New tech companies are going beyond the gadgetry to learn how to change population behavior through simple incentives.
Remote Monitoring is a popular idea that has spread amongst healthcare innovation circles over recent years. This idea states that if we give patients a bunch of “smart devices” that can gather data on their health and behaviors while they are outside of care settings, we can better allocate resources and intervene before something bad happens. As a result, there has been a proliferation of smart devices. We have created smart glucometers, smart blood pressure cuffs, and even pills with tiny embedded chips that can be ingested and report back as to whether Hypertensive Joe took his medication today or not. But there is one key issue with all of these smarter devices. The problems that plague our healthcare system, the billions of dollars wasted on preventable hospitalizations, readmissions, and complications, are not the product of “dumb” devices. We do not suffer from technology problems, we suffer from behavior problems.
The true essence of our healthcare problem has begun to be borne out by a number of thought-leading researchers. Kevin Volpp and his group at the Center for Health Incentives and Behavioral Economics (CHIBE) at UPenn performed a study in 2014 where they gave away connected glucometers, blood pressure cuffs, and scales to Diabetic patients and told them that their three biometrics would be monitored everyday by physicians. By the third month, less than half the patients were still using the devices daily. By the sixth month, only 27% of patients still used the devices. So, the vast majority of these smart devices had become expensive paperweights, sitting in patients’ homes and collecting dust.
But since Dr. Volpp is an expert in Behavioral Economics, he understands how to use the right incentive structures to change patient behaviors. In another group of Diabetics, he gave away the same devices and instructions but this time offered just $1.40 a day for three months to patients who used all three connected devices. The results were astonishing. At month three when the incentive period ended, 75% of patients were still using all three of the remote monitoring devices every day. At month six, even after three months of no incentives, 62% of patients were still adherent to their daily biometric check-ins. So, by offering only about $130 of incentives to patients, the CHIBE team was able to double the effectiveness of remote monitoring.
Devices, no matter how smart they may be, are useless if patients don’t use them.
There are a number of companies that have begun to take the proven concepts from Behavioral Economics research and apply them to real world healthcare problems. Last year, CVS Caremark instituted a new smoking cessation program in their own employees that leveraged loss aversion by allowing employees to deposit their own money in a pledge to quit smoking. Coincidentally, this program resulted after another study by CHIBE that showed the ability to triple six month smoking cessation in CVS Caremark employees. DietBet is a company that applies a similar concept to weight loss by allowing participants to bet their own money against their weight loss goals. The participants who fail to hit their goal lose their money to those who succeed. According to DietBet’s website, the company has helped over 470,000 participants lose an aggregate 6.3 million pounds. At Wellth, we allow payers and risk-bearing providers to offer incentives to chronic condition patients in order to produce more adherence to medications and disease appropriate remote monitoring. In a pilot with a large national insurer, we were able to demonstrate the ability to increase both medication adherence and glucometer check-ins by more than 45%. We are currently studying our ability to increase adherence and decrease readmissions in the 90 days after heart attack and congestive heart failure hospitalizations at UPenn and Princeton Healthcare System, respectively.
There is a common dream shared by every doctor, health system, payer, and venture capitalist. A dream where new technologies scale broadly and produce massive improvements to population health and healthcare efficiency. A dream where patients receive the exact right care at the exact right time. A dream where we are able to save millions of lives and billions of dollars. This dream will never become a reality by simply creating new apps, devices, and widgets that measure, monitor, and annoy patients. In order to achieve this dream we have to focus on effectively changing patient behaviors.