What health care stakeholders can gain from consumer behavior change

We conducted a meta-analysis, sifting through 50+ studies (a majority of which were published in the last five years) that focus on the impact of health-related behavior changes to identify which patient behaviors have the greatest evidence of impact on stakeholder goals. The stakeholders we considered were:

1. Health systems (common goals include increasing referrals and improving care quality)
2. Physicians (common goals include increasing patient loyalty and avoiding burnout)
3. Payers (common goals include reducing costs and retaining members)
4. Employers (common goals include reducing costs and maximizing employee productivity)
5. Life sciences (including pharmaceutical companies, pharmacies, and device companies) (common goals include obtaining regulatory approvals and increasing product sales)
6. Digital health (common goals include driving patient and provider satisfaction and increasing product sales)

At the onset of this research, we surveyed 20 Advisory Board research leaders to represent our members, including provider and non-provider organizations (e.g., health plans, pharmaceutical companies), on the types of behavior changes we should study. The three categories below represent their top selections. We then conducted further research to identify the specific behaviors to include in each category.

Note that we solely examined patient-driven behaviors as opposed to externally driven behavior change interventions, such as care management programs.

To illustrate the magnitude of evidence impact for each behavior change, for each stakeholder we placed behavior changes into two tiers. Tier 1 includes behavior changes for which we identified three or more evidence-based studies and tier 2 includes behavior changes for which we identified one to three evidence-based studies.

Exclusions and limitations

In addition to excluding purchasing-related behavior changes and externally driven behavior change interventions, this research has a few other exclusions and limitations that are important to keep in mind:

• Stakeholder goals considered: Positive patient outcomes are a high priority for consumers as well as for all health care industry stakeholders. However, health care stakeholders typically have additional goals, such as driving patient loyalty, controlling costs, reducing unnecessary utilization, and/or increasing sales. We were primarily interested in assessing the evidence-based impact of behavior change on goals other than driving positive patient health outcomes.
• Divergent impacts of behavior change: Behavior change is not “one size fits all.” While one stakeholder can “win” from a particular behavior change, another might “lose.” For example, preventive lifestyle changes can lead to lower costs for health plans but can lower revenues for pharmaceutical companies. As such, we studied and organized our findings by each stakeholder group separately. It will be important for these groups to consider the divergent impacts of behavior change on other stakeholders of interest, particularly as the entire health care ecosystem becomes more interdependent.
• Indirect impacts of behavior change: While we primarily “counted” studies that showed direct impacts on stakeholder goals, behavior changes can also have indirect effects on goals across stakeholders. We considered and highlighted these indirect effects where evident, but there are likely more to be considered.
• Implications of this research: This research can help stakeholders prioritize which behavior changes to drive by detailing which have the greatest evidence of impact on their specific goals. However, a lack of evidence for any given behavior does not necessarily imply that that behavior would be ineffective in achieving a stakeholder goal, but only that there is minimal evidence of it being able to do so. Additionally, prioritizing behavior changes is only the first step in effectively driving behavior change. Additional steps for stakeholders include identifying the best strategies to drive chosen behavior changes as well as the best stakeholders positioned to do so. This research is meant to be a tool utilized in just step one, prioritization.
• Existing study limitations: Based on subjects chosen, the studies we examined were not always representative of the entire U.S. population (e.g., all races, ethnicities, socioeconomic statuses, and insured types). Where possible, we gathered studies with large and diverse samples. Additionally, most medication adherence metrics used in studies were limited in that they did not assess whether a patient actually took their medication, but rather the number of days the patient was covered by their medication or had their medication on hand.

Medication adherence has the greatest evidence of impact across health care stakeholders compared to other behavior changes. While preventive care behavior changes, particularly around screenings and primary care, also had an impact on many stakeholder goals, the evidence is less significant for these behaviors. As such, health care stakeholders—specifically health systems and payers—should prioritize efforts to drive medication adherence to achieve organizational goals, while also considering the value of conducting and sponsoring more research on the impact of preventive care behavior changes on those goals.

Evidence of the impact of most episodic care behavior changes (short-term medication adherence, treatment plan adherence) and other chronic behavior changes was minimal. Additional research is required before stakeholders can feel confident in investing efforts to change those behaviors. 

Finally, we found no evidence of behavior change impact on digital health companies, though this is likely a result of the recency of digital health adoption rather than a lack of impact.