By Evereth Woodruff 
It’s been four years since The World Health Organization declared that “behavioral science is underutilized in public health, and ineffective behavior change techniques continue to be used.” A small number of innovative health systems and plans have incorporated technology and cultural integrations that recognize the comprehensive cognitive, social, and environmental drivers and barriers that influence member behaviors. However, progress has been slow and the benefits under-recognized as the trendlines for American adults reporting one or more chronic conditions like cancer and diabetes continue to worsen.
The care for these individuals accounts for 90 percent of the $4.5 trillion the U.S. spends each year on healthcare, according to the CDC, a number that continues to climb annually. This makes improving care management outreach more than just important — it makes it vital to turn the tide on spending and strategies that benefit members and those providing and paying for their care.
Here are three key areas where behavioral science can significantly impact plans and their members – and why.
Care management outreach: Beyond the “what” to the “how”
Whether it’s medication management tools, patient education materials, or communications about managing multiple conditions, care management outreach needs to be individualized. The conundrum is that traditional means of outreach are not.
Yes, analytics can tell us when a member is most likely to open an email, and in what condition they are trending to push them in the best direction before such conditions become chronic. But after the “what” is established, it’s the “how” that’s still communicated manually or via batch-send emails generated much the way mass-market footwear retailers advertise.
The answer lies in truly personalized outreach that puts us in each member’s shoes to optimize engagement. Today, that’s less of a Sisyphean hike than ever before when artificial intelligence capabilities are united with behavioral design principles. Digital outreach can be designed in the language a member uses at home, vary the images to reflect the ethnicity, age, and geography of patients, and be sent in a way that prioritizes the most important conditions first without overwhelming the recipient with message volume.
Member engagement: From the “we” to the “me”
Personalized member outreach, designed and deployed at scale, is also about much more than smarts – it’s about feelings and perception. Imagine if I see someone who looks and speaks like me in a text message or email, or I get a follow up message checking in to see if I have questions about my prescription or a recent medical appointment? The ability to curate personalized communications clearly intended for the “me” — not the “we” — goes a long way toward firming up tenuous member trust levels and improves health literacy and education.
Behavioral science united with AI is just the shot in the arm that many health plans need to flip the script from transactional outreach such as bill payments or benefit explanations to educational and perhaps even inspirational. For all the talk of healthcare gamification, there’s been little progress when it comes to kudos for a “job” well done. Personalization platforms have the power to transform outreach that lauds member actions such as scheduling and attending healthcare appointments, or reducing blood pressure for those involved in remote patient monitoring, for instance.
Lower costs: From reactive to proactive
Health plans and systems know that we have a much larger communication problem than a care challenge. They recognize what needs to be done, but just need the means to connect the dots and nudge patients and members in the best direction. That’s a direction that promotes the best outcomes – and experiences – at the lowest cost.
With advanced personalization technology and enhanced trust, we can guide those with the highest and costliest needs to in-network services, sooner. This can stave the tide of spiraling costs and contribute to data access and transparency that reduces the need for duplicative services.
It’s also worth considering value in the cost equation. The earlier a member engages to be treated for breast cancer so that it doesn’t progress from Stage 2 to 3, for instance, the less it costs a payer to support that care (about 40 percent less, in fact, in the 24 months following a diagnosis). Measures like NCQA and HEDIS aside, earlier action and treatment yield a quality of life score that’s undeniably better for the member, and more sustainable for those responsible for their care.
How personalization will help us meet yesterday’s and tomorrow’s promises
It’s been almost two decades since the Institute for Healthcare Improvement articulated the Triple Aim: improving the care experience, improving population health, and reducing the costs of care. Yet, only sluggish progress has been made. Today, we have the opportunity to revolutionize that trifecta by incorporating advanced behavioral science with computer science. It’s time to harness largely untapped resources to rethink not our goals, but how we achieve them.
Photo: Thanakorn Lappattaranan, Getty Images
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