Philip Graves is a consumer behavior consultant, author, speaker and regular contributor to the media. For the last six years he has been working with international businesses, providing expert advice on consumer behavior and behavioral insight. Follow him on Twitter at @PhilipGraves.
The U.S. is inundated daily with advertisements for new prescriptions, so much so that we might think that drug companies spend as much effort on marketing as they do on developing drugs. The blanket advertising actually belies a deep problem in the healthcare industry and if the pharmaceutical companies developed drugs the way they have traditionally developed the marketing of them, we would -- quite frankly -- all be dead.
Current drug marketing is developed using what are, in essence, decision making placebos. For all the great work that has been done to create robust experimental designs to evaluate whether a new compound elicits health benefits, the route to understanding how to convey that product to the people who might benefit from it is littered with bogus market research pseudoscience.
Over the last twenty or so years, advances in our understanding of how humans think and make decisions make it abundantly clear that asking people questions as a route to understand their behavior is no more useful than asking them if they think C9H8O4 will make their head hurt less. (The answer, by the way, is yes).
Nevertheless, routinely, the marketing of drugs is developed, shaped and ‘validated’ by asking questions of people who have no access to the unconscious mental processes that actually drive their behavior, and in a context that exerts a wide array of biasing influences that will never be present in reality.
As we continue to think about re-working our healthcare system and the crucial role that technology will hold in its future advancements, we need to acknowledge that informed decision-making is a broken process for patients; they aren’t in a position to judge what is best for them nor how they will react after a diagnosis. Yet with advancements in Intelligent Virtual Assistants (IVAs) in personal health, we can begin to gather the inputs both for ourselves and our doctors that can create real-world decision and testing data that mirrors how the technology industry itself develops.
In essence, we are in a position to make far more objective decisions by applying the principles of behavioral economics to patient care by capturing data, influencing behavior and analyzing health outcomes.
The Dangerous Myth of “Patient Choice”
Most patients aren’t in a position to make well-informed decisions about their healthcare.
Talk of ‘patient choice’ in a healthcare market is naïve, not least because the people concerned are often elderly and, to state the obvious, unwell. Being cared for and making decisions are, in psychological terms, all but incompatible.
The reality is that most patients are intrinsically biased towards believing that they can trust the information they receive: they do so because they want to be able to trust it and because the alternative is psychologically overwhelming.
Without the capacity, energy or opportunity to effectively explore what different options might exist – they can’t become their own test and control conditions – they are all but obliged to make decisions that are based largely on belief, not evidence. Whether that is a belief in the doctor treating them, the website they find convincing, or the objectivity of the drug trial they find online, at some point there is a requirement for faith.
Health providers who have their patients’ best interests at heart need to recognize that there is a big gap in the market for helping patients deal with all the aspects of their chronic health conditions; for example, identifying when they have a need for medical care, should switch to a different drug or could safely move on from a phase of treatment. However, crucially, bridging this gap requires better, deeper, timelier insights than have traditionally been available to healthcare providers. In short, they need to understand how their patients actually behave and what they can do to help them make changes.
A misplaced faith in market research has resulted in many large organizations evolving in a way that gives them little capacity for the live trials that behavioral economics shows can provide such reliable and valid insights to support decision-making. Of course, a number of technology companies grew up learning the vast majority of what they know from seeing what really worked and what didn’t: I’ve been reliably informed that every third time you visit Google you’re part of an experiment. For these businesses, live testing is the foundation on which their decisions are built.
IVAs and Real-Time, Real-World Data in Healthcare
The good news for the health sector is that the next generation of technology has arrived with the capacity to help them be much more patient focused: it can integrate existing business processes into one user-friendly interface and provide a connection with users that is perfectly suited to the application of behavioral economics.
Intelligent Virtual Assistants that use a natural language platform and multimode interface don’t just provide an infinitely scalable presence on a smartphone – a device that is not just widely owned but also virtually attached to most people, making it an ideal tool to keep in touch with patients who have chronic health conditions. They can also capture real-world data, reflecting needs that healthcare companies and patients may not even know exist.
Perhaps of most significance to behavioral economists is the fact that they also make randomly controlled trials easy to implement: put another way, they deliver an infinite opportunity to learn what and, just as importantly, how people really think in real-time.
Whilst no one would suggest that such a device could replace the skill and capability of a human healthcare professional (HCP), the potential of such technological support goes beyond handling the day-to-day administration of patient care. Dr. Carolyn MacGregor found that, by using technology to constantly track the data from equipment monitoring premature babies, she could identify a health issue 24 hours before the healthcare teams who were recording the information on paper charts at intervals.
An IVA has considerable potential to record measures that might, through analysis over time, enable the identification of warning signs that could alert healthcare practitioners to intervene before a more serious situation develops:
- Tracking how frequently and reliably medication has been taken.
- Accumulating physiological data collected in-home, such as blood sugar, temperature, physical activity levels, blood pressure or heart rate.
- Evaluating qualitative data to gauge how the patient is feeling: because people are able to speak naturally to their IVA, aspects such as tonality might be monitored for signs of fatigue or depression.
That the technology exists for a smartphone to be a coach, confidant, expert health resource, memory aide and personal assistant are all good reasons for healthcare companies to want to offer them to their customers. However, it is the capability IVAs deliver for experimentation that means that, commercially speaking, companies are missing the single biggest opportunity to gain a competitive edge if they don’t develop them.
Given their potential, I’m convinced that IVAs will become as common as prescriptions in healthcare within the next decade. With Accountable Care Organizations becoming established, the profitability of companies involved in the delivery of healthcare will be increasingly related to the effectiveness of their ability to deliver the best possible outcomes.
However, beyond making care accountable, clinicians should be excited about the capability this technology provides to capture, record and analyze rich new sources of patient data. This readily attainable, but unprecedented data can be analyzed over time to anticipate patient needs and proactively deliver the appropriate intervention before the healthcare provider or patient would be aware it’s needed.
Understanding how and what your customers/patients think has never been more important, but behavioral economics shows us that what people say and what they do are rarely aligned. Companies who understand this sufficiently to make the right choices about what data they collect, reference and analyze will be the ones that prosper in the changing healthcare landscape.