A key promise of the population health phenomenon, so important to payors, providers, and suppliers is this: We need the public to get healthier. That requires participation. If payors pay, people will take advantage of free preventive services to get healthy.
Here’s how the Kaiser Family Foundation put it in their recent Health Reform overview (see bold): A key provision of the Affordable Care Act (ACA) is the requirement that private insurance plans cover recommended preventive services without any patient cost-sharing. Research has shown that evidence-based preventive services can save lives and improve health by identifying illnesses earlier, managing them more effectively, and treating them before they develop into more complicated, debilitating conditions, and that some services are also cost-effective. However, costs do prevent some individuals from obtaining preventive services. The coverage requirement aims to remove cost barriers.
The reality is that while cost is a barrier for some people, it’s not the only barrier. It may not even be the main barrier. Now you might be thinking, if preventive services have been proven to improve health and save lives, why would people NOT make use of them, especially when they’re free? What other barriers might there be?
In my two decades of experience working with CDC, CMS, FDA, and many public health efforts, behavior change is the holy grail. And maybe the hardest to achieve. The main barrier I believe is not money, but motivation. People will find all kinds of reasons (beyond costs) to NOT sign up for free preventive services, including: 1) I’m not sick, 2) I don’t need whatever those services are, 3) I’ll do it later.
Prevention has alway been a tough sell. The fundamental benefit promised is that something bad (illness) will not happen down the road. Many people don’t see that as compelling or personal relevant in a life with so many demands in the here and now.
The solution requires: 1) increasing immediate personal relevance, 2) making it simple to do. As my friend and colleague Peter Mitchell, head of Salter Mitchell’s MarketingForChange practice, says, make it fun, easy, and popular. Building on that, I like the FEFE acronym- Fun, Easy, Fast, Effective.
Research trends in the science of persuasion, behavioral economics and decision-making, social psychology, and marketing science, provide convergent evidence that motivating health behavior change and utilization of preventive services is no simple task, and requires far more than data, information, and logic.
Bottom line, population health players need to employ multiple approaches to motivate behavior change, and to not assume that a logical (and free) offer will do the job.
FYI, here are a few more resources on motivating health behavior change: