A number of proposed interventions to improve patients’ health behavior appear cumbersome, or require additional people and time, notes Scott Halpern, Deputy Director of the University of Pennsylvania’s Center for Health Incentives and Behavioral Economics. What are the key components to designing programs that ultimately have the potential for scale?
Dartmouth College marketing expert Punam Keller emphasizes “segments of one” in helping patients overcome barriers to changing their health behavior, such as in the example of her heart study. “You are identifying people’s barriers and you’re tailoring solutions right there on the spot, based on the information that you have in your toolkit,” she says.
In another example, a study on voluntary medical male circumcision to reduce the acquisition and spread of HIV/AIDS virus in southern Africa faced a “long list” of barriers, such as issues of masculinity and a perceived license to cheat on one’s partner. But the study persisted, and in less than four years, the market for voluntary male circumcision grew from almost zero to 1 million. How did the program scale? “You create demand for it,” says Keller. “You make it legitimate. You make it pervasive. It’s no longer taboo.” Then, she says, you let others take over the market while you “go create demand for resolving another health issue somewhere else.”
Harvard economist David Laibson highlights three effective tools for creating low-cost scalability in health care: automaticity, active choice, and logistical simplification.
- Automaticity: “By and large, people go with the flow if you’re creating something that they want,” Laibson says. “Typically, if it’s well designed, it is something that they want.” Automatic processes typically lift participation by about 70 or 80%, according to Laibson.
- Active choice: If automating a process is inefficient, compel people to make an active decision instead, advises Laibson. “Do you want to have an appointment? Yes or no. You force the choice,” says Laibson. “Now they’re actively engaged, they’re making an active decision.” Active choice can result in a 40 or 50% lift in participation.
- Logistical simplification: This involves stripping the forms for your processes down to their most basic elements. “If you have a five-page form, often you can shrink it to a half-page form,” says Laibson. Logistical simplification typically only results in 10% extra participation, but, as Laibson reminds us, 10% is still progress.
From the NEJM Catalyst event Patient Engagement: Behavioral Strategies for Better Health at the University of Pennsylvania, February 25, 2016.