This Week in Health IT
September 30, 2020

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September 30, 2020: For all the technologies that the healthcare industry is rolling out, behavioral economics is at the forefront. What are the behaviors you need someone to be doing? What are the top mistakes health systems make? Karen Horgan, CEO of VAL Health outlines the essential tools required to successfully apply change. How do you make the right path? The easy path? Is the behavioral pattern around awareness? Is it around obstacles? What about framing? We know that words matter. How do you use common language and personalization to make a much bigger impact? How can we bring in the social proof and nudges to get patients going for the greater good of the healthcare community?

Key Points:

  • Humans are irrational and biased [00:03:05] 
  • To encourage people to take the COVID-19 vaccine you need to have local presence and campaign [00:09:15] 
  • Provider behavior change and patient behavior change [00:13:56] 
  • How does social media drive behavior? [00:16:31] 
  • Automated hovering [00:17:50] 
  • If people pay money for tools, e.g. FitBit, are they more prone to use them? [00:19:00] 
  • AB testing [00:20:45] 

Behavioral Economics

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Behavioral Economics with VAL Health CEO, Karen Horgan 

Episode 310: Transcript – September 30, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[00:00:00] Bill Russell: [00:00:00] Behavioral economics. You’re going to love that term. Once we get done with this episode, it was a fascinating topic for me to explore. And it really is, I think, at the forefront of the foundation for all the technologies that we’re rolling out, it’s at the forefront of changing behaviors in the community and population health. and I think you’ll agree with that. One of the things I wanted to make you aware of, and one of the things I’m really into joining is I’ve started a conversation on LinkedIn. And what I do is every morning I get up around five 30. [00:00:30] I collect a couple of stories. I decided which one I’m going to talk about.

[00:00:33] I put a story out there and I write one up to the limit of the number of characters that you can do. And we’ve had some great conversations going back and forth. So if you’re not following me, please do that. That is one way that you can get, can engage in the conversation. And, and, again, the back and forth has been fantastic.

[00:00:53] And I want to invite everyone to be a part of that. Also, you can follow the show. over on LinkedIn, that’s another area where we [00:01:00] are investing significantly to upgrade. And if you haven’t checked out the YouTube channel lately, we have really updated the YouTube channel, categorize everything. And this is the benefit of having sponsors.

[00:01:11] I have a team of people that is working really diligently to make this stuff accessible to you, and to your, into your teams. thanks. And I hope you enjoy this episode.

[00:01:26] Welcome to this week in health IT where we amplify great thinking to propel [00:01:30] healthcare forward. My name is Bill Russell, healthcare, CIO, coach, and creatpr of this week in health IT, I set a podcast videos and collaboration events dedicated to developing the next generation of health leaders this episode.

[00:01:41] And every episode, since we started the COVID-19 series, that’s been sponsored by Sirius Healthcare. Now we’re exiting in that series. And Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show’s efforts during the crisis and beyond.

[00:01:56] All right. Today, we are going to explore a topic [00:02:00] that is really interesting to me. This is actually, I’m going to say upfront. It’s not a paid episode. Cause sometimes people are like, Oh, you’re, bringing on a consulting firm. Is this a paid? So it’s not, this is such a fascinating area for me. And I think it is going to be for our listeners as well, which is why I have Karen Horgan, the Co-founder and CEO of VAL health on the line.

[00:02:20] And VAL Health is a big  economics consulting firm. Good morning, Karen. Welcome to the show. 

[00:02:25] Karen Horgan: [00:02:25] Good morning. Thanks for having me 

[00:02:27] Bill Russell: [00:02:27] This is one of those topics I’ve [00:02:30] always wanted to talk about. And as we were talking about earlier, and until you can get me to stop going to McDonald’s, I’m going to be a health risk, right?

[00:02:39] And that’s what behavioral health and behavioral economics is really about. Changing behaviors. Give us an idea of what behavioral economics is and what your firm does. 

[00:02:49] Karen Horgan: [00:02:49] Great. I will tackle that. And afterwards, we can have a longer conversation about McDonald’s and how to drive your specific behaviors.

[00:02:56] We cannot create a whole plan for you. Anyway. Thank you again for having me. [00:03:00] Behavioral economics is a science of understanding that humans are irrational. We have biases to the present, which is why we eat the chocolate cake. When it comes around on a desert tray we have aversion to loss and regret. We that’s why we hold on to houses or stocks that we should be selling off.

[00:03:16] We overweight probabilities and spent over $70 billion a year on moderate. So behavioral economics is that science that we now understand how humans are going to behave rather than trying to get people to not behave that way. But we can do in [00:03:30] healthcare is acknowledge those irrationalities and decision biases and incorporate them to drive specific behavior changes.

[00:03:38] Bill Russell: [00:03:38] So are you saying where we’re predictable in our irrational behavior? Is that what you’re saying? 

[00:03:44] Karen Horgan: [00:03:44] I am saying that. Yes. And so we know that we have certain tools in our arsenal that if you make the right path, the easy path, because we’re lazy, we’re going to stick with the default. How many times do you watch it, binge on Netflix because they just give you six seconds to roll right into the next episode. [00:04:00] We know that we’re social beings, especially during COVID, we’ve all seen this. Yeah, we like to do what others are doing. And we like to see what other them to see what we’re doing. And we model our behavior after them.

[00:04:11] Let’s use that to our advantage and good. Let’s not be like a gambling company. Let’s not be like McDonald’s to try and get people to eat, supersize your French fries and try and use it for our good. 

[00:04:23] Bill Russell: [00:04:23] So, let’s, you’re going to talk to us about how health systems can apply this to, the good [00:04:30] and how, digital startups can apply this to the good, which I assume are the types of clients that you work with.

[00:04:35] But let’s talk about the bad, because there’s a lot of people trying to get us addicted to, checking our phone off and apps, try to get us addicted to things. And food tries to get us addicted to things and gambling tries to get us not tries to, but has the. u-nintended consequences of getting us addicted to things, is this science used on both sides of the equation to pull me in one direction and then [00:05:00] we need to, start to strengthen the, muscle on the other side to pull us in the other direction.

[00:05:05] Karen Horgan: [00:05:05] The short answer is yes, the longer answer, which won’t be too long is that behavioral economics has been a fine, that’s been around 40-50 years. And it has been used in finance. It’s been used in retail. It’s been used in gambling. It’s been used in so many ways to get people, to do certain things, to buy for a dollar.

[00:05:25] So you’re going to buy three when really you could just buy one for 33 cents or the [00:05:30] gambling machines, the slot machines, they know exactly how long you’re going to be playing until you’re about to give up. And they give you a little bit of a win, which gives you a little optimism bias. And so healthcare has been very slow to the game.

[00:05:42] To bring in behavioral economics because in healthcare, the industry as a whole I’ll call it stubborn has always thought, we’re just going to give people information and that is going to drive change. We’re going to tell them how many calories there are in a big Mac. And data shows people purchase the same number of calories before and [00:06:00] after with our team that went into a subway sandwich shop and change the order in which items are listed.

[00:06:05] So part of the big, low calorie items listed first, the other day, high calorie items looked at first people purchase 25%, fewer calories when low items are listed first. And so healthcare has just not played on the fact that really the, and we do all of that and we need to start doing it. 

[00:06:22] Bill Russell: [00:06:22] That’s interesting. So you’re saying. We do lean pretty heavily on the education side. We think if we educate people that there are all of a sudden going to start [00:06:30] making the right decisions, if people knew that a 2000 calorie diet was, for, somebody who I’ve looked at this way too many times for me, but a 2000 calorie diet is what I should have.

[00:06:41] And I should exercise this much. And I don’t need any more information, but still I struggle in those areas. Still healthcare keeps trying to educate me. On the things I think I already know 

[00:06:53] Karen Horgan: [00:06:53] Think about mammograms and colonoscopies, whereas the affordable care act colonoscopies were free. People aren’t running out and [00:07:00] getting their colonoscopies.

[00:07:01] Like even once you remove the cost or mammograms or wound up 57% of target, women are going to get their mammogram, even though you’re giving you facts that it can save lives. If that information doesn’t just drive behavior and 40% of our chronic conditions, this is pre COVID. Statistics valuable change are brought on by lifestyle because we literally want to eat our cake and be healthy too.

[00:07:28] Bill Russell: [00:07:28] All right. So we have a [00:07:30] significant challenge. That’s going to be facing us here shortly, which is vaccine, right? So there’s going to be a vaccine. That’s comes out soon. And so is that the kind of thing that somebody would come to your company and say, look, we need to get somewhere in the, neighborhood of 65%. We have this many that distrust, this many. we have the statistics, we know what it is and people, I, know some people who are in public health and whatnot are scratching their head today going, I don’t know how we’re going to get to this 65, 70%. Is that the kind of thing [00:08:00] your, organization does?

[00:08:02] Karen Horgan: [00:08:02] Yeah, that would be spot on. So my co founders are Kevin Volpp and David Asch. They are academics at Wharton school. Kevin, Dr. Volpp Runs the NIH funded center for health assessment, behavioral economics, and Dr Asch is heavily involved in Penn medicine’s nudge unit. And so they have the raw science that’s been published in peer review journals, numeral journal JAMA, as we get VAL Health bring this out into the real world.

[00:08:26] And I recently read an, op ed from a [00:08:30] great economist saying that the government should pay every American, a thousand dollars to go get their vaccines. And I, wanted to pull my hair out because I think that is the worst idea we possibly to do as a country for a couple of reasons. One what’s the statistic, 30, 40, 50% of people say they’re going to get a vaccine anyway.

[00:08:48] So you’re paying them for what they would have done. So that’s going to cost us $150 billion. As the other half are now going to do some decision tree in their head of the [00:09:00] government is trying to pay me because they think this isn’t a good vaccine and there’s gonna be all kinds of side effects. And they’re trying to bribe me with a thousand dollars and that’s completely irrational.

[00:09:10] And so what we know we need to do on the vaccine side is you need to have local presence and campaign. So I live in the New York city area. If you have. the mayor or governor here doing a campaign and the arid in Texas, it’s gonna make no sense. So you need to find local communities [00:09:30] and the vaccine needs to come down to the local level of you’re doing it for the safety of your community.

[00:09:34] You’re doing it for the opening of your community. It’s not about the broader country and it’s not about the broader globe. People are gonna respond more to personalization. We know that. 

[00:09:44] Bill Russell: [00:09:44] So, it’s community organizations, it’s, places of worship it’s, grocery stores. It’s a local drug store. it’s those kinds of things.

[00:09:55] Karen Horgan: [00:09:55] It could be the quarter. It could be the quarterback on the football team. if you’re, if NFL, if you’re in green [00:10:00] Bay and the Packers are on the line picking on the Packers, but they’re there, everyone loves the Packers, have the team talk about it in that you find something that’s central to the community.

[00:10:12] And personalization and you’re doing it for others and that’s going to drive people to do the right, which I think is the right thing. 

[00:10:20] Bill Russell: [00:10:20] So what do people, what are the, the question I’m really gonna dive into here is what are the tools in your tool belt? his story, one of those things, is it, [00:10:30] pictures too? If, you have the picture, I’m picturing an ad of the green Bay Packers with a full stadium and with an empty stadium. And essentially painting this picture of, we want you back in the seats and in order to get back in the seats, we need everyone to step up and, go get back. Yeah. 

[00:10:50] Karen Horgan: [00:10:50] Yep. So the tools, in our toolkit, and I love that. I think I should call the Packers. I hadn’t thought about this until right now, and I’m not a Packers fan, so not sure where that came from. So [00:11:00] if you think about the main tools in our toolkit, one is choice architecture, which is how do you make the right path, the easy path. And we know that if you change default, people are going to stick with that.

[00:11:10] I already mentioned Netflix and we’ve seen this work in healthcare to get people to complete health risk assessments, to get people, to schedule appointments. All of that, the second tool in our arsenal is around framing. We know words matter. Losses are more powerful than gains. We know that if you use common language, it makes a lot more, a much bigger impact.

[00:11:31] [00:11:30] I mentioned we’re social beings. So social elements we’ve used social proof. For example, with Mount Sinai in New York, again, free COVID and got a five percentage point reduction in patient. No show rates. By making explaining to people that the norm was, people show up for their appointments. I’m the third tool in our arsenal is financial incentive.

[00:11:47] Financial doesn’t just mean I’m going to pay you X to earn Y a lot of the financial component could be framing around if there’s no cost share or what the benefits are. And how do you frame that? Because we know if you anchor people. [00:12:00] It makes a big difference. If you’re going to buy a car and they tell you for $30,000, you got this car that has a winter package and all the bells and whistles, or for $29,000, you lose the winter bells and whistles.

[00:12:11] People are going to stick with the 30 because they’re anchored there. But if you start at 29,000 and you have to spend an extra thousand to get the bells and whistles, they’re not going to do that. And so a few anchor people, if you have quick wins around the financial component, that makes a difference.

[00:12:25] Bill Russell: [00:12:25] All right. Let’s, talk about engagements. So I want to head in two different directions [00:12:30] of one being a digital startup, the second being a health system. And it sounds like you’ve partnered with Mount Sinai and some of the work that you’ve done. And so let’s go down that path first. Where do they typically engage you? Do they, come to you with a problem with a hypothesis? or, do they come to you with a problem? We need to get the vaccine out and you go, okay, let’s, start to design some programs. 

[00:12:56] Karen Horgan: [00:12:56] The first project we tend to do in an organization is more of the latter [00:13:00] of we have a specific problem. If we need people to, we work with Sutter house, their problem challenge was we want our patients to use our portal more and they’re out of, so we looked at what are the components and the features that people can do. And we ultimately honed in on, we’re going to drive people to schedule appointments online.

[00:13:19] Because if the patient satisfier, I can do this at any hour and it saves cost because each time the patient calls in there’s a cost of someone handling that. And so we focused on [00:13:30] using, email communications to drive people, to schedule appointments online. And they had 4.9 times as many people using the portal and scheduling appointment.

[00:13:38] And so there was a specific problem that they had. And then we advanced the next one was we want more women to go on for their pap smears includes to care. And we more than doubled the rate at which women did that. And so it’s almost easier for a health system to think about specific problem that is a behavior change.

[00:13:56] It could be a provider behavior, change our patient behavior change. And then how [00:14:00] do I let’s bring behavioral economics to do that? Because the organization has probably tried for years, just telling people are doing the same thing over and over. 

[00:14:08] Bill Russell: [00:14:08] And one of the things is we’re talking to the technologists and one of the mistakes we’ve made, over the decades is essentially if you build it, they will come. So we’re going to build a portal. We’re going to build this really cool technology. We’re going to roll out this program. That’s for the good of the health of our community. maybe not a technology thing, but a of what the health system, how we think. but the [00:14:30] reality is we should really wrap almost any kind of thing that we’re looking at, changing behaviors, either internally, how people use in the EHR, externally, how people engage our system. We should wrap that with, some aspects of behavioral economics. 

[00:14:47] Karen Horgan: [00:14:47] That is so well said. So we, look at it as you can retrofit, or you can make behavioral economics and from the start. So if we think of digital health companies, some of them we work with they’re really early stage and behavioral economics is just core to their strategy.

[00:14:59] They’re [00:15:00] always thinking as they’re designing it, how do you make the right path? The easy path. How do you eliminate steps and enrollment? How do I use the buttons in the right way to frame it? So people want to take action, but usually what happens more often than not is they come to us. Later on. And they’re like, we built it and no one’s coming.

[00:15:16] And then where we call that the retrofit and wrapping behavioral economics around it, and a lot of it’s in the communications and then it, sometimes it is enhancing the journey as well. 

[00:15:27] Bill Russell: [00:15:27] Do you, work with digital startups? I was a [00:15:30] chief information officer, but I also do the digital side and we had a couple of startups. And it would seem to me that you would want to bake a lot of this into the user experience. Does this get caught in the sort of user centered design or does it really have to be broken out and thought about how are we going to get people to engage with this tool? 

[00:15:49] Karen Horgan: [00:15:49] Oh, the right way should be part of users.

[00:15:51] These are standard designs, but usually what is happening now is, there’s a lot of respect that people have an idea first step, and the founders are [00:16:00] entrepreneurial and creative and they build it to their best of their ability. And it’s new. It’s interesting, but then ultimately is not getting the engagement that they and their investors want.

[00:16:09] And that’s when we come in. And I get it because if you’re an entrepreneur like I am, and you think, you know what you’re doing, you’re not going to bring in an expert from the beginning. That being said, there are a couple startups that aren’t just in concept phase that we are working with now. And it’s more fun for us because if you can get behavioral economics done right from the beginning, it’s going to be that much more powerful than [00:16:30] putting it as a bandaid.

[00:16:31] Bill Russell: [00:16:31] Why? so talk to me about social media tools. So TikTok in the news right now being bought by Oracle I an acquisition. I do not understand. I cannot explain to anyone who’s asked me, but the, you have TikTok, you have Facebook, you have linkedIn. And it’s funny. Cause every week my phone sorta shows me, Hey, this is how much time you’ve engage with your phone.

[00:16:56] And it just cracks me up because I think I’m cutting back. I’m coming back and every week it goes [00:17:00] up a little bit. and so there’s this, they have, they’ve locked into this. They know how to get me hooked into scrolling through the entire feed or watching these videos, even though it’s a waste of time.

[00:17:14] And you touched on Netflix a little bit there, can we do that same thing in health? Can we ever get to that point where it becomes a habit forming thing where I’m exercising and I’m dieting and all those things. 

[00:17:30] [00:17:30] Karen Horgan: [00:17:30] Oh, I’m going to take you to a controversial statement on that. I actually think we want to get to the point where you don’t have to be thinking about your health, but your you’re actively doing it.

[00:17:38] So let’s take exercise off the table for this part of the conversation. But if we want people to be checking their blood sugar or checking their, their blood pressure. And all of the things that go into managing chronic conditions. There’s a concept that Dr. David Austin, my co founders coined called automated hovering.

[00:17:55] How can we use technology to take away steps that we’re asking people to [00:18:00] do? Can you wear one of these kind of Packers that I found on my wrist that will tell me if my blood pressure gets too high? Or are there ways that you can check my blood sugar if I’m diabetic, without me having to think about it.

[00:18:11] And you’re only alert me to when I need to know, so that way I can live my life with my chronic conditions and you’re using technology in a way to proactively tell me, and then there’s the designing for exercise. There’s also things such as. If you’ve got diabetes and you want to eat the pizza, [00:18:30] go eat the pizza.

[00:18:31] And they’re going to tell you, if you eat that pizza, go for a 15 minute walk after to counter it and you might be willing to do that because you’re like, okay, I really want to get pizza. I can go for 15 minute walk. And so it’s breaking it down into bite sized pieces that can help nudge and create new habits.

[00:18:47] Bill Russell: [00:18:47] this, the, this is one of those Bill russell’s just asking a question. Cause I’m curious, w I’ve seen health systems who like handout tools. They like give them away. Is there something about investing in the tools that when people actually [00:19:00] have paid money for a Fitbit or whatever, that they’re more prone to, use them?

[00:19:07] Karen Horgan: [00:19:07] The short answer, I don’t have data behind this. I like to qualify. I’m a very data driven person. You’re more likely to start using it, but it doesn’t mean that you’re going to stay engaged. So you have intrinsic motivation. And if I go spend money on my Fitbit shows up, I’ve already exhibited the fact that I’m interested in using it because I’ve gone and purchased it and it shows up, You’re [00:19:30] hitting on an interesting point that if my health plan just sends me something, I never asked for it. I might not even open the box. I’m not intrinsically motivated. And so I might not use it.

[00:19:41] The longer term implications are very, could end up being the same, but if you actually spend the money, you’re more likely to start using it. And we actually work with out of a health plan who do send these remote monitoring devices to people. Or even in, COVID trying to get people to do close gaps at home and send the kids back.

[00:19:57] How do you actually get people to follow through when they never [00:20:00] asked for it? 

[00:20:01] Bill Russell: [00:20:01] So is this research going on all the time? Are you asked to do some research as a result of these projects? 

[00:20:08] Karen Horgan: [00:20:08] so we, as a consulting company, I would not call us a research organization. That being said, when we work with our clients, if they can AB test.

[00:20:18] That is fantastic for us because it’s a real world test, but etcetera health, we were able to AB test with hundreds of thousands of patients as well. We’ve worked with blue cross blue shield of Louisiana. There was tens of thousands of [00:20:30] members. And so we can then take those learnings and bring them out to healthcare in a greater sense, because then we know how people are acting in the real world.

[00:20:39] Bill Russell: [00:20:39] So just to clarify AB testing, just give us an idea of what that is 

[00:20:44] Karen Horgan: [00:20:44] Great. So some of our clients are, for example, already sending their standards letters out to the members and then they’ll have their letters. And then a second group of members will get the letters that we’ve crafted with version a is theirs and version B [00:21:00] is ours.

[00:21:01] Bill Russell: [00:21:01] Yeah, absolutely. And we’ve been doing that in marketing for years, right? So it’s just a, it’s a way of testing two different methods against you. it’s, this is such a fascinating topic. we can go in so many different directions. What are some of the mistakes that health systems just make.

[00:21:21] let’s package them up real, quick of, what’s the, top five mistakes that we make as we, [00:21:30] we go out there and try to change the behavior of, people for the good of the community for health. But what are the mistakes we make? 

[00:21:37] Karen Horgan: [00:21:37] I, it’s a great question because people don’t knowingly make mistakes. And I actually think you said it well, that they think they’re doing the right thing. And we’ll look at it and say, that’s a mistake. So for example, health systems will offer 17 options to people you can like to manage your condition or here’s, all the different, that’s a concept called choice overload and we just shut down and we make no [00:22:00] decisions.

[00:22:00] And so what they really should be doing is to giving you three options. And then literally if they want to have the restaurant, have you literally double click or ask for more so it’s not taking away choice, but we’re more likely to take action if there’s limited. The other thing they do is they make, they use technology that actually makes things more complicated.

[00:22:18] So speaking to someone the other day, and he said, very interesting. It’s in healthcare, all we do is add technology on top of technology on top of technology and we never break it down and just start over. And so it ends up [00:22:30] being so crazy and that is something we do. We don’t stop back and step back and say, how is this from the member experience?

[00:22:37] Like in healthcare using technology, the opposite of using Amazon or my phone or any of that yesterday, I got a. email from my health plan saying you have a new summary. I don’t even know what a summary would be out. So they’re not using common language. I click on it because I’m curious because of Karen and then I need to know my username and [00:23:00] password, which I’ve forgotten.

[00:23:01] And then I try and reset it and they come, you have to call a phone number. It’s just when we’re making, we’re hiding behind HIPAA and privacy and not trying to actually still make things easy. The other thing that hospital systems regularly do, they don’t use common language. They use language that maybe the doctors understand, but the patients and the consumers don’t understand.

[00:23:22] And so we’re less likely to take action. They spend that we spend not by our team, but that’s interesting. Is it smokers going for a [00:23:30] lung capacity reading and they’re given the results in a numerical format. That means something to the physician. 6% of them quit smoking a year later. And they’re given a lung age of your 28 year old male belongs to a 42 year old, 15% clean smoking a year later.

[00:23:43] So double the number, quit smoking when they get it and using the common language, figuring out the user, it’s something that health systems can really improve on. 

[00:23:53] Bill Russell: [00:23:53] Yeah. it’s, interesting. we’re, caring for my father-in-law here. He lives with us and [00:24:00] we’ll get these bills and he’ll go, Oh, I got a bill today. I’m like, no, that’s not a bill. It’s an explanation of benefits. But to him, it’s it’s a bill. It should, and I, sat back and I thought, okay, it doesn’t explain anything. And it doesn’t really add any benefit whatsoever. It’s not, it’s an explanation of nothing. It’s it’s, a, it’s added confusion.

[00:24:22] And so how, system, or I don’t know why my AR so high. Nobody understands what we’re supposed to pay. You’ve made it so [00:24:30] complex. I don’t, know what am I supposed to send money? And now how about now? How about now? When am I supposed to send you the money? It’s so crazy. 

[00:24:39] Karen Horgan: [00:24:39] And then they factor, they pay, they tell you a mountain billed $5,000, our price, $2,000. You owe 70 for this and that. None of it makes any sense, like why there different numbers? 

[00:24:54] Bill Russell: [00:24:54] There’s just, they’re just numbers. And to my father actually, I’m in the industry [00:25:00] and I’ve only really run across maybe two health systems that have really attacked this problem and done it well. Or they said we are going to make these very understandable and they ran into so many challenges along the way in terms of regulatory and compliance and other things. but, they, plowed through in order to make it better for the, community. But so few have done it. It’s hard work. 

[00:25:26] Karen Horgan: [00:25:26] We’ve worked with a couple of hospitals on their bills because they want to [00:25:30] reduce their bad debt. And it was, how do you communicate to people? Sometimes the bad debt they found out was people just didn’t know. They actually were supposed to pay because they get all these other things that they’re not supposed to pay. And so we worked with them on how to simplify the statement, to communicate specifically what they owe and why, and also using common language and what they’re getting billed for, as opposed to the, like the ICD 10 codes.

[00:25:52] You have something that people understand of MRI of your knee and they’re rolling it out now. I don’t have the results, but it’s [00:26:00] quite interesting to see how hospitals recognize that they can reduce that, way. 

[00:26:04] Bill Russell: [00:26:04] We’ve talked a little bit about language and this is probably my last question.

[00:26:07] Let’s talk about language a little bit, because we use a lot of, inside the door kind of language inside the hospital door language, but then we set up these call centers and they’re interacting with patients and they’re still using that language. Do you end up working with organizations around, around their language and how they, approach their consumers?

[00:26:28] Karen Horgan: [00:26:28] Yes. That is a great [00:26:30] question. So we regularly work on passing soundbites. For our call centers to use either around specific behaviors or just in general. So we worked with one food plan on the West coast and they wanted their members to select the PPP and to have, a attributed PCP and when their members were calling her and they were encouraging people to do that.

[00:26:50] And if they weren’t getting the results we came in and we did, we changed, I think it was seven words. And we’ve doubled the rate where they went from 16% to 32% [00:27:00] of people selecting the PCP on that phone call by changing those seven words. And I bring that up because they put us in the end and they said, we paid you for seven words and my answer as well.

[00:27:10] We literally doubled what you, your impact and you didn’t have to change your processes or anything. It was just changing a sound byte that was in there. And we changed it to a default concept of, Oh, if you don’t have a PCP, which of these three do you want? And people selected one of them. 

[00:27:26] Bill Russell: [00:27:26] Oh, that’s so. Behavioral economics is so powerful. [00:27:30] It sounds like, cause you, know why I’m making the decisions I make. And if we get you involved earlier in the process, you can help us to maybe get to be a lot more efficient quicker. 

[00:27:43] Karen Horgan: [00:27:43] That’s right, because the way we approach this is we, focused in on what are the behaviors you need someone to be doing?

[00:27:49] What are the hurdles to doing that behavior? It could be awareness. It could be the obstacles that I need to on my member ID. I need to know how to download an app. Then what are the touch points we have to reach you? [00:28:00] And then how do we intervene? Can we change to make the right path, the easy path change for the fall?

[00:28:04] How do we bring in the words, how do we bring in social proof and nudges and get you going? And again, we use it for good, not for bad. 

[00:28:14] Bill Russell: [00:28:14] Thanks for coming on the show, Karen, I really appreciate it. How can people get more information about this or follow you or what, how can they, get it more information?

[00:28:24] You can follow me on LinkedIn. I regularly post, Karen Horgen as your. [00:28:30] We do monthly insights at bell health where we send out behavioral economics insights. So you can go to in front of the monthly insights and keep learning. And I encourage you all to try and bring this into your day to day life or ask yourself what can I do today to make the right path, the easy path for my customers or my stakeholders or whomever they are.

[00:28:52] Yeah, that’s fantastic. I really appreciate it. Thanks again, Karen. And, yeah, I look forward to following you and staying up to date [00:29:00] on what you guys are doing in behavioral economics. Thank you for your time. 

[00:29:04] Karen Horgan: [00:29:04] Thanks for having me 

[00:29:06] Bill Russell: [00:29:06] That’s all for this week. Don’t forget to sign up for our clip notes. Send an email, hit the website we want to make you and your system more productive, special.

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