Kara Trott is the Founder and Chief Executive Officer of Quantum Health, a consumer navigation and care coordination company. Throughout her career, Trott has had success designing and executing research-based consumer intercept strategies for major consumer brands like Citibank, Ford, Walmart, and Coca-Cola. She brought this same expertise to healthcare. In 1999, Trott founded Quantum Health, the first company in the healthcare industry to apply consumer behavior mapping strategies. In Part 1 of a series on “The Consumer’s Journey,” she contributed her perspective on recent industry shifts and their impact on experience in healthcare. Here in Part 2, she further defines and explores the differences between the two operating modes of the healthcare consumer - "On the Journey" and "Be Healthier":
There has been a great deal of attention paid to the issue of consumer health engagement. In order to appropriately address the issue, one needs to understand the health consumer and what is needed to support engagement. I’ve observed that in the healthcare industry we seem to view healthcare consumers as one type, or acting in a single mode. We see this on a regular basis with the tools and support that employers offer their employees within their health and welfare benefits.
The commentary I hear is often along lines of, “We want people to make healthcare decisions like they do other things, like buying a car.” The problem is that the cognitive function and decision-making process that a person utilizes to purchase that car is often different from that used by the person making healthcare decisions. There are essentially two distinct consumer modes in healthcare. We call them the “On the Journey” consumer mode and the “Be Healthier” consumer mode. To be clear, these are NOT distinct people – these are modes of operating. A person can operate in “On the Journey” mode at one point in time and in “Be Healthier” mode at another point in time. Which mode the consumer is operating in dramatically changes their emotional reality, cognitive functioning, priorities, ability to act, and behavior.
Strategies that work for the “Be Healthier” mode DO NOT work at all for the “On the Journey” mode. To understand why, you have to truly understand how the “On the Journey” and “Be Healthier” consumer modes differ. This knowledge will also help answer important questions, such as, “Who should work directly with members?,” “What types of questions should these individuals be able to answer?” and “What are the best practices for successful engagement?”
“On the Journey” Consumer Mode
The “On the Journey” mode exists when people are thrust into the healthcare journey because something is wrong with them, irrespective of the complexity of the underlying problem. “On the Journey” mode, whether it is triggered by a knee injury, a cancer diagnosis, or an elective procedure, results in the same human reaction. Common characteristics of “On the Journey” mode include:
- It is an unchosen journey – people are thrust into it against their will (even during elective care or services).
- At best, this unchosen journey is disruptive; at worst, life threatening. Whether disruptive or life threatening, there is a common human response to externally imposed change and stress.
- The unchosen nature of the journey triggers a primal human response well documented in neurological science – cognitive functions are diminished, the “reptilian brain” takes over, and people begin functioning at a primal emotional level with classic human stress responses of fear, freeze, flight or fight (deny). The ability to access and use cognitive logic and reasoning is not just impaired but turned off by the primal neurological stress response system.
- The common experience of the consumer is one of bewilderment and confusion. They suddenly have to make a lot of decisions (research says on average 41) crossing financial, benefit, care, and life issues at a time when their cognitive functions are diminished, leaving them without normal logic and reasoning, and when they are not at their best physically. They have to interact with an insurance and medical system that people feel is impersonal and have to speak a language they don’t understand.
- People don’t have good self-trust during this journey.
- People don’t have institutional trust in the insurance industry and perceive that their insurance company may hurt them.
- Age does not play a significant role in the help and support that a consumer in “On the Journey” mode needs and desires. All consumers, regardless of age, while on an unchosen journey are in a similar emotional state and therefore need similar support.
Key to understanding this mode is that people are overwhelmed by their emotions and are adjusting to their new reality. Basic concerns take front and center. For example, a member recently diagnosed with colorectal cancer was more concerned with whether diapers were covered by her insurance than about which facility to go to or with second opinions; she wanted to maintain her dignity so that they could go out in public. Another member, recently diagnosed with diabetes, was more concerned with how they would pay for the four medications prescribed by their doctor than looking up recipes for healthy eating. We also see this type of behavior from consumers with short-term acute problems. A member who had broken his ankle was focused on who would walk his dog or drive his children to school rather than where he should go to get the most cost-effective follow-up x-ray of his ankle.
So, how are we as an industry trying to support members in “On the Journey” mode? Many point solutions are purchased by employers aiming to help the consumer make quality, cost-effective decisions. These include transparency tools, advanced second opinion, decision support tools, centers of excellence, specialty networks, and myriad condition-specific solutions. All of these point solutions can be valuable to people in “On the Journey” mode – if they remember these tools exist and think to access them when they can be useful. As the examples above demonstrate, however, the overwhelming emotional experience of members in “On the Journey” mode focuses their attention elsewhere, on the most immediate, pragmatic concerns, and not on things like price transparency and second opinions.
Frustrated by low engagement in such solutions, employers often turn to a more aggressive communications strategy to increase awareness. They may repeat mass communications, such as advertising, done in the initial stage, accelerate follow-up communications to more than a few times a year, and feature the solution more prominently as a benefit on digital platforms and on websites. The operating assumption is that, once informed, the consumer will be aware that the solution exists and, if they have a need, will access it.
The underlying problem is not one of awareness, rather one of misunderstanding and mismatching communications to the reality of the consumer experience while in “On the Journey” mode. This is why we often fail to connect with“On the Journey” consumers in a way that fits with the natural flow of their experience. People in “On the Journey” mode cannot reliably access their usual cognitive abilities to seek out the tools and services that employers have purchased to help them. Not understanding the emotional reality of members in “On the Journey” mode prevents us from getting these tools to people when they can be helpful.
The approach that works best is one that understands the member’s natural flow and connects with them in the way they are naturally experiencing the journey. This requires an understanding of the emotional and cognitive effects when the member has that moment when they consciously realize they are on a healthcare journey. This requires an understanding of how these members first “show up” when they begin to access their benefit plan; how issues come together for them and when it makes sense to present solutions; and how to know they are moving from point A to point B and where to intercept them along that path. Given the vulnerable and primal emotional state of members in “On the Journey” mode, their low trust in themselves and in the institutional players (primarily the healthcare system and the insurance companies), who connects with them, guides them along this journey, and brings them solutions is critical to earning their trust – and therefore the single most important ingredient to this successful approach.
Which mode the consumer is operating in dramatically changes their emotional reality, cognitive functioning, priorities, ability to act, and behavior. - Quantum Health CEO Kara Trott
“Be Healthier” Consumer Mode
The “Be Healthier” mode exists when people make an affirmative choice to reorder their existing behavior patterns and to strive for better health. In this mode, consumers may choose to engage in preventive care and to become aware of their biometric numbers and what they mean, or they may begin a weight-loss program or attend smoking-cessation classes. Common characteristics of “Be Healthier” mode include:
- It is a conscious, affirmative choice to enter this mode.
- In making this affirmative choice, the person generally has made a decision that it is important to make changes in their life (hence, reordering their life). They affirmatively choose to do this because the outcome they achieve is more important and is worth the change. This intrinsic motivation gives them the strength of will to do the hard work of fighting their own well-established habits. For instance, someone may seek help with weight loss because of a life event, such as the birth of a grandchild. The reward is the ability to play a more active role in the child’s life.
- The desire to engage in this change process is intrinsically, not extrinsically, motivated.
- Once in this mode, this consumer exhibits curiosity, seeks out information, and is open to support that will help them make and stick with their chosen change. This behavior makes high use of cognitive functions and executive decision-making skills. Emotion in the “Be Healthier” mode provides a positive sense of purpose that fuels the hard change process.
- There is a perceived meaningful reward as a result of going through the change.
- The age of the health consumer in this mode may affect the tools utilized and by the consumer to successfully engage in the “Be Healthier” mode as well as modes of communication and engagement.
In benefits strategy, we are often seeking to figure out how we can trigger and reinforce intrinsic motivation so people will enter or sustain the “Be Healthier” mode and behaviors. We know from data that many people can benefit from engaging in these kinds of changes and believe that long-term it will not only be beneficial to them, but that it will reduce the demand for healthcare services.
While the affirmative decision to engage in “Be Healthier” consumer mode is intrinsic, benefit approaches that provide financial or benefit incentives, such as reduced premiums, can add initial external motivation in order to activate intrinsic motivation, helping the consumer to see it as worth their time and effort to willingly go through this life change. In addition to the use of extrinsic “kick-starting” incentives, many employers offer coaches as a way to enable consumers to identify, or unlock, their intrinsic motivators and stick with the process.
Providing tools and services that inform and support people in “Be Healthier” mode along this journey can be welcomed. In this mode, the consumer has the cognitive ability to make the cost-benefit decisions and to become aware of and appreciate the value of benefits and services, as well as being in a position to affirmatively make and act upon their choices. There are many ways people operate in this mode based on their decision-making and information-seeking preferences, as well as cognitive capabilities and socio-economic situation, so understanding the various segments is important to effective strategy.
In order for employers to successfully engage the healthcare consumer, they have to understand them. This means understanding that, as healthcare consumers, we have two modes of operation: “On the Journey” and “Be Healthier.” The tools, interactions, and support that we give consumers is directly associated with the mode that the consumer is in at that time and the goals that are trying to be achieved. Being able to really understand the “On the Journey” consumer mode will enable employers to better match who is working directly with their members, the scope of services and authority these individuals need to be able to deliver, and how to best engage consumers in a way that is responsive to their emotional state and doesn’t rely on cognitive capabilities that aren’t fully accessible in “On the Journey” mode.