The Challenge of Engaging Patients to Engage

“Build it and they will come” is not a sound strategy for anything in healthcare.

Digital programs or apps don't tend to go viral like Angry Birds or Candy Crush. Engaging in one’s own health is not nearly as immediately compelling as launching a rotund bird with a slingshot or matching colorful pieces of candy. As a result, plenty of well-meaning and expensive programs designed to help patients by engaging them—adherence or CRM programs—have suffered from an inability to entice enough patients to join.

In our experience in the marketplace over the past four years—with our online and mobile adherence platform leveraging education, rewards and gamification—we have thought long and hard about patient recruiting and offer the following insights:

  • Recruiting needs to be multi-channel. Tap into existing email lists. Try snail mail. Link the program to other offerings such as the copay card. Leverage online lead generation. The best bet is all of the above, in combination.
  • Communicate the program’s value to physicians and other health professionals. Use prescribers as advocates. They understand first-hand that even the most effective medications are worthless if patients don’t take them.
  • Experiment. If sign-up is online, test different landing pages and email subject lines. We’ve tested invitations that emphasize rewards vs. those that emphasize education. We’ve been surprised by the results. It’s hard to anticipate ahead of time what will compel people to open an email, click through, and complete registration. Given the lengthy timelines that result from regulatory constraints, it’s difficult to be nimble in pharma, but it pays to be as nimble as possible.
  • Pilot programs, in particular, can suffer from a commitment problem: insufficient up-front recruiting efforts. The thinking here is: this is only a pilot, so we’re not going to commit much here. The result, however, is often meager enrollment rates, which then reflect poorly on the pilot as a whole, decreasing the chances that a program will be commercialized.
  • Brand managers in pharma change jobs frequently. The new manager may not be as personally invested in recruiting for a program as the manager who got the program up and running, even if it is delivering results.
  • The last thing patients want in healthcare is more forms to fill out. Keep registration as simple as possible. Pre-populate where possible. Limit the fields to only what is necessary.
  • Make the registration process fun. Offer a reward for completing it. Make it more like a game. Or at least, keep the hassles to a minimum.
  • The benefits of joining need to be crystal clear. What’s in it for the patient? In particular, what are the short-term benefits? Our natural human “present-bias” (in the parlance of behavioral economists) dictates that near-term benefits are easier to appreciate than longer-term benefits. Therefore, “join this program and enjoy better health” is probably not compelling enough to most people. Too abstract. Too long-term. Most people would prefer to know: What can I get out of this program now?

Assuming a patient is sufficiently intrigued by a program to enroll, and then engage, perhaps the harder trick is sustaining engagement long enough for the intervention to have an appreciable impact. We are often dismayed by the high bounce rates and small number of repeat logins and page views demonstrated by health-related digital offerings out there in the marketplace. It’s a tough challenge.

On the sustained engagement front, we believe the following are important:

  • Offer dynamic content. Make sure the content is not too boring or scary. Even though people joining the program are “patients” with a “condition” they’re still just people who would appreciate useful and enjoyable content. In addition, the content should not be too simplistic. If someone is engaging with health content online, they’re likely to have better than a fourth-grade education.
  • Build both online and mobile versions of the program. Not everyone has a smart phone, and some functionality may be easier on a bigger screen even for patients who do have a smartphone. Flexibility is a good thing. Some people like to bookmark a site and check it as desired, but might forget about yet another app.
  • If the program is a “one-trick pony” it is not likely to appeal to a wide diversity of patients. Some patients are motivated enough to take their medication such that a simple reminder is sufficient to prevent the occasional missed dose. Other patients lack the motivation to even refill at all, and those patients need much more than just a reminder. A multi-faceted program offers a diversity of levers, giving patients the ability to chose which of those levers they respond to most. Plus, a person’s motivational state can change over time. Sometimes they need more help, sometimes less.
  • Add elements beyond dynamic content that will compel patients to return. Gamification, goal-setting, and rewards can all improve that anticipation and fun factor that make people spend valuable time playing games outside of healthcare.
  • If possible, make the program unbranded so that ISI requirements do not interfere with the user experience. We believe that some patients are less likely to engage in pharma-sponsored programs as compared to programs sponsored by other healthcare constituencies. It may help to make a program the least “pharma-like” as possible, while still keeping it clear who the sponsor is.
  • Offer patients choice in communications preferences. Outbound communications should be as flexible as possible. Text message vs. email vs. push notification. Let them limit or opt out of communications but still remain a part of a program, if desired. An annoyed patient will become a disengaged patient.

No engagement program in healthcare has yet cracked the code in terms of maximizing recruiting success and sustained engagement, but incremental advances with an eye towards incorporating an understanding of human psychology and motivations can go far in improving upon efforts to date. Now that we’re in an era where we recognize that a person’s engagement in their own health and wellness is perhaps the most critical key to better outcomes, it’s not too far fetched to say that engaging patients to engage can be, literally, a matter of life or death.

The Patient Summit 2014

Jun 17, 2014 - Jun 18, 2014, London

An integrated approach to patient-centric outcomes