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Behavior Change Theorem: Using a debt model to promote whole patient health


More than ever, people are seeking ways to alter their behavior and, thus, their overall health.

The debt snowball method tells us the best way to eliminate debt is by gaining traction through early success. Essentially, we start by listing all debts from smallest to largest, regardless of interest rate. Then, we move down the list, gaining momentum as we eliminate one item at a time. Finally, we roll each debt service amount that is freed up into the next. No matter how large the debt, knocking one out makes the next one easier. 

As it turns out, this same snowball effect has concrete applications in healthcare.

Help a patient say, “I lost some weight,” and he or she will be more motivated to take another step in managing a chronic condition. Innovative companies across a myriad of industries are leveraging this behavior change theorem: People are actively seeking resources to help change their behavior and achieve better health.

Consider the popular Noom app, which uses in-app notifications to teach and motivate users to exercise and eat meals that are more nutritious. According to Noom, average users log up to 50 percent more green foods after just three months of using the app. For many of them, it is the first step toward lasting lifestyle changes.

Small tech changes small behaviors

Medically underserved individuals who are managing chronic conditions stand to benefit from the same measured, real-time, high-touch approach. Wearables especially have the potential to take the physician and patient experience to new heights, yet access to these devices is limited for this population. This does not mean we should not continue marching forward.

Pew Research reports that most Americans own cellphones, and smartphone reliance for internet access is especially prevalent among younger adults, people of color, and those in lower-income brackets. What’s more, underserved people often use tech, not a health system, as their main health resource. Experts from the Commonwealth Fund believe these trends will ultimately increase access to wearables and other tech tools.

I have heard directly from clinical colleagues who are utilizing their patients’ bands, watches, and applications to align health recommendations, set goals between appointments, and track general success. A simple goal of 8,000 steps a day, validated every three months by a physician, can be incredibly powerful for a patient trying to reduce hypertension or the effects of Type 2 diabetes.

Recent tech advances even provide at-home services that were previously only available in healthcare facilities. For example, the ECG app on a wearable tech watch provides leading cardiac technology to the public for the first time.

These very capabilities recently helped a friend and colleague of mine when he began experiencing shortness of breath, dizzy spells, and anxiety while performing surgery. Initially, he thought his symptoms were related to stress and fatigue. However, after he picked up the latest wearable tech watch and enabled the ECG function, it began alerting him of an elevated heart rate. I referred him to a cardiologist who ultimately diagnosed him with atrial flutter.

Through technology, we will ideally be able to meet people where they are and provide resources to effectively manage their conditions. This has the potential to assist health plans in lowering costs and improving overall member health.

Be more engaging, and patients will follow

The reason small changes add up and “snowball” into better health is because outcomes are intrinsically tied to engagement. Most people will try anything once. What they will not do is waste time or money on something that does not excite or engage them. Additionally, people are unwilling to continue an activity or change behavior when they do not see wins stacking up.

You cannot change behavior without engagement, and you cannot engage patients without a curated experience focused on the individual (in this case, the patient). Through engagement and early wins, we can keep the healthcare snowball rolling; in this way, we can promote true behavior change and improved health.

The rules have changed, and any organization tasked with solving the problem of increasing healthcare expenses must engage more members directly (and with products and services that empower individuals to stay engaged). To do this, every change we suggest must be member-centered and delivered in a way that feels personal and allows the health snowball to build.

Jeremy Corbett, MD, serves as a divisional chief health officer for Envolve Health, providing oversight and guidance in all aspects of product development. Corbett is a board-certified emergency physician focused on transforming the way we think about (and manage) chronic disease.

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