Why Patient Behavior Change Is Key for Chronic Disease Management

June 27, 2018 - Chronic disease management may rank as one of the key priorities in the healthcare industry right now. With a multi-billion-dollar price tag, ensuring patients know how to manage their illnesses and prevent costly health episodes is a key goal.

But in many cases, this level of chronic disease management goes against the grain of traditional medicine. For centuries, medicine meant a patient presented to the doctor with a physical ailment, and the doctor prescribed a treatment. Appendicitis calls for a surgery, while the flu might call for a slew of prescription treatments.

But chronic disease management might be more akin to selling toothpaste, according to Karl Ronn, a managing director at Health 2047, the American Medical Association’s Silicon Valley health IT innovation center.

“It’s all like toothpaste, healthcare, at least when it's behavioral,” Ronn told PatientEngagementHIT.com in a recent interview. “There is a goal we want to achieve, which is to not have cavities. And the toothpaste achieves that goal, but you have to brush daily to do that.”

Through his previous experiences as an expert in market behavior change for various Proctor & Gamble brands such as Mr. Clean, Swiffer, and Febreze, Ronn knows the trick to marketing a product like toothpaste is through the carrot, not the stick.

READ MORE: How Patient Engagement Supports Chronic Disease Management

He could note the perils of getting a cavity or try to make the consumer afraid of a filling or another dental procedure. But in the end, selling the promise of a sparkling, white smile is most likely to spark consumer behavior change. If the user knows the toothpaste will make his smile more attractive, he’s going to adopt that behavior change.

“Chronic care is all toothpaste, but the trouble then becomes, what's the solution?” Ronn posited. “What's the patient’s end objective and what can you do on a daily basis to reach it?”

As the healthcare industry continues to embrace health IT as a patient engagement and chronic care management aid, it’s important that technology answers the “end goal” question. At Health 2047, Ronn wants to see technology that creates a behavior change and doesn’t simply serve as yet another annoying daily reminder to complete a task.

Right now, technology doesn’t exactly meet those parameters, Ronn said while referencing his smartwatch.

Throughout the day, his watch will buzz with activity reminders. But to him, those reminders are useless because he already knows what he’s been up to. He knows if he’s walked a little more than usual and is meeting his goals, or if his seven-hour flight is going to completely prevent him from satisfying the wearable.

“Tech reminders that aren't rooted in something like the toothpaste smile are never going to actually accomplish what you want,” Ronn explained. “What we really want to be able to do is understand what we are trying to get done. What's going to work for the patient? Then it would be ideal to have the technology be in a supportive role, but not in an irritating role.”

One of the fundamental issues is that health IT – and current chronic disease management tactics – are missing a key layer of empathy. While a clinician may be compassionate, kind, and respectful of patient wishes, she may not be relating to that patient on a personal level. This means that clinician is missing the key goal that could spark patient behavior change, Ronn said.

Too often, a clinician sits down with a diabetic patient and instructs that patient to cut sugar from her diet. That clinician could be using quality patient-provider communication strategies, understand the patient goal of reducing diabetes complications, and have the patient’s best interest in mind. But that paternalistic approach to patient activation likely will not work, Ronn said.

Instead, that provider needs to sit on the same side of the metaphorical table as the patient and consider the strategies that will work for the patient.

“How would I, as a provider, make it so delightful that the patient completes the health action?” Ronn questioned. “That's a harder problem to solve. How do I delight you?”

Ronn looks at the question of chronic care management and health as living a life with more good hair days than bad hair days, he said as an example. There will be bad hair days, he noted. But if he starts to see there are more bad days than good, he knows he might need a new style or a different product.

The same goes for chronic disease management strategies. If a patient is falling into a habit of negative health behaviors, maybe she and her clinician need to identify a new strategy. It’s not about making the patient fit the prescriptive management approach, but instead about making that approach fit the patient.

“Because if you don't love it, you're just not going to do it,” Ronn asserted. “And if you love it and you get the right health associations, you're going to do it. You're going to come back and say, ‘well that was really cool. Can you give me one more thing to do?’ And now we're on this journey of wellness.”

Some of healthcare is doing this really well, Ronn added. The CDC’s Diabetes Prevention Program (DPP) does an excellent job of offering patients the resources necessary to identify their health goals, the actions that will fit into patient lifestyles, and guiding patients through carrying out those goals.

Through ample access to health coaches and other integral patient engagement resources, CDC has successfully worked to cap diabetes in patients at-risk for developing the disease.

The trouble is the issue of scale, Ronn said. One in three adults currently have elevated sugar levels, which puts those patients at-risk for developing diabetes. This is a public health crisis that, if left unaddressed, could put tens of millions of patients in diabetes management programs.

“The good news is the CDC developed a program that has individual coaching sessions weekly that for a short period of time focuses on changing a patient’s life,” Ronn said.

But those coaching sessions are not extensive enough. Weekly coaching that checks in on patient progress, identifies areas for improvement, and helps develop a new habit will be effective at truly putting a cap on diabetes development.

At Health 2047, Ronn and his team have been working with the CDC and other key healthcare stakeholders to determine how they can deliver those services in full scope to more patients. In the case of the DPP, those services must scale to tens of millions of people.

Right now, the issue is primarily financial, Ronn said. This is a $3 billion business that needs to have a $3 trillion impact. The resources are simply too scarce.

There is some hope of making a dent in that financial issue, Ronn said. The government and healthcare industry are both on the same page about chronic illness prevention and are working to reframe reimbursement to place value on that prevention.

Health 2047 has also developed its Capital Partners arm that works with investors to make these health programs a financial reality. There are a lot of good ideas out there, Ronn said, and it’s their goal to fund those ideas before they die due to lack of funding.

But as new healthcare innovators continue to develop these plans, they need to ensure the patient is the focus. It is not enough to create a strategy that, if completed, will improve outcomes. Chronic disease management experts must also ensure the patient will want to complete the strategy.

“We need to enable people to help themselves,” Ronn concluded. “You can't compel people to buy toothpaste. They have to want to buy toothpaste. Just as you can't compel people to change their lives; you have to make them want to change them.”