Messaging in Healthcare: Making Sound and Fury Signify Something

Recently, there was a bit of a dust-up over whether it was appropriate for the Secretary of Health and Human Services (HHS) to engage the National Football League (NFL) to help HHS with the process of drumming-up enrollment for health insurance exchanges. In the end, the NFL and other sports leagues decided they were not going to be involved fearing the appearance of taking political sides.

In our view HHS is better off with this outcome. To our way of thinking the exercise would not have delivered the desired results and would have left individuals confused and created a political distraction. At the heart of most public health communication plans are three main functions: create a message, deliver the message and get people to act on the message (many variations: example, example, and example). The HHS/NFL combo would likely have failed the test:  What exactly does someone who catches a football for a living say that would make the uninsured purchase insurance on an exchange? While it’s easy to single out HHS and the administration, the opposition party also thinks messaging alone will solve all of its ills but that is far from correct assumption in our view.

In terms of creating a message, our first instinct would be to recommend a governmental agency like the FCC but for healthcare. We would call it something like the clinical communications clarification committee (CCCC).  However, given recent concerns about “Orwellian” government information gathering, perhaps a more open-source, crowd-sourced approach to communicating may be more readily accepted. What we have in mind is a something like Pubmed meets Wikipedia where the information is readily available, credible, and based on updated facts. Inevitably something like this would need to be proctored to keep unreliable information out. Many crowd-sourced communities do a good job of self-policing but it couldn’t hurt to have an adult watching just in case.

Assuming we can create information (the message) in a way that is understandable and credible, how to transmit this information (the medium) becomes the next challenge. While we are pretty sure the “wired generation” who wear body monitoring devices are getting the “right” information via mobile devices, the web etc., we think that more important populations that are not technologically savvy may be missing out. Dual-eligibles for example, who are major drivers of cost and poor outcomes in the system, are not in our view, easily able to access useful information via high-tech gadgetry.

We have noticed an interest on the part of some investors to replace humans with technology. It seems to us that before we remove humans from the picture (if it ever happens) we ought to set our sights a little lower in the near-term and as a half-measure use technology to make providers more effective at communicating. We already have a very large healthcare workforce that spans the gamut from home health aids, to paramedics, pharmacists, nurses and physicians. Making the healthcare workforce more able to explain information seems like a reasonable solution. Of course we recognize that allocating capital (i.e. paying practitioners to provide a service) is a tricky subject in an era of tight budgets but compared to investing in healthcare IT systems that don’t always work, a provider-based intervention looks like a bargain.

Once we have found the message and the medium, how do we get people to respond?  Not everyone that presently needs to lower their sodium intake or should be purchasing their insurance on an exchange is doing so. Motivational techniques drawn from behavioral finance to nudge people along have been shown to be effective in some cases although no magic bullet has been found yet. So when designing outreach we should anticipate small changes rather than home runs and make sure that the returns on investment justify whatever effect we will obtain.

Our knowledge base on how to explain health information continues to expand. A few modest assertions: 1) We know that communication channels will advance over the next few years. 2) We know that the crowd will play a greater role in the creation and dissemination of information. 3) We think we know how to get people to respond to information. What is lacking to date is some creativity on harnessing the new tools to communicate health information whether its policy, wellness or investment.  The next 18 months will provide ample opportunities for policymakers and others to deliver new messages. Recent developments like releasing rules changes in a data dump during a holiday, are not encouraging and shows we have a lot of work to do.