We frequently talk about the concept of achieving better healthcare outcomes and lower costs through more effective engagement strategies. Depending on to whom you’re speaking (a health plan, healthcare provider or employer), we use terms like member engagement, patient engagement, employee engagement, member experience, patient experience and more.
The reality is, we’re talking about the same thing and the same people. For the most part, every individual who engages in the healthcare system, at one time or another, is all of these: member, patient, employee. People – you, me, our families, friends, neighbors, colleagues – are members and patients and employees, depending on the situation and specific discussion taking place. You’re a member when you call your health plan to find out if a certain physician is in-network. You’re a patient when you visit your primary care provider. And you’re an employee every day when you show up for work.
But although various entities use differing strategies and tactics to try to better engage people in their health, the goal is always related to achieving the Triple Aim – lower costs, better outcomes, more satisfied and engaged members, patients and employees.
So why do most engagement strategies fail?
Because most organizations – health plans, provider organizations, employers – don’t consider common cognitive biases that influence behavior and determine how people will respond or not respond when developing engagement strategies.
Here are seven common cognitive biases and how they can impact engagement in healthcare decisions and behavior.
1. The Confirmation Bias
The Confirmation Bias refers to our natural drive to seek out and believe information that conforms to our opinions and beliefs and to ignore or discount evidence that is contrary to our beliefs. Creating a healthcare environment based on better awareness and understanding of motivations, opinions and beliefs, and personalizing messages, experiences and interactions, will help ensure people respond positively to engagement strategies. Healthcare providers who counsel patients about the dangers of smoking using facts and figures about smoking-related illness and mortality won’t convince patients to quit if they don’t believe smoking is as dangerous as everyone claims.
2. The Anchoring Bias
People are most heavily influenced by the first piece of information they hear, referred to as the Anchoring Bias or anchoring effect. How you begin matters. Health plans, providers or employers looking to impact engagement and behavior must consider the initial message, outreach and communication because it will anchor or guide the entire conversation and pathway forward. Common in the marketing world is A/B testing, whereby marketers deploy two campaigns with slightly different messages – such as different subject lines in an email or different headlines in a digital ad – to test and compare the effectiveness relative to a desired action. Using similar tools and analytics available on their employee population, employers can also similarly compare the effectiveness of different messages on employee engagement.
3. The False-Consensus Effect
We tend to over-estimate how much and how often other people share our beliefs, opinions, values, attitudes and behaviors. In examining reasons why engagement is or is not successful, healthcare organizations and employers must ensure alignment between their objectives, strategies and tactics and those of their members, patients and employees. This not only impacts how receptive people will be to engagement strategies but also their ability to take specific actions.
4. The Halo Effect
The saying goes you only have one chance to make a first impression. This is because of the Halo Effect, the tendency for people to allow their initial impressions to guide what they think going forward. This bias is the reason why honesty and trust is so important to better engagement and outcomes. If people know and trust that their health plan, physician and employer have their best interest at heart, they will be more receptive to information and more engaged in the relationship. Think about how the experience of new members or even existing members who haven’t interacted often with their health plan could be dramatically different based on that initial phone call. Health plans are focusing more on member advocacy programs that provide a better, more holistic member experience and seek to understand the needs and wants of their members beyond simply servicing their accounts.
5. The Self-Serving Effect
The Self-Serving Effect shows up when people tend to credit themselves for successes, but lay blame on others for shortcomings. We’ve all been guilty of this at one time or another. That diet that didn’t work out or the gym membership that now goes unused or the third failed attempt to quit smoking. It’s easy and helps us preserve our self-esteem to lay blame on something external – something out of our control – rather than admit failure.
6. The Availability Heuristic
The Availability Heuristic refers to the way people estimate the probability for a particular outcome based on how many examples they can readily recall from memory. Depending on the type of situation and impact, people may be more receptive to engagement strategies based on what readily comes to mind. For example, a patient with a familial history of breast cancer and who has perhaps lost family members or friends to the disease, may be more receptive to communication about screening mammograms.
7. The Optimism Bias
In general, people are too optimistic for their own good. The Optimism Bias, which is rooted in the Availability Heuristic, refers to the tendency for people to over-estimate the likelihood for positive outcomes and under-estimate the likelihood of adverse events. It often shows up in conversations about lifestyle change, adherence to care plans and risk. People under-estimate their chances of dying from smoking, alcoholism, or obesity-related conditions like heart disease and diabetes, and therefore have difficulty engaging in meaningful, permanent lifestyle change.
We’re all human
We’re all human and all susceptible to common cognitive biases, including those of us working for healthcare organizations and employers who are trying to meaningfully impact people’s lives and improve the system of care. This means that organizations must consider these concepts when developing, implementing and analyzing strategies to effectively communicate with and engage members, patient and employees in their healthcare and programs designed to improve quality, lower cost and create a better experience for all.