety & Depression, while those who respond better to audio can be directed to a podcast like Mental Health Matters. 

Providing on-demand, curated content can motivate consumers to take control of their health and execute healthier behaviors, leading to improved outcomes and a better consumer experience.

Impacting Beyond Mental Health

We asked Tibebu why personalization in mental healthcare should be important to payers specifically. She responded, “because mental health is at the vortex of all health…for all of these other conditions, expensive conditions, that are impacted as a result of poor mental health.” Consumers who are negatively affected by mental health are more likely to develop chronic conditions, which piles up costs for both the consumer and the organization providing services. This creates an opportunity for plans and providers to adopt innovative solutions that promote well-being through tailored engagement. 

MagellanRx Management serves a complex population and recognized the need to incorporate well-being content for their members who were experiencing loneliness and anxiety from COVID-19. They partnered with mPulse to deploy digital fotonovelas, which use culturally sensitive stories in a comic-strip format to improve health education and activate diverse populations. The program drove impressive outcomes, yielding over a 38% engagement rate and a 90% member satisfaction score. 

We questioned how organizations outside of payers and providers can “step up” to make mental healthcare more accessible. Walmart Wellness is a nationally recognized brand whose goal is to “help customers raise their hand and more easily access their hubs,” Tibebu clarifies. Walmart partnered with mPulse to implement SMS solutions along with streaming health education to drive their customers to the right well-being resources. The program included custom learning plans across several wellness topics and produced significant improvements in customer engagement. 

After chatting with Tibebu, we are reassured that mental healthcare should be the focal point of an effective engagement strategy. Innovative companies can promote mental well-being and health literacy by leveraging technology that personalizes outreach. Educating consumers with tailored content through timely and convenient engagement builds self-efficacy and lasting behavior change.

Learn more about Conversational AI and streaming health education here.