Patient Engagement

Consumerism in Health Care

Article · January 11, 2018

Many have heralded the wave of consumerism that is coming to health care, but less has been written about how tried-and-true consumer engagement practices are benefitting this sector. I come from a family of physicians and previously worked in the consumer industry as the leader of one of the largest frequent-flier loyalty programs in the world. I joined Humana, a U.S. health insurer that strives to improve the health of seniors living with chronic conditions, because I believe that these practices can be applied to engage our members in their health. Our early experiments have shown promising results.

What Is Consumerism in Health Care?

While there are several possible ways to define consumerism in health care, I think of it as the personalization of care to facilitate health outcomes. To help an individual, the health care sector can offer a choice of services, provide expert suggestions, and facilitate consumer interactions with trusted organizations and individuals.

Ultimate personalization, that is, a “one-to-one relationship” between a company and an individual, is increasingly possible with the data and analytics that are now within our reach. However, organizations still need to build the capabilities that are required to deliver that high degree of personalization. A very productive step that the health care industry can take toward the goal of ultimate personalization is managing its customer base in ever-more-discrete segments. When I first joined the health care industry, I was struck by the relative simplicity of the customer segments that were used; in clinical studies, for example, segments are largely based on age, sex, and race. The consumer sector uses much more complex behavioral segmentation that considers not only these demographic factors, but also the behaviors exhibited by individuals in their interactions with companies. For a health insurer, the available behavioral data include patient interactions with both payers and providers. All of these dimensions can be used to cluster people into behavioral segments that can provide richer insights.

There’s No Accounting for Taste (or Budget, Time, and Biases)

Given the same set of options, people make different choices, have different tolerances for risk, enjoy different activities, and so on. The realization that individual choices are driven not only by personal tastes, but also by budget constraints, time constraints, and cognitive biases has led to the provision of tailored services in the consumer sector. One of the classic issues in managing long-term health is that people have a bias to the present, resulting in actions that are inconsistent with their desired future outcome — for example, choosing to sit on the couch and eat a bag of chips rather than exercising to increase heart health. As the consumer sector has done, we can use such knowledge to tailor health engagement approaches on the basis of individual behavior. Indeed, with the advances in precision medicine, we can even go a step further by tailoring treatments based on both genetics and individual behavior.

Personalizing Services for Airline “Road Warriors”

One of the ways in which we were able to personalize service in the airline sector was to understand the specific needs of individuals. In that sector, the term Road Warrior emerged from a specific study demonstrating that a single-digit percentage of the customers were driving one-third of the profits. Catering to the needs of these Road Warriors drove the delivery of new services for frequent fliers. Years later, while searching for ways to improve services further, we realized that these Road Warriors were not all the same: some wanted high-touch service, whereas others wanted to breeze through the airport without talking to anyone. This insight was a major impetus for the development of computerized kiosks and mobile applications.

Humana’s Journey to Personalization

In a similar fashion, we are developing a deeper understanding of our members at Humana today. Similar to how all travelers do not engage with airlines homogeneously, consumers engage with their health and health care providers in a wide variety of ways: from health service maximizers on one side to individuals who would rather not accept (and therefore ignore) their condition on the other side, with many segments in between. Some will say, “we know that these segments exist already.” The advancement is the ability to proactively categorize each member into a behavioral segment. To that end, we are experimenting to identify which tactics, messages, or experiences drive the behavior of specific member segments.

Using Personalization to Increase Medication Adherence

One area of focus at Humana has been medication adherence. We have learned that some tools are only effective for specific subgroups, and sometimes only in specific situations. In one test, we shared a “scorecard” with nonadherent members that showed how their current adherence compared with a desired adherence level. As many people tend to overestimate their medication adherence, the hypothesis was that providing members with their actual information might motivate them to improve. In a second test, we applied the concept of “Fresh Starts” to medication adherence by scheduling messages to arrive at times when members might be more open to behavior change, such as New Year’s Day or a birthday. In both of those these studies, we thought that the experiments had failed when the results were measured across the entire membership base. However, filtering the results according to behavioral segments showed an intriguing result, namely, that each experiment was successful in engaging at least one of our least-responsive segments.

We also have found that it is helpful to intervene with our members based on their attitudes toward their health, which are often revealed by their behavioral segment. For our member segments with the lowest adherence, for example, we hypothesized that a high-touch, hands-on approach was needed. Some members have hundreds of prescription refill opportunities a year, with some prescriptions being refilled this week, some next week, and so on. We hypothesized that having all refills come due simultaneously would reduce the number of opportunities for these members to miss or delay a refill. The ability to synchronize medication delivery resulted in substantial improvement among patients with poorer baseline adherence, with 23% to 26% improvement in the intervention group, compared with 13% to 15% improvement in the control group. When we synchronized the prescriptions of members who previously had been refilling on time, we noted a small but significant improvement in adherence. The development of a personalized service was especially effective for many of our most at-risk and less-adherent members.

In addition to diverse attitudes toward their own health, our members have varying attitudes toward Humana as their health insurance provider. For some of our more skeptical members, we may not be at the center of their circle of trust; insurance payer–initiated campaigns may meet resistance. The same medication adherence message that may be treated with skepticism when received from a payer may be viewed differently when received from other sources, such as primary care physicians, pharmacists, and even celebrities. We have tested these voices to identify which ones serve as the best “medication adherence spokespersons” and are now using this information to promote healthy behaviors for different target segments.

Personalization: A Powerful Paradigm

We believe that the cultivation of a mindset that views our members as individuals, with different personalities and preferences, is a powerful paradigm that can allow us to help our members to achieve their best health. We are still in the beginning stages of delivering personalization. The results from the first steps of managing segments of members is highly encouraging.


Disclosure: Robert Sahadevan formerly led United Airlines’ Mileage Plus frequent-flier program.

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