Patient-Centered Care Skinner meets Prochaska to M otivate Health Behaviour Change

Patient-Centered Care Skinner meets Prochaska to Motivate

Health Behaviour ChangePresented By

Susanne CooksonCynthia Hastings-JamesCo-founders

What We Know Today

For 100 Average North Americans…

Roughly;• 25 have cardiovascular disease • 12 are asthmatic • 6 are diabetic • 26 have high blood pressure • 30 have high cholesterol • 38 are overweight • 21 smoke • 31 use alcohol excessively • 63 don’t exercise enough to gain

health benefit • 44 suffer from stress

By 2020, chronic diseases will account for almost

three-quarters of all deaths worldwide

http://www.who.int/nutrition/topics/2_background/en/index.html

5

The Vast Majority of Chronic Disease Could be Prevented

The World Health Organization (WHO) estimates that…– At least 80% of all heart

disease, stroke, and type 2 diabetes, and more than 40% of cancer

would be prevented if only we were to do three things:

Stop smokingStart eating healthyGet in shape

World Health Organization (WHO), Preventing Chronic Diseases: A Vital Investment (Geneva: WHO, 2005).

Let’s Explore Key Trends

• Patients are becoming “super-consumers”– Internet, social media, smartphones, self care movement – Incentives driving patients to take more responsibility for

their health decisions• “Value mining” — what is the relative value of

interventions? – EHRs and social media are creating an explosion of data

Adapted from Progressions The third place: health care everywhere, Ernst & Young, Global Life Sciences Center, 2012

Evolution of the Patient Role In Healthcare

Evolution of Patient Role In Healthcare

“Old School” Medical Model

Patient is passive, receives treatmentPhysician dominates the conversationCare is disease-centered

Physician is the “quarterback”, decision-makerPatient not likely to adhere

Evolution of Patient Role In Healthcare

“Old School” Medical Model

“Super-consumers” Taking Ownership

Patient is passive, receives treatment

Patient is active, a partner in the treatment plan

Physician dominates the conversation

Physician listens more, collaborates with patient: discussion re: pros and cons

Care is disease-centered Care is quality of life-centered, prevention strategies

Physician is the “quarterback”, decision-maker

Patient-centered healthcare team collaboration

Patient not likely to adhere More likely to adhere when treatment accommodates for needs/culture/values

BUT Daily Lifestyle Decisions Remain a Challenge

We tend not to feel “connected” with our future selves, and thus adopt behaviors that please our present selves (whether or not we recognize the incipient harms to our future selves)

Bartels DM, Rips LJ. Psychological connectedness and intertemporal choice. J

Exper Psychol: Gen 2010; 139: 49-69

We Don’t Consider the

Consequences

People are Irrational

Given our health “superconsumers”, what are the best practices in consumer marketing to drive engagement

and behaviour change?

Consumer Marketing Best Practices:Loyalty Programs

Loyalty Program Participation On the RiseOver 2 Billion Loyalty Program Memberships in the

US Alone

http://www.colloquy.com/files/2011-COLLOQUY-Census-Talk-White-Paper.pdf

Translating the “points craze” to health behaviour change

Moving Forward

“…everybody engaged in health care will inevitably find themselves in the behavioral change business.”

Progressions The third place: health care everywhere, Ernst & Young, Global Life Sciences Center, 2012

Behaviour Change is Complex

http://live-the-solution.com/blog/category/mind-map/

Bottom Line

Provide personalized care plans that address multiple motivators and drive sustainable and measurable

health behaviour change.

Skinner meets Prochaska

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B.F. Skinner

“What gets rewarded, gets repeated!”

If this, then that works when …

– There is a simple set of rules– Focus – User can see the goal

Prochaska

Identify Stage of health behaviour change

Creating – Autonomy– Mastery– Purpose

Behavioural Economics

Using Incentives to Boost Engagement in Healthy Behaviours

Systematic reviews by Stone et al. (2002) and Sutherland et al. (2008) show that financial incentives consistently improve ‘single shot’ preventive care behaviours like vaccinations, clinic attendance and cancer screening.

Using Incentives to Boost Engagement in Healthy Behaviours

Systematic reviews by Paul-Ebhohimhen & Avenell (2007) and Burns et al. (2012) show that financial incentives can serve as a potent catalyst for weight loss. Volpp et al. (2008) and John et al. (2011) are examples of high-caliber studies, published in high-impact journals that produced significant weight loss of about 14 and 8 lbs at 4 and 8 months, respectively.

Using Incentives to Boost Engagement in Healthy Behaviours

Volpp et al. (2009) examined the role of incentives in increasing smoking quit rates. They found that 6 months after the incentives were withdrawn the incentivised group maintained a higher quit rate than the control group.

Using Incentives to Boost Engagement in Healthy Behaviours

A scan of the literature re impact of financial incentives for weight loss, exercise and/or smoking in workplace revealed that 84% of the studies had significant favorable effects in the intervention groups.

Health Promotion Innovation A Case Study from Canada

Healthy rewards for a healthier you

• Universal health loyalty program involving all stakeholders in healthcare

• Puts users in control • Centralized, scalable, turn-key

solution• Advisory Board & multiple

stakeholders…

BestLifeRewarded: Coalition Partners and Collaborators

Medication Adherence

HospitalDischarge

plans

Personal Health RecordsGovernment

Non-profit Prevention

Employers

GeneralPublic

BestLifeRewarded: A Coalition Approach

BestLifeRewarded.com

A “coordinated assault” with multiple

stakeholders and funders through co-branded micro-sites

and targeted wellness programs

Stand-Alone “White Label”

Incentive Program s

Skinner meets Prochaska

Driving Sustainable Behaviour Change

Extrinsic Motivation

Segmentation, HRA

Personalized Motivational Messaging, Education & Tools

Track Results (reward efforts and outcomes)

Continued Engagement & Encouragement (online and offline)

Intrinsic Motivation

Employees, Consumer, Patients

Sustainable Health Behaviour Change

Partner Microsites (employers, NGO’s, hospitals, pharma, etc)

Members earn points by; Completing custom training

modules Making pledges to get healthy

(nutrition, activity and/or smoking cessation)

Learning about safe and effective use of medication

Tracking results Becoming more health literate Medication and lifestyle

adherence Participating in all

BestLifeRewarded tools...

Personalized Member Dashboard

General health content – 30+ modules developed in partnership with NGO’sSegmentation Surveys, HRA’sHealth Trackers – BP, blood sugar, cholesterol, weight, COPD, etcPersonal goal setting/trackingRegular email communicationsMedication and lifestyle remindersRewards store Links back to sponsor wellness web site

BestLifeRewarded Education

Redeem for 200+ Existing Health Rewards

Donate points to charityOther “custom” reward offerings

Employer Wellness Program Case Study: Ministry of Health Pilot Flu Shot Program

Challenge: Ontario Ministry of Health looking to implement workplace programs in increase uptake of the flu shot for 2011 season

Solution: – CJL secured a workplace with a 5-year history of on-site flu clinics– CJL implemented online education on the myths and facts of flu shot

• Employer promoted the education via email and intranet• Employees logged on to BestLifeRewarded, completed the module and received points

for completing Q&A and survey on intent to get the flu shot (clinic or doctor office)– CJL provided “thank you” cards with bonus points for employees following

vaccination at the on-site clinic• Employees entered PIN code on BestLifeRewarded to collect points

Results: 34% increase in uptake of flu shot vs. 2010 with the addition of BestLifeRewarded education and incentive program

One Final Thought on Motivation

http://youtu.be/gimcdV-8FzY

Progressions The third place: health care everywhere, Ernst & Young, Global Life Sciences Center, 2012

Thank you!