Patient-Centered Care Skinner meets Prochaska to M otivate Health Behaviour Change

1. Patient-Centered CareSkinner meets Prochaska to Motivate Health Behaviour Change Presented By Susanne Cookson Cynthia Hastings-James Co-founders

2. What We Know Today

3. For 100 Average North Americans… Roughly; • 25 have cardiovascular disease • 12 are asthmatic • 6 are diabetic • 26 have high blood pressure • 30 have high cholesterol • 38 are overweight • 21 smoke • 31 use alcohol excessively • 63 don’t exercise enough to gain health benefit • 44 suffer from stress

4. By 2020, chronic diseases will account for almost three-quarters of all deaths worldwide http://www.who.int/nutrition/topics/2_background/en/index.html

5. The Vast Majority of Chronic Disease Could be Prevented The World Health Organization (WHO) estimates that… • At least 80%of all heart disease, stroke, and type 2 diabetes, and more than 40% of cancer would be prevented if only we were to do three things: • Stop smoking • Start eating healthy • Get in shape World Health Organization (WHO), Preventing Chronic Diseases: A Vital Investment (Geneva: WHO, 2005).

7. Let’s Explore Key Trends • Patients are becoming “super-consumers” • Internet, social media, smartphones, self care movement • Incentives driving patients to take more responsibility for their health decisions • “Value mining” — what is the relative value of interventions? • EHRs and social media are creating an explosion of data Adapted from Progressions The third place: health care everywhere, Ernst & Young, Global Life Sciences Center, 2012

8. Evolution of the Patient Role In Healthcare

9. Evolution of Patient Role In Healthcare

10. Evolution of Patient Role In Healthcare

11. BUT Daily Lifestyle Decisions Remain a Challenge We tend not to feel “connected” with our future selves, and thus adopt behaviors that please our present selves (whether or not we recognize the incipient harms to our future selves) We Don’t Consider the Consequences Bartels DM, Rips LJ. Psychological connectedness and intertemporal choice. J ExperPsychol: Gen 2010; 139: 49-69

12. People are Irrational

13. Given our health “superconsumers”, what are the best practices in consumer marketing to drive engagement and behaviour change?

14. Consumer Marketing Best Practices:Loyalty Programs

15. Loyalty Program Participation On the RiseOver 2 Billion Loyalty Program Memberships in the US Alone http://www.colloquy.com/files/2011-COLLOQUY-Census-Talk-White-Paper.pdf

16. Translating the “points craze” to health behaviour change

17. Moving Forward

18. “…everybody engaged in health care will inevitably find themselves in the behavioral change business.” Progressions The third place: health care everywhere, Ernst & Young, Global Life Sciences Center, 2012

19. Behaviour Change is Complex http://live-the-solution.com/blog/category/mind-map/

20. Bottom Line Provide personalized care plans that address multiple motivators and drive sustainable and measurable health behaviour change.

21. Skinner meets Prochaska +

22. B.F. Skinner “What gets rewarded, gets repeated!” If this, then that works when … • There is a simple set of rules • Focus • User can see the goal

23. Prochaska Identify Stage of health behaviour change Creating • Autonomy • Mastery • Purpose

24. Behavioural Economics

25. Using Incentives to Boost Engagement in Healthy Behaviours Systematic reviews by Stone et al. (2002) and Sutherland et al. (2008) show that financial incentives consistently improve ‘single shot’ preventive care behaviours like vaccinations, clinic attendance and cancer screening.

26. Using Incentives to Boost Engagement in Healthy Behaviours Systematic reviews by Paul-Ebhohimhen & Avenell (2007) and Burns et al. (2012) show that financial incentives can serve as a potent catalyst for weight loss. Volpp et al. (2008) and John et al. (2011) are examples of high-caliber studies, published in high-impact journals that produced significant weight loss of about 14 and 8 lbs at 4 and 8 months, respectively.

27. Using Incentives to Boost Engagement in Healthy Behaviours Volpp et al. (2009) examined the role of incentives in increasing smoking quit rates. They found that 6 months after the incentives were withdrawn the incentivised group maintained a higher quit rate than the control group.

28. Using Incentives to Boost Engagement in Healthy Behaviours A scan of the literature re impact of financial incentives for weight loss, exercise and/or smoking in workplace revealed that 84% of the studies had significant favorable effects in the intervention groups.

29. Health Promotion Innovation A Case Study from Canada

30. Healthy rewards for a healthier you • Universal health loyalty program involving all stakeholders in healthcare • Puts users in control • Centralized, scalable, turn-key solution • Advisory Board & multiple stakeholders…

31. BestLifeRewarded: Coalition Partners and Collaborators

32. BestLifeRewarded: A Coalition Approach A “coordinated assault” with multiple stakeholders and funders through co-branded micro-sites and targeted wellness programs Stand-Alone “White Label” Incentive Program s BestLifeRewarded.com

33. Skinner meets Prochaska

34. Driving Sustainable Behaviour Change Employees, Consumer, Patients Sustainable Health Behaviour Change

35. Partner Microsites (employers, NGO’s, hospitals, pharma, etc) • Members earn points by; • Completing custom training modules • Making pledges to get healthy (nutrition, activity and/or smoking cessation) • Learning about safe and effective use of medication • Tracking results • Becoming more health literate • Medication and lifestyle adherence • Participating in all BestLifeRewarded tools...

36. Personalized Member Dashboard • General health content – 30+ modules developed in partnership with NGO’s • Segmentation Surveys, HRA’s • Health Trackers – BP, blood sugar, cholesterol, weight, COPD, etc • Personal goal setting/tracking • Regular email communications • Medication and lifestyle reminders • Rewards store • Links back to sponsor wellness web site

37. BestLifeRewarded Education

38. Redeem for 200+ Existing Health Rewards Donate points to charity Other “custom” reward offerings

39. Employer Wellness Program Case Study: Ministry of Health Pilot Flu Shot Program Challenge: Ontario Ministry of Health looking to implement workplace programs in increase uptake of the flu shot for 2011 season Solution: • CJL secured a workplace with a 5-year history of on-site flu clinics • CJL implemented online education on the myths and facts of flu shot • Employer promoted the education via email and intranet • Employees logged on to BestLifeRewarded, completed the module and received points for completing Q&A and survey on intent to get the flu shot (clinic or doctor office) • CJL provided “thank you” cards with bonus points for employees following vaccination at the on-site clinic • Employees entered PIN code on BestLifeRewarded to collect points Results: 34% increase in uptake of flu shot vs. 2010 with the addition of BestLifeRewarded education and incentive program

40. One Final Thought on Motivation http://youtu.be/gimcdV-8FzY

41. Thank you! Progressions The third place: health care everywhere, Ernst & Young, Global Life Sciences Center, 2012