Hacking Behavior

    Walmart’s (Behavioral Science) take on healthcare

    Kristen Berman
    Aug 16, 2019 · 6 min read

    It’s no secret Walmart wants into the healthcare game. In the last few years, they have beefed up basic health care services for customers. This includes doctor and nurse practitioner access, mental health therapies, lab diagnostics, better pharmacies, dental, and vision access. They also have a relentless focus on improving quality and cutting costs for their employees, championing a Center Of Excellence model for people with complex diseases.

    Marcus Osborne, Vice President of Transformation and Wellness for Walmart explained three initiatives that have found success within the stores.

    All three initiatives were not obvious on the outset. They take a page from Rory Sutherland’s book to ‘try something a bit different’. That said, all of them have some behavioral insight that may be core to their success.

    #1: They have found a successful way to help employees manage weight.

    But it’s not a weight management program. It’s a forum. A place for employees to post stories about what has worked for them with weight loss. While he doesn’t report actual outcomes, he suggests that this is the most successful thing Walmart has ever implemented in this domain. As Marcus reports, associates love bragging about their successes and likely also like peeking in on what their peers are up to.

    Marcus said close to 60% of associates are active on these forums.

    To fuel this kind of heavy engagement, Walmart pays people to post. Well, they pay for posts that are successful, the ones that get a lot of likes/comments. And they pay them a lot — $5k to $50k. One associate started by attempting to just walk around a Walmart. This was tough but she kept at it. She ended up doing a 5k. The stories chronicle the journey of weight loss, not just the destination. They have over 1M stories on the forum.

    Behavioral Principle: NORM CHANGE.
    The forum is a public and visible way to promote weight loss. This allows people to brag about their own successes and share and congratulate others for theirs. By posting about their journey, others may be motivated to start doing something for their own health.

    Behavioral Caveat: The food bought at Walmart contributes to an obesity crisis. One could argue the most effective intervention is changing the displays within the stores to increase healthy foods and to decrease unhealthy ones…

    #2: They engaged caregivers with options for support

    Walmart realized that many of its customers and associates were also caregivers. Caregivers are people (mostly women) who care for their elderly parents when they get too old to care for themselves. It’s a tough place to be — taking care of kids and your mom! Data shows that becoming a caregiver is taxing. Within 2 years of becoming one, caregivers experience personal declines in their health outcomes.

    Given that insight, Walmart kicked off campaigns to help caregivers manage their health. Their first attempts fell on deaf ears. They put up signs up in stores and had brochures at checkouts that offered ways to get help. Not many people took the brochures or called the caregiver number.

    So they got creative — actually, they got a little bold.

    They asked their cashiers in a North Boston store to put on Angel Wings. These were large angel wings.

    When customers asked the associate or cashier what the angel wing was all about (and about 90% of customers asked…) the cashier answered:

    We support caregivers. Are you a caregiver?

    This simple prompt started a conversation. The conversation led to the cashier giving the customer a brochure and phone number to call for support. Walmart claims this initiative was wildly successful and had a direct impact on improving caregiver health outcomes.¹

    Behavioral Principle: Attention
    By putting on the wings, Walmart cashiers captured customer’s attention. Customers were curious about the wings and had an excuse to engage with a cashier. This was enough to trigger a conversation. In dating, this phenomenon is called “peacocking”. Seth Godin argues it’s the Purple Cow.

    Behavioral Caveat: The Angel website currently links to a generic government state site on aging. These sites tend to be overwhelming. While Walmart reports that outcomes improved, it is questionable if or how the caregiver followed through and got support.

    #3: They are the #1 provider of basic health screenings

    Walmart has put health kiosks in stores. The kiosks measure basic health stats blood pressure, weight, BMI, vision. The kiosk assessment is free (yes, it’s ad-supported). The kiosks are open 24 hours a day.

    Marcus said that in any given week more people have health assessments at Walmart kiosks than all health assessments combined in America. Walmart has provided more than 2.5M screenings.

    The kicker?

    The people who use the kiosks the most are the same people who don’t consume most other healthcare goods — 35–55-year-old men! Why is this? Marcus attributes older male kiosk usage to the non-judgmental nature of the kiosks (“no one is telling me not to eat red meat!”). However, behavioral science suggests it is something else. The kiosk doesn’t require an appointment. It is free. There are virtually no barriers to using it.

    Behavioral Principle: Reduction in Friction
    Consuming health care in America is tough. You have to log into your insurance site to pick a doctor, which requires you to know your password. You have to wait for the appointment. You have to remember the appointment. You have to take time off work for the appointment and then get tests/screenings to figure out basic issues! While this kiosk hasn’t solved getting people to take action, it has started the conversation on health within a population that is likely to avoid making an appointment at all!

    Behavioral Caveat: Will people do anything after seeing their results? The kiosk recommends making an appointment with a doctor if there is an issue, but it’s unclear if people take the advice. Our educated guess is that most may not convert the information into action. Marcus holds that they do and that the very fact that there is no judgmental telling people what to do encourages usage. We find that hard to believe — people don’t actually know what the machine will say before they start using it. But we do appreciate the reasoning that health is a personal topic that people can enjoy consuming solo.

    Note on General Walmart Lens on Health Care:

    • Consumers and not patients: The hypothesis is if people are treated as customers vs. patients, they will be more active in their health care. The risk of being a patient is you’re too passive and lack the typical engagement you’d have if you’d be buying any expensive good, which healthcare is for most.
    • Service focused: They study customer-focused firms like Chick-Fil-A. Chick-Fil-A has grown to be the third-largest restaurant chain in US (behind McDonalds and Starbucks)! Walmart has attributed this to Chick-Fil-A’s relentless focus on service. This is, arguably, the exact opposite of how traditional health care acts. Chick-Fil-A goes out with iPads to take people’s order if the lines are too long in the drive-through. They once gave away thousands of dollars of food when there was an electricity outage in the Orlando airport. They have daddy-daughter days and days when people dress up like cows. Chick-Fil-A gives same day free refills! The question posed was: what if health care behaved with the same relentless service-based mindset that successful businesses had?
    • Cost transparency: Walmart believes it should not matter what health plan you are on to be able to afford basic care. They are striving to increase cost transparency while also radically bringing costs down. $1 a minute for Therapy. $70 for a back to school physical and vision test. Under $50 for basic visit — one day, maybe $7.
    • Don’t make people work: Normal health care has you get a bunch of tests for some insights. They are working towards delivering insights with less work (e.g., they look at your search history to see indicators of early-onset diseases so you don’t have to take a Quest test).
    • Quality of care: They believe that #1 issue in health care is variation in care. Some providers are over-prescribing medicines or not following basic guidelines. By controlling the quality, they can control the costs. This means they only use specific in-house doctors, and Centers of Excellence for their employees.

    Like this post? Clap for it. You can clap up to 50 times. Go nuts. Or, consider amping up your behavioral chops. We have a Bootcamp that is currently accepting applications.

    Hacking Behavior

    Kristen Berman

    Written by

    Thinking about Irrationality. Behavioral Scientist. Co-founder of Irrational Labs and Common Cents Lab.

    Hacking Behavior


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