Health behaviour change: the next frontier

Why is now the right time for personalised healthcare

When researching for this article I came across a McKinsey article with a similar title (I had thought up my title last night and was feeling pretty smug about it, but was shattered when I discovered the McKinsey article title!) — Changing patient behaviour: The next frontier in healthcare value (Dixon-Fyle, S. et al, 2012; hereon called the McKinsey article). The article is spot on about the criticality of behaviour change in the next wave of healthcare innovation, but was written in 2012, a bit ahead of its time. Some things have changed in the past 10 years while most things have remained the same. Healthcare is an extremely slow-moving industry where the move-fast-and-break-things approach does not work. The McKinsey article describes a ‘person-focused paradigm that uses a behaviourally based rather than disease-based orientation to drive sustainable behaviour change’. Without going into much detail — it describes a winning combination as one that integrates behaviour change into existing care delivery using better patient engagement leveraging the powers of social, technology, and better business models. I will build on this concept in this article and describe why both payers and providers need to start paying attention to this paradigm or risk losing significant market share in the coming decade.

I will avoid hashing out the economic arguments for focusing on behaviour change — this has been covered in numerous articles discussing the increasing burden of chronic diseases (WHO 2021), impact of behaviour change on lifestyle (chronic) diseases, building up of cost pressures within health systems, and increasing prioritisation of primary care within the industry. Instead, I will walk through why the timing is right for such a change.

There are 3 driving forces that make focusing on behaviour change imperative for healthcare leaders today:

· Maturing digital health landscape

· Increasing consumer awareness

· Emergence of personalised health

Maturing digital health landscape

The first wave of digital health companies, mostly focused on health management, that started about a decade ago such as Ginger.io, Omada Health, Babylon Health (full disclosure: I used to work at Babylon), Propeller Health, etc. are mature enough and most have integrated into existing care delivery systems and reimbursement models. There are several other companies in the telemedicine & remote monitoring, diagnostics, patient education and AR/VR space that are in development and maturing as well. This shift from the old model of care to digital first care means more frequent interactions between the health system and the patient, leading to more (and hopefully better) engagement. Availability of digital first care schemes has led to increased choice. Providers that are just adding a layer of video consultation and calling their services digital first will lose out if they don’t move towards a well-integrated behaviour change approach which shares with their patients ownership and responsibility of their health outcomes. This sharing requires providers to monitor, prescribe, and measure behaviour change interventions — making it easier for their patients to act on their health advice. Patients will preferentially move to those providers who have such behaviour change tools and trackers, abandoning providers who refuse to accept the shifting power dynamic.

Increasing consumer awareness

Today’s newer generations, millennials and gen Zs, are increasingly health conscious, better educated, and tech savvy compared to the outgoing generation of baby boomers. Firstly, despite lamentations from healthcare providers and payers, we demand an excellent customer experience in healthcare, similar to what we get in other aspects of our lives such as online banking, shopping and entertainment. Without personalisation achieved by understanding patient preferences and needs, this customer experience isn’t possible. Secondly, our generations carry the mantle of the green movement — desiring everything to be sustainable, local and natural. It follows from this that these generations are much more prevention-focused, wanting to be ‘empowered’ not ‘treated-upon’ to achieve better health. Preventive health is achieved either through better policy (top-down approaches which have their own place in history but are slow and arduous, consider the 50-year long battle against Big Tobacco) or through individual-level behaviour change (bottom-up approach). Individual-level behaviour change can impact aspects of almost all determinants of health, including diet, exercise, sleep, mental health, socialness, and environment.

More than anything, providers and payers of today need to be purveyors of agency to their patients — empowering them with knowledge and tools to make up their own minds in order to change behaviour. Anything short of this will turn off savvy healthcare consumers who wield the power to shop around for a truly equitable partnership.

Emergence of personalised health

The promise of personalised health has gone unfulfilled over the past few decades. The emergence of digital health was heralded as a new age in which bespoke pharmaceutical drugs would be manufactured or diet and exercise recommendations would be personalised to each one of us. This has not come to pass yet, primarily because individual behaviours are not well-understood and therefore hard to account for. Blockers include also lack of better non-intrusive continuous data collection systems for individual level health data. As such systems are developed (check out FreeStyle Libre 2 or similar systems used at Levels), we will begin understanding behaviour at the individual level and may be able to draw inferences that help us truly personalise healthcare delivery. Providers and payors will be left behind if they do not start actively engaging in this conversation as start-ups emerge in the health behaviour change space. These digital-first new companies have the advantage of understanding deep-rooted motivations, preferences, and needs of patients that old model of care completely disregards — and therefore present the potential to displace these old models altogether. The judgement of whether this is good or bad is secondary, however, the realisation that this is a possibility in the next decade is imperative.

If we as a society do this right, secondary care will stop being the 80% cash-guzzling machinery that delivers 20% of the value — a model that is increasingly clear as being unsustainable for developed health systems across the world. Health systems focusing on primary care that adopt a digital first strategy will need to develop tools for understanding and instituting individual-level behaviour change if they want to stay relevant.

References

Dixon-Fyle, S. et al. “Changing patient behavior : the next frontier in healthcare value.” (2012).

I work in the exciting space of preventive health, artificial intelligence, and behaviour change. If you are as excited about the future of health, please do get in touch — I’m on Twitter @xenoach

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About the author:

Xeno is a Harvard-trained epidemiologist and public health specialist focusing on digital health and healthcare technology transformation. He led the epidemiology team at Babylon Health and is currently a health technology consultant. He regularly writes and speaks about the use of AI/ML technologies in healthcare and preventive health.