4 Ways to Shape Healthcare Through Meaningful Behavior Change

Matthew Loper

How behavioral economics can help us stick to more than just a New Year’s diet
The advent of a new year often brings a renewed resolve to change—whether that’s waking up earlier, drinking less caffeine, spending more tech-free time with friends, or getting outdoors everyday. Yet achieving that long-term behavior change is easier said than done. 
In fact, Strava—a popular fitness tracking app—shares that of its 800 million user goals and activities set, most of them have been quit by January 19th. And broader studies show that 80% of individuals abandon their New Year's resolutions by February. 
While this trend is concerning when considering individual goals, it becomes even more concerning when considering how to best help members and patients achieve positive behavior change for long-lasting health. 
The role of behavioral economics
The same principles that help us make and achieve individual growth goals can be applied to building better habit formation in healthcare. 
Behavioral economics rethinks the way we build habits and change behavior—utilizing principles that account for and address human weaknesses to strengthen the likelihood of success in achieving change. In healthcare, this means making extra efforts to anticipate common pitfalls members face when trying to take medications, get required preventative care, eat healthy meals, or otherwise follow prescribed care plans.
Leveraging behavioral economics to overcome present biases through regular reminders and intentionally-structured incentive programs can be effective in creating lasting behavior change for members to help better manage chronic conditions. 
Example one: Increasing use of medical devices
Worldwide, 24% of individuals use or have used connected medical devices to help manage chronic conditions, and that number is likely closer to 60% in the U.S. Ensuring consistent device use, however, is a different story. 
In a study measuring regular usage of a glucometer, only 59% of adults with diabetes used their glucometers as prescribed. 
Behavioral economics can help members increase use of prescribed medical devices by forming habits that make remembering to use devices easier. In a Wellth program using behavioral economics, adherence to daily glucometer readings increased to 89%, resulting in lower HbA1c and a reduction in ED utilization for enrolled members. 
Example two: Achieving better quality of sleep
Sleep apnea impacts roughly 22 million Americans, leading to fatigue, depression, and physical conditions like high blood pressure, acid reflux, a weakened immune system and more. While CPAP machines can be effective in improving sleep, studies show that, generally, one-third to one-half of individuals prescribed a CPAP machine fall into nonadherence within a year of beginning the CPAP treatment.
Members enrolled in the Wellth program show different results. 
Using behavioral economics, Wellth incentivized members to use their machines—offering $75 in rewards for proper machine use 70% of the time. Members who did not meet the 70% lost their entire reward.
By offering the incentives upfront—a principle known as the endowment effect—adherence improved. As a result, Wellth-enrolled members achieved 82.4% usage compared to 62% for control groups. 
Example three: Improving diet
Gestational diabetes accounts for $636 million in care costs each year, impacting 10% of pregnant women. Successfully managing gestational diabetes requires a careful and often complex care regimen—including healthy meals, regular glucometer checks, and insulin—leading to a less than 7% successful adherence rate for diagnosed mothers. 
With daily check-ins, adherence to diet (and subsequent controlling of blood sugar) becomes easier with increased accountability. Leveraging behavioral economics to make these check-ins a habit, a daunting regimen becomes something manageable. As one Wellth member—enrolled in the gestational diabetes program to improve her eating and glucometer habits—shares: 
“I keep a notebook of my blood sugar levels. Wellth helps me track the times and dates for my own records. I think any woman that is expecting and has sugar problems should use the app. It’s very helpful.”
Example four: Medication adherence 
Although studies have shown the strong correlation between strong medication adherence and improved outcomes for members with COPD or congestive heart failure, many individuals with these conditions still struggle to take medications as prescribed. This can lead to high readmission rates and poor overall outcomes. 
At AdventHealth DeLand, Wellth was implemented to help address the intent-behavior gap stopping individuals from taking medications as prescribed. Enrolled members were incentivized to take and submit photos of each time they took their medications as prescribed, and would lose some of that incentive each time they missed a day. 
Not wanting to lose the incentive (a behavioral economics principle known as loss aversion), adherence increased—achieving 91% average adherence—and subsequently readmissions fell 57%. 
Rethinking how we think about goals
The Wellth team has recognized that we’re able to most effectively improve the health of those with chronic conditions when we embrace—not ignore—our humanity, and create programs that enable people to succeed despite human weaknesses. 
When it comes to achieving our own goals as individuals or as healthcare providers, adopting that same empathy can help. 

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