Amazon and other vendors deliver just about everything but health care — yet probably know more about your habits and behaviors than your doctor does. That may be changing as health care providers begin using the consumer profiling tools that shape advertisements to get to know their patients beyond the examining room.

Commonwealth Fund
Sep 10, 2015 · 7 min read

By Martha Hostetter and Sarah Klein

Determining how two patients with the same disease will respond to treatment can be hard, but predicting how they will make decisions about where and when to get care may be easier. That’s because there are just five or six types of patients in the United States, experts in consumer profiling say. Among them are the ones who follow their doctors’ advice without question, those who give more credence to information they find on their own, and a striking number who want little if anything to do with the health care system.

This kind of segmentation — based largely on surveys that reveal consumers’ values, attitudes, and beliefs — has been used widely in the retail and banking sectors to tailor products and services, as well as advertising campaigns, to different types of customers. Those quirky insurance commercials you’ve seen? Some are aimed right at you, but not all. The health care industry has lagged in such differentiation — taking instead a one-size-fits-all approach to communication, which can fall flat and fail to engage some groups of patients.

This may be changing, as health care providers increasingly enter into contracts that hold them accountable for improving their patients’ health outcomes and reducing costs. Success in these efforts depends in part on motivating patients to make lifestyle changes, such as losing weight or exercising more, and encouraging those who aren’t taking advantage of health care services to do so.

Segmenting patients by their motivations and behaviors can make it easier to target interventions and deploy resources to those most in need of them, says Cynthia Kilroy, senior vice president of consumer solutions group strategic solutions and business development at Optum, a health services consulting firm. Combining that information with clinical data “is the next frontier in population health,” she says.

TriHealth, a health system in Greater Cincinnati, is piloting a segmentation approach in its health coaching program. It’s using a survey tool developed by the Cincinnati, Ohio–based consumer marketing firm c2b to identify employees in a health coaching program who may have difficulty changing their habits and those who will stay on top of health issues with regular check-ups and screenings and don’t need extra help. c2b’s 12-question survey is a winnowed-down version of one that was used to assess how 9,000 Americans — representing different demographic and socioeconomic groups, and diverse health needs — view health and wellness. From that, the company came up with five groups of patients, including “Direction Takers,” who are likely to go to the doctor at the first sign of a health concern and view their doctors as the most credible source of information. At the other end of the spectrum are the “Willful Endurers,” who live for the moment, only visit doctors when they absolutely must, and can be some of the toughest patients to work with.

TriHealth is using this segmentation to help build connections with patients and motivate them to achieve their health goals. For example, one coach realized that her tendency to ask a lot of questions to guide people toward their own realizations was less effective for “Direction Takers,” who want clear guidance and specific advice. For “Balance Seekers,” who like having lots of information and choice, coaches may want to spend more time talking through different treatment options.

“We, as health care providers, are used to working with patients in ways that are comfortable for us,” says Terri Hanlon, COO of TriHealth’s corporate health program. “We all want to do the right thing, but to provide patient-centered care we need to make an effort to understand what motivates patients.”

Building a Better Patient Profile

Combining consumer data with clinical information can produce insights into utilization patterns, according to the New York City–based consulting firm McKinsey & Co. The firm used consumer and demographic data to help a large U.S. payer figure out which patients with chronic conditions were more likely to have an emergency department admission or hospitalization. Among other findings, they discovered that patients who were socially isolated had 24 percent higher hospital costs and lower prescription drug use — a sign that they might need help adhering to medication recommendations.

Such information can be invaluable in gauging their needs, but it’s hard to track down using typical approaches. For this reason, some health systems are looking to social media — which has a rich trove of people’s day-to-day behaviors — to help fill in those blanks. The University of Pennsylvania Health System is exploring whether social media feeds can help predict clinical risk or provide insights about patients that help determine the best ways to engage them. “We’re interested in how the constellation of digital data might create a picture of overall health and could inform a more personalized approach to care. Are there some medications or treatment regimens that might be a better fit for a certain lifestyle, for instance? We’re still in the early days of understanding what’s possible,” says Raina Merchant, M.D., director of the Penn Social Media and Health Innovation Lab.

The software company Ginger.io already uses information tracked by smartphones — such as movement, calling, and texting records — and users’ responses to questions about their moods to detect unusual patterns that may suggest depression or other problems.

Treading Carefully

Using consumer data and nontraditional sources of information to help inform providers’ efforts to engage patients is not without its challenges — for one, it can be very expensive. The data also need to be made actionable within the contexts of existing care management programs. “It’s a very different type of data than you typically see in health care . . . but we are beginning to open our borders and learn from other industries,” says Stephanie Pronk, who leads the consulting firm Aon Hewitt’s health transformation team.

There are also concerns about privacy, particularly because the information collected via social media and smartphones captures so many facets of our lives. “We get so caught up in technology about how fun it might be to use and how easy,” says Linda Hull, a principal with the health and benefits consulting firm Mercer.

“Consumers don’t
realize how
this information
can be used or
even fathom the
possibilities of it.”

Indeed, while many have no qualms about sharing information about their friends, the restaurants they frequent, and their shopping habits, consumers may still be sensitive about sharing health information, which is discernable through Google searches and other means, says John Carroll, an assistant professor of mass communication at Boston University. “Once you go outside of health care institutions that are obligated under federal law to protect your privacy, you are fair game for all kinds of people who are data-mining,” including pharmaceutical companies and insurers, he says.

Given this, it will be important for consumer marketing firms venturing into health care to tread carefully — making sure they disclose to consumers what information they are collecting about them and how they intend to use it. But for those trying to engage patients in efforts to improve their health, looking beyond the medical record may be key.

“Engagement occurs when you understand people’s motivations and abilities, and then implement intervention strategies that enable them to take action,” says Ralph Perfetto, chief analytics officer at Eliza Corp., a firm that specializes in health care consumer communication and data-driven engagement management.

Commonwealth Fund

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Affordable, quality health care. For everyone.

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