April 2022

Improving Care Engagement Through Behavioral Design

By Ramon Jacobs-Shaw, MD, MPA

Far too often, the healthcare landscape dismisses the value and detail of personal experience — instead, reducing names to symptoms, or patients and clients to statistics and demographics. Such a system-focused approach erases the specific relationships and hopes, habits, and hardships that make each of us uniquely us

Belong Health is firmly committed to a different philosophy of care — one that centers on expertise and results while also embracing the complex human qualities that fuel or concern each doctor, patient, and provider. Because high degrees of specificity and empathy are especially important in the aid of dual-eligible communities with complex needs, we seek to understand not only how every individual relates to their own health, but how everyone can best direct their own care. That’s why the notion of behavioral design is essential to our work. 


What is Behavioral Design

Put simply, it’s the study of the gap between what people say they’ll do and what they’ll actually do. Thoughtful, thorough examinations of this gap — followed by implementation of operational solutions with which to bridge it — are invaluable in nearly every industry. Consider, for example, how understanding behavioral design informs financial aid applications for college: 

Every academic year, financial aid applications offer some of the strongest predictors of whether a student will enroll in college and persist to graduate. Sadly, every year, at least two million eligible students fail to submit the Free Application for Federal Student Aid (FAFSA) — ultimately leaving $2.5 billion unclaimed in loans, grants, and scholarships. Why?  

Flow chart of federal student aid application

An abundance of “friction points”: the speedbumps that overwhelm each of us leading to indecision and confusion that too often stalls us from taking any action at all. 

Behavioral design pushes back against these habits. At its core, its science is composed of three steps: 

  1. Identification of the behavior that needs to be addressed 
  2. Identification of the psychological biases that come into play 
  3. Study of what actions people take vs. what they say they will do 

With this three-step process, behavioral design smooths friction points and dismantles barriers holding each of us back from action. In applying the behavioral design process to the above financial aid example, our friends at Irrational Labs (a celebrated team of behavioral scientists) found that, when students at West Texas A&M University were presented with FAFSA completion as not being an optional benefit but a required task, application completion and delivery rose significantly — and if such an approach were implemented nationwide, an additional 230,000  students would find themselves eligible for financial aid every year. That’s a lot of happy students (and parents)! 


Biases, Boundaries, and Behaviors in Healthcare 

Now: let’s train the tools of behavioral design on the world of healthcare. Meet Patricia, a 60-year-old woman with multiple chronic illnesses including dialysis, anemia, pulmonary hypertension, pulmonary fibrosis, arthritis, congestive heart failure, scleroderma, and depression. Prior to being enrolled in a D-SNP plan through MVP Health Care, Patricia had been on an MVP-managed Medicaid plan and was not actively engaged in her care management.  

With a host of chronic conditions and a personal aversion to reaching out for care, Patricia was largely left to her own devices and was frustrated at feeling like a “burden” to her adult daughter. Behavioral biases and barriers had popped up all around Patricia — it was even hard to get her on the phone — but Belong Health remained committed to helping. 

The first step was just to get Patricia comfortable and talking. And even that was aided by a focus on behavioral design. 

Flow chart of phone call with D-SNP member


Belong Health let Patricia know that, with the help of the MVP Dual Access Program, she could now be equipped with her own personal care team of a registered nurse, a licensed clinical social worker, a community health worker, and pharmacy support. Once this group got to work and came to know Patricia on a human level, she finally opened up about her private feelings of hopelessness — and a series of behavioral design processes, directed towards engaging with Patricia at the hours and in the styles that best suited her, finally chipped away at her self-protective walls. 

As the process unfolded, this once-isolated and discouraged woman was reminded that a full and vibrant community of support was present for her. 


Patricia and beyond

As is often the case for Belong Health, engagement with this member was iterative — each participant of the connection learning as we went, making changes to improve communication, programming, and a highly curated relationship. With other members, Belong Health is already exploring text-based messaging capabilities to ease connection and to schedule appointments. Even in those developments, behavioral design again plays a role: We’ve found use of inviting language, such as, “most of our members connect with us to make appointments by text” has elevated the level of interpersonal engagement in that form. 

And what’s the latest for Patricia? She’s doing great. After having frequently been in and out of hospitals before her engagement with Belong Health, she’s so far had zero hospitalizations or emergency room visits in 2022. Just as important, she knows the name of every member of her personal care team and feels no reservations about connecting with them if she’s not feeling well. And now, she better incorporates her family (including the daughter she was so worried about “burdening”) into her decision-making around her chronic conditions. 

Recently, Patricia told the Belong Health team: “I’ve never had anyone look after me the way you all do.” 

It’s the highest of compliments – but you might say our behavior is uniquely designed for exactly this sort of result.