How To Activate & Engage Patients In A Value-Based Healthcare Model

We know the key benefits of value-based healthcare are widely described as better care for individuals, improved population health and lower overall costs.

We also seem to all agree that value-based care requires patients as well as the general public to take an active role in both their wellness and sick care.

Where things start to get rather opaque, however, is when we try to actually “activate” patients and the community at large.  How do we educate, foster, influence, and manage patients on care plans?

This is where we get a lot of questions from our healthcare clients.  Questions like:  Why don’t patients take their diagnosis seriously?  Why do patients fall off their care plan?  Don’t people understand the risks associated with poor health choices?

Although there is not one magical answer, there are proven techniques that can improve patient engagement, increase patient adherence to care plans and get community members to care more about their general health.  These tried and true Business-to-Consumer techniques are easily adapted to fit today’s value-based healthcare model. 

Before sharing the concepts and techniques, it is important to first understand that our personal decisions are not always grounded in cold hard facts.  If they were, we would be much better at following our doctor’s orders!  Although a doctor’s advice, research data, and clinical patient portals are important, they may not be enough to change a person’s behavior.  Maybe the behavior change seems too daunting.  Maybe a person doesn’t fully understand the consequences.  Maybe other personal issues are in the way.  The list is never-ending.

Without further ado, the keys to greater patient activation and care plan adherence are to:

  • Utilize multiple techniques that align with both natural human behaviors and personal preferences.

  • Orchestrate wellness or diagnosis-based patient journeys that are understandable and achievable – using smaller steps with smaller decision points.

  • Reward for the right behaviors and outcomes.

And here is how you do it:

1.     Be Easy To Do Business With

This is obvious.  It may not be easy, but it is so very important.  Meet patients where they are, when they want to engage, and how they want to engage. Start with identifying all patient entry points/process flows and redesign them with patients and prospects in mind.  This work entails creating journey maps of the current state followed by refinements to a desired state.  Once you are happy with the future state design, bring it to life.  For more details on how to patient journey map and journey manage, read my article here.

2.     Deliver Deeper Value

This may be the most important attribute to the care delivery equation, but I can tell you from past client experience that this is also one of the most often overlooked concepts.  Whether a patient is interested in wellness programming, entered into a “learn and concern” phase due to symptoms being experienced or has been officially diagnosed and placed on a care plan, the patient must be supported beyond clinical activities.  In addition to an orchestrated “push” of information from the health system/provider, it is necessary to allow for a “pull” of information from the patient – when they want it.  As I mentioned, the solution for supporting patients should be far more than clinical – it should go beyond diagnoses and test results to better support of the “person” and anticipate individual needs.  The most compelling example of this approach is the smart phone.  The smart phone does more than making and receiving phone calls.  Apple saw the need to support a “person” in their daily lives – well beyond the phone call.  Beyond text messaging.  Beyond the internet.  The smart phone has become our camera, calculator, pedometer, compass, flashlight and more.  Apple looked beyond the phone call and anticipated our needs.  Apple wanted to win us as a customer for life.  Health systems have the opportunity to create better experiences, improve outcomes and capture customers for life.  In fact, the Customer Lifetime Value for securing just one household is $1.4 million in hospital-based revenue.

3.     Check In Often

One of the best ways to build an on-going relationship and monitor care plan adherence is to proactively check in with patients on a regular basis.  According to the World Health Organization (WHO), approximately 125,000 people with treatable ailments die each year in the United States because they do not take their medication properly.  The WHO also reports that 10-25 percent of hospital and nursing home admissions result from patient noncompliance. Furthermore, about 50 percent of prescriptions filled for chronic diseases in developed countries are not taken correctly, and as many as 40 percent of patients do not adhere to their treatment regimens.  Some of the primary reasons for patient non-compliance include denial, cost, difficulty of the regimen, side effects, lack of trust, does not comprehend the importance or poor past experience and unwilling to try again.  In order to timely detect non-adherence and to provide the support needed to get back on a care plan, we must check in with our patients – and do it often.  With the connected, modern consumer-patient and current technologies this can be easily done through multiple channels.

4.     Be Personalized & Dynamic

It is commonplace for care plans to change due to a number of factors.  Some are patient-requested, some are health based and so on.  Whatever the reason, the plan changes and it is communicated to the patient.  The problem is patients may not understand the plan or may confuse the new plan steps with previous instructions.  It is important to not only communicate the new plan but also to support the patient during the transition and through future activities. 

5.     Use Proof

Prior to making decisions, there are typically three major steps we go through.  Step one is to recognize the problem or need.  Step two is to gather information about how to solve for the problem or need.  Step three is to evaluate the options before taking action.  So, it would only make sense that patients and prospective patients want to understand the how and why from trusted sources before making decisions.  It is incumbent on healthcare providers to share the details about the steps in an action plan to make the patient feel more comfortable and to buy-into the path ahead of them.  Too many times patients and prospects turn to friends and unreliable internet sources that can lead them astray.  Make sure to provide access to information that supports chosen treatment plans.

6.     Foster Action

Psychology Today published an article on the five most common reasons we procrastinate which include:  absence of structure, unpleasant or boring tasks, timing of the reward or punishment, anxiety surrounding failure, and self-confidence regarding the ability to complete the task.  Providing patient-facing tools can help address these reasons and foster forward-moving progress.  By simply adding structure to a care plan, providing on-going support, monitoring timelines and introducing patient incentives, patients will be less likely to procrastinate. 

7.     Hint/Nudge

The Hint/Nudge concept is to encourage or suggest the “right” choice without taking away other choices.  A very relatable example is a typical restaurant menu.  How many times have you opened a menu to see the “Our Customers’ Favorite Pasta” the “Famous Burger” or the “Chef’s Award-Winning Special”?  These call out boxes (or hints) are strategic.  This is an example of allowing someone to make a choice but attempting to persuade them toward a specific decision.  Presenting content and hints along the way will help patients to make the right decisions. 

8.     Reduced Options

I mentioned in the section above that the Hint/Nudge concept does not take away the ability for one to still have choices – but – that doesn’t mean there should be a huge selection of choices, either.  In fact, a fairly well-shared study proved this out.  In a supermarket study, shoppers were presented with either six or twenty-four different kinds of jams that could be purchased.  The table with twenty-four jams generated more interest but the people were far less likely to purchase a jar of jam than in the case of the smaller display (about ten times less likely).  What this tells us, is that while choice seems appealing, choice overload can generate the wrong action or no action at all.

9.     Lead With A Foot-In-The-Door

The underlying philosophy of this approach is to start with a small request that is fairly simple to agree with.  From there, larger or more difficult requests are not a far putt from the initial request and the likelihood of compliance is much higher than starting with the big ask.  My mother was a master at this technique!  As just one example, she asked if I would watch my younger sister for an hour after school.  From there she requested I help my sister with her homework.  Once that was in place, I became responsible for the daily laundry tasks.  And it didn’t stop there.   In hindsight I see how it played but while it was happening, it didn’t seem overwhelming at all!

10.     Offer Incentives

I saved the most engaging technique for last. Patient incentive programs are the perfect way to jumpstart or continue to build upon the emotional, reciprocal relationship between your health system and your patients. The first component of patient reward programs is based on thanking patients for completing the right activities at the right time.  It’s an exchange of sorts that shrinks the time interval between completing a task and receiving a reward. If a patient receives incentives and/or perks for desired behaviors, they are more likely to “return the favor” in the form of completing more tasks, scheduling more visits, adhering to their care plan and even sharing friend & family referrals.  The second aspect of patient incentive programs addresses retention.  One of my go-to examples is the airline industry.  If you are a frequent flyer, the airlines want to win your business and retain you as a customer for life.  The more you fly with them, the more points and perks you earn.  For health systems, it is also important to retain patients.  After expensive acquisition activities, the last thing you want is to see your patients switch to your competitor.  And remember, the cost of acquiring a new customer is anywhere from five to 25 times more expensive than retaining an existing one!

With the right approach and tools, activating and engaging patients are within your reach. Better outcomes can be achieved.  More lives can be saved.

About the Author:  Sue Butler is the EVP, Client Success and co-founder of Customer Evolution, focused on advancing the consumerization of healthcare for a transformative health experience. With an extensive background in consumer-facing innovation that spans process improvement, experience management and product development, Sue has worked with clients in the fields of healthcare, insurance, financial services, technology services and hospitality.

About Customer Evolution: The Customer Evolution team is committed to helping health systems engage modern medical moms and digitally savvy patients in new, innovative ways. End²End™ was borne from our years of helping shape customer experiences and influence behavior outside of healthcare.  Our heritage serving world-class organizations such as Hilton, American Express, Chase, Wells Fargo and others cultivated a deep understanding of the proven methods which consistently deliver on the goals of experience and outcomes.  We combined this with the deep knowledge we have gained serving Tampa General, Henry Ford, Humana, Florida Blue and many more respected health institutions.  The result is a platform specifically designed to solving the journey management challenges facing health systems today. Learn more at