Changing patient behavior: The next frontier in healthcare value

Articles

To address the rising cost of chronic conditions, health systems must find effective ways to get people to adopt healthier behaviors. A new person-centric approach to behavior change is likely to improve the odds of success.

Changing individual behavior is increasingly at the heart of healthcare. The old model of healthcare—a reactive system that treats acute illnesses after the fact—is evolving to one more centered on patients, prevention, and the ongoing management of chronic conditions.

This evolution is essential. Across the globe, a fundamental shift in healthcare risk is taking place, driven by an aging population and the increasing incidence of behaviorally induced chronic conditions. Health systems are innovating on the delivery side to meet this chal­lenge through a growing emphasis on primary care, integrated care models, and pay-for-value reimbursement.

Yet more must be done to reorient health systems toward prevention and the long-term management of chronic conditions. In an analysis we conducted of US healthcare costs (which are now nearing $3 trillion annually), 31 percent of those costs could be directly attributed to behaviorally influenced chronic conditions. Fully 69 percent of total costs were heavily influenced by consumer behaviors. Poor medi­cation adherence alone costs the United States more than $100 billion annually in avoidable healthcare spending.1 The burden consumer choices place on low- and middle-income countries is similarly staggering: Harvard and the World Economic Forum have estimated that noncommunicable diseases result in economic losses for developing economies equivalent to 4 percent or 5 percent of their GDP per annum.2 Unless health systems find ways to get people to change their behavior (in terms of both making healthier lifestyle choices and seeking and receiving appropriate preventive and primary care to manage their health conditions), they will fail in their quest to tame healthcare costs without impairing care quality or access.

Designing and implementing programs that enable people to achieve sustainable behavior change is hard. Few programs tried in the past achieved sustained impact. However, many of these interventions were rooted in the old model of healthcare, focusing on the treatment of clinical problems after an acute event. Too often, the interventions had poor program design, insufficient measurement rigor, and implementation issues. The failures led many health system leaders to be skeptical about whether any behavior change program can achieve long-term impact. We believe that behavior change programs can succeed, but only if their design paradigm is rethought. This article describes an emerging approach—a person-focused paradigm that uses a behaviorally based rather than disease-based orientation to drive sustainable behavior change. Instead of assuming that individuals are fully rational, it recognizes that human decision making is affected by systematic cognitive biases, habits, and social norms. Instead of focusing exclusively on the clinician-patient relationship, it seeks to create a supportive ecosystem that engages individuals and those closest to them. Our perspectives draw on an analysis of global trends, our extensive experience working with clients throughout the healthcare industry on this topic, and interviews with leading experts. They are grounded in emerging insights from the behavioral sciences that shed light on how individuals actually make decisions, as well as new technological advances. Leveraging these insights, we have developed an integrated frame­work to help healthcare organizations across the value chain understand the new paradigm and how they can design and implement high-impact, patient-focused interventions.

This originally appeared in Health International

  1. Osterberg L, Blaschke T. Ad­herence to medication. N Engl J Med. 2005;353:487-97.
  2. Bloom DE et al. The Global Economic Burden of Non­communicable Diseases. World Economic Forum and Harvard School of Public Health. 2011.