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Nudging Members: Using Behavioral Economics To Drive Engagement

by Dr. Vindell Washington, Chief Medical Officer, BCBSLA

January 9, 2019

How behavioral economic solutions help Blue Cross and Blue Shield of Louisiana keep members engaged in care management programs.

A big driver of Louisiana’s historically poor health status is the high number of residents with chronic health problems like diabetes, heart disease, high blood pressure, and kidney disease.

One of the most direct ways Blue Cross and Blue Shield of Louisiana helps members who have long-term or complex needs is to connect them with our in-house team of nurses for health coaching, access to community resources, and personalized education. It costs the member nothing to work with a health coach, and this can go a long way toward improving their outcomes.

Although this program is free, true improvement in clinical outcomes requires behavior change from members. They must choose to exercise and eat healthy and, if their health fails, stick to their doctor’s treatment plan and take medicine as directed.

So, how can we drive greater engagement and participation in our care management programs? In 2018, Blue Cross partnered with VAL Health, a nationally recognized leader in behavioral economics, to develop practical solutions. At its heart, behavioral economics takes advantage of the irrational behaviors that we all exhibit as people—focusing on short-term gains, overestimating the probability that good things will happen, and taking the path with the least resistance.

The tactics we’re using involve different stakeholders—providers, members, and the health coaches—to give a gentle nudge to folks to do the healthy thing.

Our solutions now use the principles of behavioral economics.

Authority and Ease of Action

We developed a prescription pad for primary care providers to give patients with conditions that qualify them for care management, telling them how to call Blue Cross and enroll. This carries the weight of the provider’s recommendation, using her authority as a health care expert, and gives members an easy direct route to be connected with a personal health coach. We are piloting the prescription pad with providers in our Quality Blue program, which also focuses on driving better health outcomes with quality improvements.

Exclusivity and Clarity of Requirement

Previously, Blue Cross sent a standard form letter to members who signed up for care management. We’ve changed to a more personalized welcome card. The card’s language reinforces the member’s choice to sign up and gives a clear call to action (to RSVP for health coaching using an enclosed card).

Adherence to Public Commitments

Pledge cards that the members fill out with their health coaches once assigned nudge the members to commit to working toward their health and wellness goals. The pledge is a public declaration of the member’s commitment to his health.

All of these solutions were simple, easy to implement, and immediately useful. These quick wins helped build trust among stakeholders, and the pilot efforts deepened relationships with provider partners.

Using behavioral economics has helped us fulfill our mission: To improve the health and lives of Louisianians.