Healthcare Decision Support Tools: Bridging the Gap Between Theory and Practice

Consumer decision support tools were going to transform healthcare.  They promised automated enrollment and deeper consumer education leading to consumer empowerment weighing value over price – it didn’t happen.

Let’s explore the origin of consumer decision support tools, the major categories of support tools, barriers to consumer adoption and strategies to maneuver towards consumer satisfaction.

History

Stepping boldly forward, with the intension of improved customer experience your organization as decided that a consumer decision support tool will improve consumer satisfaction, drive enrollment, and improve the overall customer experience.  Where do you start? Where should you start?  Looking to your right most leaders will jump into the wilderness with talk of real-time data, big data analytics, integration, cloud platforms and other concepts that conventionally drive value.  Looking to your left the other leaders will start by focus groups, observation studies pull data directly from the consumer. Of course it becomes hard not to have your mind wonder to Steve Jobs consumer insights. During a May 1998 interview with Business Week Steve Jobs said “A lot of times, people don’t know what they want until you show it to them.” About 80% of folks will take one of these two ‘accepted’ approaches.  Why? They are both safe and easy to defend to a CEO, board or other c-suite leaders.  I’d offer neither of these will generate 10x results. Arguably they might not generate any results at all. We must start in the mind of the consumer.

To move curtain and discover the why consumers are making decisions, the Cynefin Framework initially appears helpful. There are five domains cross segmented by unordered and ordered decisions and includes appropriate choices when making decisions within that domain.  The unordered domains include Complex (probe, sense, respond) and chaotic (act, sense and respond) and the ordered domains include simple (sense, categorize, respond) and complicated (sense, analyze and respond) and a trailing fifth called disorder. Unfortunately, this logical decision making process doesn’t translate to consumers.  

We can all learn a lot from Michael Porter.  Michael Porter wrote the initial model for the Five Forces in 1979. He published “What is Strategy” in a 1996 Harvard Business Review article.  Porter then wrote his seminal book Competitive Strategy in 1981 and Competitive Advantage in 1985. There is little question that Porter is a visionary and many of us, find ourselves referring to his earlier works with regularity. However, these strategies were all before the internet.  They are models and theories that didn’t consider how to compete with free.  Porter’s contributions to strategy and competition were before behavioral economics research.  Behavior economics is a subfield of microeconomics that studies how individuals and organizations make economic decisions.  This research suggests that consumers do not make rational decisions and therefore markets are not rational.  Emotions dominate. Let’s apply this to consumer decision support tools. The process of selecting healthcare products and treatments is complex. Then why wouldn’t the complex domain apply, following a logical probe, sense and response approach? Decisions are often instantaneous based on gut and while a logical sequential thought processes appear, practical they often aren’t applied.

In Blink, The Power of Thinking Without Thinking, Malcolm Gladwell states that, “truly successful decision-making relies on a balance between deliberate and instinctive thinking.” Gladwell pokes at the notion that instantaneous decisions at times are better than decisions resulting from thorough rational analysis..

If we are able to manage deliberate decisions through rational means of information dissemination, then how do we alter natural instinctive thinking to drive consumers towards behavior changes? Gladwell, takes a run at tackling this challenge too: “our first impressions are generated by our experiences and our environment, which means that we can change our first impressions — we can alter the way we thin-slice — by changing the experiences that comprise those impressions.”  We alter instinctive thinking through managing a consumers’ first experience with our products or services.  Michael Porter’s “What is Strategy” article reminds us that, “the essence of strategy is choosing to perform activities differently than rivals do.” If we follow our competitors, we’ll never be leading them. We start by defining the ‘what.’

Creation and Selection

Operational effectiveness means doing things better than competitors, strategic positioning means doing things different from competitors and having better products and service. We introduce consumer decision support tools to do things different not better.  This is a critical element of a successful consumer support tool adoption that is in the center of social media and being shared and a simply link on a website that is lonely and rarely engaged.

Start by stepping outside your office and looking around.  Look outside your industry, open the curtain. Ask yourself what other industries have been using consumer decision support tools?  U.S. News and World Report has for year published America’s Best Colleges. What are they trying to accomplish and why will the consumer experience change for the better? Other industries have similar examples.  The food and beverage industry has Nutrition Facts Panels and the automotive industry has Consumer Reports: Car Buying Guide. When creating or evaluating consumer decision support tools take a wide view.

There are many type of healthcare consumer decision support tools including selecting a health plan, choosing a type of health coverage (e.g. HMO vs. PPO), choosing between difference medical treatment options, comparing difference prescription medications, selecting a primary care physician, choosing between prescription options (e.g. grand vs. generic) and selecting a provider (e.g. hospital or physician for a given service). While the offerings vary they generally land in one of two categories: prevention or treatment support. It’s important to understand the ‘what’ you’re trying to accomplishing as you push forward working to empower your customers. The first type of tool ‘selection,’ occurs before you’re aware of care, focused on anticipating future costs. Selection consumer decision support tools often include out-of-pocket cost estimators, HSA savings calculators, side-by-side plan comparisons, health benefits/needs questionnaires, and open enrollment presentations focused on education.  The second type of tool care treatment support, occurs after the consumer knows they have a condition, may have treatment, or has become the patient. Treatment support consumer decision support tools often include symptom checkers, knowledge databases, health-related videos, online customer service, personal health records storage and access to provider databases. The primary difference between selection and treatment support tools, is selection is focused around anticipating costs, treatment selection is focused on mitigating the costs. Treatment support products assume the consumer is already in a health plan and is looking for options based their current coverage.

Barriers to Avoid and Strategies for Success

To create a desired end-state, we must understand key barriers to effective use.  Each of these barriers should be considered as you roll out a consumer decision support tool. Classic barriers to effective use include: lack of consumer awareness, lack of relevant and standardized content, poor design and presentation, missing features in web-based tools (poor UX), lack of trust in the source of the support, low levels of health literacy and lack of online access to web-based tools.  We could spend all of the available hours of a day planning, anticipating, and building mitigation strategies. We could spend time wondering ‘what if.’ Dedicating some time for developing a strong plan b is time well invested.  Spending too much time on ‘what if’ scenarios is a waste of time. 

Building effective consumer decision support tools starts with a discussion about ‘what’ you plan to offer and ‘why’ you are offering it. Once you have defined the ideal future consumer state and established the buy-in to move forward, where do we start?  There are five important strategies for promoting more effective use, which your leadership team should be aware of including: 1. understanding the decision context and audience 2. crafting appropriate content 3. Establish strategies for presenting complex information, 4. selecting an appropriate medium, and 5. maximizing awareness and value of the tool.

Selecting a consumer decision support tool starts by understanding where in the member to patient experience, the tool will be assistive.  Then define the ‘what.’ What are we trying to accomplish e.g. out-of-pocket cost savings or education? Lastly we need to clarify the ‘why.’  Fast forwarding a year, why has the consumer’s experience changed? Why are they happy?

Once your team has answered these hard questions, you’re read to transform the consumer experience. God Speed.

References

Rosenthal, R. (2014). 5 Psychological Tactics Marketers Use To Influence Consumer Behavior (online image). Retrieved October 26, 2015, from http://www.fastcompany.com/3032675/hit-the-ground-running/5-psychological-tactics-marketers-use-to-influence-consumer-behavior

Peter Nichol, empowers organizations to think different for different results. You can follow Peter on Twitter or on his blog. Peter can be reached at pnichol [dot] spamarrest.com.

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Peter is a technology executive with over 20 years of experience, dedicated to driving innovation, digital transformation, leadership, and data in business. He helps organizations connect strategy to execution to maximize company performance. He has been recognized for Digital Innovation by CIO 100, MIT Sloan, Computerworld, and the Project Management Institute. As Managing Director at OROCA Innovations, Peter leads the CXO advisory services practice, driving digital strategies. Peter was honored as an MIT Sloan CIO Leadership Award Finalist in 2015 and is a regular contributor to CIO.com on innovation. Peter has led businesses through complex changes, including the adoption of data-first approaches for portfolio management, lean six sigma for operational excellence, departmental transformations, process improvements, maximizing team performance, designing new IT operating models, digitizing platforms, leading large-scale mission-critical technology deployments, product management, agile methodologies, and building high-performance teams. As Chief Information Officer, Peter was responsible for Connecticut’s Health Insurance Exchange’s (HIX) industry-leading digital platform transforming consumerism and retail-oriented services for the health insurance industry. Peter championed the Connecticut marketplace digital implementation with a transformational cloud-based SaaS platform and mobile application recognized as a 2014 PMI Project of the Year Award finalist, CIO 100, and awards for best digital services, API, and platform. He also received a lifetime achievement award for leadership and digital transformation, honored as a 2016 Computerworld Premier 100 IT Leader. Peter is the author of Learning Intelligence: Expand Thinking. Absorb Alternative. Unlock Possibilities (2017), which Marshall Goldsmith, author of the New York Times No. 1 bestseller Triggers, calls "a must-read for any leader wanting to compete in the innovation-powered landscape of today." Peter also authored The Power of Blockchain for Healthcare: How Blockchain Will Ignite The Future of Healthcare (2017), the first book to explore the vast opportunities for blockchain to transform the patient experience. Peter has a B.S. in C.I.S from Bentley University and an MBA from Quinnipiac University, where he graduated Summa Cum Laude. He earned his PMP® in 2001 and is a certified Six Sigma Master Black Belt, Masters in Business Relationship Management (MBRM) and Certified Scrum Master. As a Commercial Rated Aviation Pilot and Master Scuba Diver, Peter understands first hand, how to anticipate change and lead boldly.