Using Patient Behavior to Improve Outcomes, Care

In a session at Health Care Quality Congress 2019, David Asch, MD, MBA, of The Perelman School & Wharton School of the University of Pennsylvania, discussed how patterns of behavior can be used to improve outcomes and health care quality.

Dr Asch said, “many health challenges require the scientific breakthroughs that come from fundamental discovery.” He further explained that other challenges that require other kinds of breakthroughs include affordability, access, equity, adherence, complexity, and burnout. “We have been better at supporting breakthroughs in discovery than breakthroughs in productivity,” Dr Asch noted. 

He told conference attendees that health care is different, and it is not only high stakes, but it is highly regulated and capital intensive noting that health care has something to learn from other industries.

“I bet one of you, or maybe all of you, have used Amazon,” Dr Asch said. “What’s good about them?”

He continued to say that the company has a huge selection, lower prices, quick searching, payment, delivery, and many other notable perks. Amazon enabled the idea of “I want what I want when I want it,” which Dr Asch explained, is a goal of health care.

“The health care transformation to me is the combination of technology and behavior,” he said.

Scale is impossible without technology, and technology is useless without engaging human behavior. The total transformation equation is technology plus an understanding of behavior equals scalable health care change.

“The most persuasive view of health behavior suggests that patients and clinicians will make good decisions when they have the best information in front of them,” said Dr Asch. “Can we do better than that?”

There is a shaky foundation with information alone, according to the presentation. Dr Asch said there needs to be shared decision making, health care cost or quality transparency, informed consent, and clinical guidelines. “Clinicians and patients should get together to achieve patient goals-no one would disagree with that.”

He explained that rationality poorly describes behavior change., that the old approach to change someone’s behavior was to change their mind, but a better approach would be to use behavioral reflexes to bypass cognition.Dr Asch suggested irrationality should be used for the purposes of good.

“Behavioral economics starts from the understanding and recognizing that people are irrational,” he said. “Once you recognize how people are irrational, you are in a better position to help them.”

Dr Asch recommended that professionals move away from financial incentives to more social incentives because not only are financial incentives expensive, they can backfire. With social incentives, we can harness existing trust relationships, and become self-sustaining.

 “We now understand human behaviors, wireless devices make it easier to touch people, and health care financing shifts create economic motivation to connect with people when they are not in the hospital or office,” concluded Dr Asch.  —Julie Gould