Healthcare organizations need consumers actively involved in their own care in order to dramatically improve outcomes. As such, healthcare organizations, including health plans, need to forge partnerships with consumers.

Deborah McMahon, Senior Vice President, Aveus, a division of Medecision

Healthcare organizations need consumers actively involved in their own care in order to dramatically improve outcomes.

“Medical professionals have known for years that they can’t do this alone. If a clinician prescribes a medication to tackle a clinical problem, the consumer must take the prescription. We know that to improve clinical and cost outcomes, consumers have to be willing participants,” said Deborah McMahon, Senior Vice President of Aveus, a division of Medecision.

As such, healthcare organizations, including health plans, need to forge “partnerships with consumers. And, to make those partnerships successful, healthcare organizations have to rely on some engagement tactics that work,” McMahon pointed out.

The goal is to transform consumers from passive recipients of care to active participants in their own care. To accomplish this, healthcare organizations often need to get consumers to change their behavior. There are many effective change models but an easy one to make the point is the Fogg Behavior Model, which was developed by Dr. B.J. Fogg, founder of the Behavior Design Lab at Stanford University. The three basic elements of this model need to be in place:

Motivation: Consumers have to be sufficiently motivated to change their behavior.

Ability: Consumers must have the ability to do the behavior

Trigger: Consumers have to be triggered, or prompted, to do the behavior.1

However, the focus tends to be on triggers versus providing consumers with the motivation and ability to change behavior.

“Healthcare organizations might put up a poster, send out a brochure, create an app, place a telephone call, and think that those triggers will be enough to change consumer behavior,” said Tamara Cull, Senior Vice President of Portfolio Management at Medecision. “This rarely works, though, because the motivation and the ability to change are lacking.”

Tamara Cull, DHA, Senior Vice President, Portfolio Management, Medecision

Consumers often don’t have the motivation or ability to change because they don’t have access to their care plan or estimated costs. As such, they don’t have a clear understanding of how to move forward.

“The lack of information leads to a certain inertia or lack of action. They might think that a certain care intervention will cost an ‘arm and a leg’ so they will simply avoid it and neglect their health issues,” Cull said.

When health plans provide access to care management and cost information, consumers are more apt to have the motivation and the ability to change their behavior. Engaging consumers to become more hands-on in their care empowers them to improve their health and wellbeing.

Health plans can encourage consumers to become more engaged in their care by focusing on five critical components of care:

Using analytics to figure out where to start. With technology solutions such as the Medecision Aerial solution, it’s possible to “identify which members are struggling, and which ones the plan should start with. By leveraging data and analytics, it is now possible to more efficiently identify which members are in need of personalized care management,” McMahon said. “Before it was very hard to know where to start. If you were given a risk-bearing contract for 5,000 people, it would be difficult to determine which members needed services. You had to talk to all 5,000 and figure it out.”

Taking a holistic approach. Medecision’s Aerial solution also makes it possible to get the full picture. “Many members have behavioral health or mental health issues. Maybe it’s even just anxiety and depression. But if those are areas that they’re struggling with, and the health plan wants them to start a new healthy diet program, for example, they will not be successful. So, it’s important to conduct a holistic assessment to identify everything that is impacting their health,” McMahon pointed out.

Making it personal. Health plans typically implement disease management programs that focus on specific conditions such as diabetes.

“The engagement in those types of programs is very low,” Cull said. “To get consumers more involved, health plans need to develop more personalized programs that address each member’s needs. Instead of focusing on a disease, these programs would address the specific health and wellness issues that each member is dealing with.”

Following the consumer’s lead. A care manager could easily identify the five problems that a member needs to work on — and could then prioritize them in a logical order. “To effectively engage the consumer, though, you need to start with what they want to start with. You will eventually get to all the problems, but you need to start with what the member thinks is most important,” McMahon said.

Focusing on delivering care where consumers live — in the community. “In the past all care was delivered within the four walls of a healthcare organization. With so many technologies and mobile devices now available, though, care can be delivered to members in the community. So, they can continually receive services, instead of having to wait for services to be delivered in-person,” McMahon said. “It has become clear that what happens in-between provider visits is as important — in some cases more important — than what might happen during the visit.”

If health plans can focus on these five components, they will be on a better path to transforming consumers from passive recipients of care to active participants in their own care, which really is the end goal.


1. Daring to Live Fully. A Failproof Model for Triggering Behavior Change

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