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A Nudge in the Right Direction

Published April 6, 2016 11:56 AM by Monique Barrett
[Editor’s note: This post was originally written by Kathleen Ellmore, vice president, engagement sciences, Silverlink.]
 
“Real people have trouble with long division if they don’t have a calculator, sometimes forget their spouse’s birthday, and have a hangover on New Year’s Day.” 
― Richard H. Thaler, Nudge: Improving Decisions About Health, Wealth, and Happiness

It’s not easy to be healthy. We all know we need to do certain things to get to our best version of our healthy selves; yet, very few of us do.
 
When Richard Thaler and Cass Sunstein published Nudge in 2008, they applied the important concepts of behavioral economics to healthcare, and included insights about consumer behavior towards their own health that are still true 8 years later. It seems like an overwhelming task to get people to make better choices about their healthcare, but what we know is that a small change (or two or three) can have a very powerful and lasting effect. More than a million times a day, we apply these very principles to help nudge people into the choices that aren’t always the easiest but are the best for their health.
   
And they work. The keys to driving behavior change can be as powerful yet simple as these nudges:
 
1. The Power of the Second Chance: How many times have we all been in the situation where we know we need to do something, and yet it seems so daunting we avoid it? If we find out something important we need to do may be easier than we feared, we are much more likely to change our minds when given the chance. As Thaler said, “First, never underestimate the power of inertia. Second, that power can be harnessed.” In healthcare, a consumer may delay or avoid an important test or screening, even when they know they need it, and for a whole variety of reasons, from lack of understanding the need for it to fear or avoidance of something that might be uncomfortable. Let’s face it: Who is going to jump at the chance for a colonoscopy? We use this “second chance” nudge in healthcare very effectively. When we ask consumers whether they want to enroll in a condition management program or schedule an appointment for that overdue screening and they say “no,” we find out why and address the why. Then, by simply asking “Are you sure?”, we convert up to 30% of those initial “no’s” into “yes’s.”
 
2. Harness FOMO: I don’t know a single person who hasn’t experienced “FOMO” or “Fear of Missing Out” at some point in their lives. In other words, you want to do something because everyone else is, and this doesn’t just apply to our teenage years, at the height of peer pressure. When applicable, we use social norm messaging to help nudge consumers to make the right choice in a variety of programs, and for those folks who are hesitant, understanding many others have also made the same decision adds a powerful testimonial and influence. For example, when we told consumers who were considering a health plan choice that they would have “access to the biggest network,” the campaign results soared by 57%. As for those tendencies we all have around FOMO? The good news is social norm messaging doesn’t work as well in the Medicare population. Phew, we can look forward to finally outgrowing peer pressure!
 
3. Stop at Three: It’s so important to make sure you don’t overwhelm consumers with too many choices or too many things to do, or you run the risk of sounding like Charlie Brown’s teacher. There has been terrific research that shows consumers prefer lists with odd numbers and find them easier to digest than even-numbered lists. Over our 14 years, we have found evidence time and again reminding consumers about no more than three specific gaps in care is most effective for people with three or more gaps to close. If you start to message about that fourth gap, you’ll lose their attention, and the opportunity to close any of those gaps drops significantly. (It’s also important that you don’t lose your readers, so I’m stopping at three as well!) 
 
Behavioral economic nudges are an effective, gentle way to help consumers take the actions we need them to take to achieve better health. What nudges are you using in your programs? 
 
References:
1. Richard H. Thaler, Nudge: Improving Decisions About Health, Wealth, and Happiness
2. Medium and Baker Marketing

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