Behavior Modification in Healthcare

This video provides an in-depth exploration of behavior modification in healthcare, leveraging Professor BJ Fogg's renowned model. Dr. Eric Bricker, the presenter, begins by establishing the fundamental premise that improving health outcomes, quality, and reducing costs necessitates a change in human behavior. The core of the discussion revolves around applying Fogg's model—which posits that behavior change requires the simultaneous presence of Motivation, Ability, and a Trigger—to increase primary care utilization among members of employer-sponsored health plans.

The presentation meticulously breaks down each component of the Fogg model, illustrating how a deficiency in any one area can prevent desired behavior change. Dr. Bricker uses a visual representation of Fogg's "action line," explaining that for difficult tasks, high motivation is required, while for easy tasks, low motivation suffices. Crucially, triggers only work when an individual is on the "right side" of this action line, meaning they possess sufficient motivation and ability. If a task is too hard or motivation is too low, triggers will fail, regardless of how frequently they are applied.

Dr. Bricker then applies this framework to the real-world problem of low primary care engagement, citing statistics where only 15-50% of employees in large companies see a primary care physician within two years. He analyzes the current state, identifying that motivation is often low because the body is remarkably resilient, masking early signs of disease, and job-based incentives often fall flat due to general employee disengagement. Ability is severely hampered by the logistical difficulties of traditional primary care (time off work, travel, waiting, short doctor visits). Triggers are ineffective because they are typically generic and not personalized to individual needs, such as a 25-year-old male versus a 45-year-old female. The video concludes by outlining solutions for each component, drawing on the ancient Greek principles of persuasion (ethos, pathos, logos) for motivation, modern access solutions (on-site, virtual primary care) for ability, and personalized, multi-channel communication for triggers.

The discussion culminates with a compelling case study of Serigraph, an automotive parts manufacturer that successfully kept its healthcare costs flat for nearly a decade by implementing these behavior modification strategies. Serigraph utilized a combination of monetary and time-off incentives, established an on-site clinic to drastically improve access and ease (ability), and employed "hyper-communication" through various channels, including mandated annual face-to-face coaching, to deliver highly personalized triggers. This real-world example underscores the practical applicability and profound impact of Fogg's model when systematically applied to healthcare challenges.

Key Takeaways:

• BJ Fogg's Behavior Model (B=MAT): Behavior change (B) is a product of Motivation (M), Ability (A), and a Trigger (T). All three elements must be present simultaneously for a behavior to occur.
• The "Action Line": Fogg's model includes an "action line" on a graph where motivation (y-axis) and ability (x-axis) intersect. Behaviors above this line are more likely to occur with a trigger; those below will not, regardless of triggers.
• Motivation Challenges in Healthcare: Individuals often lack motivation for preventative health due to the body's ability to mask disease symptoms until advanced stages. Generic job-based health incentives frequently fail to engage employees.
• Ability Barriers in Traditional Primary Care: Accessing traditional primary care is often difficult, requiring significant time off work, travel, and waiting, making it a "half-day escapade" for a brief doctor interaction. This high effort severely limits ability.
• Ineffective Triggers: Broad, non-personalized communication (e.g., mass emails) fails to resonate with diverse employee populations, as healthcare needs vary significantly by age, gender, and other demographics.
• Building Motivation through Persuasion: Effective motivation for health comes from credible sources (doctors - Ethos), empathetic listening (Pathos), and then logical reasoning (Logos). Starting with logic without credibility and empathy is ineffective.
• Enhancing Ability with Accessible Care: Making primary care "super easy" is crucial, especially for those with low motivation. Solutions include on-site clinics, near-site clinics, direct primary care, and virtual primary care, which reduce logistical barriers.
• Personalized Triggers are Essential: Communication must be customized to the individual's needs and preferences. This can involve different channels (emails, texts, hard copies, spousal communication) and face-to-face coaching for tailored messaging.
• Triggers Fail Below the Action Line: If motivation is low and ability is hard (below the action line), no amount of triggering (emails, texts, counseling) will result in behavior change; the foundational issues of motivation and ability must be addressed first.
• Serigraph Case Study - Integrated Approach: The manufacturing company Serigraph successfully flattened healthcare costs for 10 years by combining incentives (monetary, time off), an on-site clinic (improving ability), and "hyper-communication" including mandated annual face-to-face coaching (personalized triggers).
• The Power of On-Site Clinics: For concentrated workforces, on-site clinics significantly enhance ability by making care convenient, quick, and requiring no time off, which was a "crux" of Serigraph's success.
• Virtualization for Distributed Workforces: For companies with geographically dispersed employees, virtual primary care is critical to replicate the "ease" factor of on-site clinics and overcome ability barriers.
• Conversations as Key to Customization: Face-to-face coaching allows for highly customized triggers, as coaches can listen, empathize, and tailor their message based on individual conversations, addressing specific social determinants of health.
• Hyper-Communication Strategy: Serigraph's success involved utilizing a multitude of communication channels—in-person meetings, emails, flyers, HR staff, managers—to ensure messages reached employees and their families effectively.

Key Concepts:

• BJ Fogg's Behavior Model (B=MAT): A framework stating that behavior change occurs when motivation, ability, and a trigger converge simultaneously.
• Action Line: A graphical representation within Fogg's model indicating the threshold of motivation and ability required for a trigger to be effective.
• Ethos, Pathos, Logos: Ancient Greek principles of persuasion: Ethos (credibility), Pathos (empathy), Logos (logic). The video emphasizes the importance of establishing ethos and pathos before presenting logos in healthcare communication.

Examples/Case Studies:

• Serigraph: An automotive parts manufacturer in Wisconsin that kept its healthcare costs flat for almost 10 years. Their strategy included monetary and time-off incentives, an on-site primary care clinic, and extensive, personalized communication including mandated annual face-to-face coaching.