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
+
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!