True Healthcare Engagement is Not About "Likes" and "Thumbs Up"
By Jeff Margolis
For many years, digital consumer engagement meant getting eyeballs on things, namely ads and getting people to click through those ads to generate revenue, but taking action is the only metric that matters in health.
The core concept of consumer health is the notion that consumers take more responsibility and control of their health. For so long, healthcare has largely been paternalistic – a doctor diagnosing care, a nurse providing discharge orders, an insurance company offering a well-baby checkup. It’s only in recent years, with the cost of care shifting and the definition of health expanding beyond clinical care, that consumers have become more central players.
This has led to organizations including health plans, providers and employers to focus more on getting people “engaged” in their health before they get sick to keep costs down and improve overall population health. Furthermore, the rise of digital health – from tracking devices for sleep or activity monitoring, to mobile applications for guided meditation, nutrition and more, has compounded the idea of engaging individuals. With this massive intersection of digital and consumer health, it is no wonder that engagement materialized as a desirable and measurable goal. Yet, in reality, engagement is unsubstantiated and meaningless on its own.
The evolution of engagement
For many years, digital consumer engagement meant getting eyeballs on things, namely advertisements, and getting people to click through those ads to generate revenue. Then, along came applications that also demand consumers’ attention and measure success based on the frequency of launches and how much time was spent in the app. Company executives would look at monthly or daily active users (MAU/DAU) as a means to evaluate success – the frequency of engagement. And many applications use endorphin-driven “likes”, which are interesting, but irrelevant to the improvement of health. While those may be meaningful metrics for Facebook or Fortnite, they are not as absolute in the consumer health world.
As the consumer health industry matures and evolves, it should become apparent that views or duration are not what makes the difference. Consumers’ actual involvement in activities that impact their health is the key to transformation. Many players in the consumer health industry are measuring the wrong metrics for success (namely, clicks and views) and it is a disservice to us all. Collectively as an industry, we should be looking at actions taken. It’s not just the number of lives you touch or have the potential to touch, but rather getting people to do the one, few or many things that will have a real impact. A person visiting a health portal or hub on a daily basis is meaningless unless they literally take action and do what is recommended to them. Once the individual engages, do they actually accomplish the desired activity or simply encounter the content and move on?
It’s all about actions
There is strong consensus that the majority of what drives a person’s health status is not genetics or clinical care, but rather environment and daily living (social determinants of health). While certain aspects of one’s environment are not controllable, people make manifold choices that impact their health everyday. What did they eat for breakfast? Are they managing an existing condition like diabetes or asthma? How much physical activity do they get in a given week? Did they take time for themselves? These examples and many more illustrate actions a person may or may not take.
As the healthcare industry collectively works to moderate skyrocketing health costs, individual taking actions to improve or sustain their health and wellbeing is an imperative. One action taken to improve one’s health becomes many actions taken by many individuals, which translates to a lift in overall population health. While various analytic approaches can define next best action these analytical findings are of little value, unless the action is taken. Therefore, the key metric of success for the health entities who sponsor health and wellbeing programming for consumers should be, “Did they complete the recommended action?”
Most employers, health plans and pharmacies sponsor flu shots, and some even incentivize consumers to get the vaccine. The costs associated with a person getting or spreading the flu (absenteeism, hospitalization, etc.) are significant enough that it is more cost effective to encourage consumers to take evidence-based preventative action. To evaluate how many people read an email about the flu shot or how many eyeballs saw a poster about it in the office is useless – the real measurement is the number of people who took advantage of the offer and signed up to get a flu shot. Similarly, is participating in a particular step related to managing diabetes, such as attending a coaching session about managing A1C levels and verifying that the person understands what they need to do.
It is worth noting that consumer health actions vary at an individual level, and must be served up as such. Connecting a 30-year-old expecting female with a prenatal support group, prompting an elder male to get a colonoscopy screening, and so on. Providing individualized recommendations exponentially increases participation, as well as maximizes the investment of the program sponsor. A generic wellness program cannot be imposed on broad-based populations. It is ineffective and inefficient to apply a one-size-fits-all model to population health. Requesting all consumers to complete all actions will result in little to no action. Unfortunately, 84 percent of American workers feel that their company offers the same resources to everyone – and not surprising, over 80 percent said they would participate more if programs were personalized. It may be easier for health entities to roll-out programming universally, but it will not breed success. The only way to achieve high-level population health goals, like closing gaps in care, increasing medication adherence and so on, is to target specific actions to specific people.
A call to action
The consumer health industry is making progress driving toward this more meaningful and measurable goal of consumer action. A popular way to do so is incentivizing people to get more actively involved in their health and reward participation or outcomes. According to the National Business Group on Health, nearly nine out of ten employers (86 percent) offer financial incentives as part of their wellbeing platform, and the average employee incentive amount increased to $784 for 2018, a 50 percent increase from the average of $521 just five years ago. Recently CVS announced it is offering Apple Watches for active health participation, further supporting the shift to action-based programming and evaluation.
Some public consumer health companies report bloated and pedantic results such as the volume of registrants of a platform, or frequency and duration statistics, which does not even hit baseline engagement. Measuring real impact – did a consumer complete a targeted activity – has become the primary measurement for many stakeholders in the industry. We report on the volume of activities completed ranging from refilling a prescription or attending a financial planning session to quitting smoking or reducing body mass index by five percent. The micro level of individuals taking these types of necessary steps to improve or maintain their health is what will have a macro impact on populations and the entire health industry.
In a passive world of likes and views, taking action is the only metric that matters in health. We owe it to the individuals who benefit from the actions taken as well as the purveyors of health and wellbeing programs. This is not only a call to action for the industry, but for consumers to take more action too. Now that deserves a thumbs up.
At Welltok, we take a data-driven, personalized approach to get consumers actively involved in their health whether it's closing a gap in care, improving medication adherence or managing a chronic condition. If you're interested in learning how we can do this for your population, let's talk.
Original article appeared in MedCity News - August 2019