Chronic Boom Part 2: Three Tips for Engaging Seniors in Preventive Health Benefits
by: Mariza Hardin, Senior Director of Health Plans
In Part 1 of our Chronic Boom series, we took a look at some sobering trends impacting Medicare and healthcare innovators. Namely, the surge of Americans aging into Medicare, and the skyrocketing costs of treating their chronic diseases. As bleak as all that sounds, we were able to end on some positive notes:
- Medicare Advantage plans are already setting the course for the shift from fee-for-service healthcare, toward prevention strategies aimed at nipping costly chronic diseases in the bud.
- Two of the most costly chronic diseases — type 2 diabetes and heart disease — are almost always preventable.
Problem solved! On paper, at least. But how does it play out in real life? How do healthcare innovators get seniors to engage with their preventive health benefits, and through that engagement, achieve meaningful and lasting health outcomes?
At Omada Health, our Prevent program has had great success helping participants change their behaviors and reduce their risk of type 2 diabetes and heart disease. And last year, we partnered with Humana’s Medicare Advantage plans to offer the same program to their members.
Prevent is a digital behavioral counseling program that helps people adopt healthier habits to ward off chronic disease. Participants receive the tools, technology and personal support they need to help them reach their goal of lasting health.
Wait. Seniors and technology? That can’t turn out well.
But it did. Contrary to the expectations of many, Humana’s Medicare Advantage members who enrolled in Prevent easily integrated the techy bits of the program into their daily routines. In fact, they did even BETTER in the program than their younger counterparts. And that trend continues, well past the Humana pilot. Today more than 2,000 participants over the age of 65 have enrolled in Prevent. Overall, 84% of them (average age: 69) remained active in the program after 6 months. More impressive: they lost an average of 7.8% of their body weight, reducing their projected 3-year risk of developing type 2 diabetes by more than 58%.
What we’ve learned in the course of our Humana partnership has shattered some stereotypes of the over-65 crowd. And it’s provided insights into how at-risk seniors can, and will, integrate technology into their daily routines to reduce their risk of developing costly chronic disease.
Here are our three key takeaways:
If your parents have ever called you home to reset the clock on an ancient VCR, “fix” a computer that merely needed to be restarted, or help unlock an iPhone with a 4-digit code or finger swipe, you understand the senior stereotype all too easily. At first glance, the older generation appears baffled by the technology we take for granted. So it might seem like a safe assumption that Medicare patients would react poorly — or not at all — to the introduction of a digitally-based behavior counseling program like Prevent.
But technology and digital health tools are popping up everywhere in healthcare. They’re used for service delivery, in-home monitoring, patient-provider communication, transfer of health information, and peer support. When we embrace the narrative that these solutions won’t work for seniors, we exclude a population that can really benefit from these tools. On the other hand, when we design digital health programs that are intuitive, compelling to use, and easy for participants to integrate into their lives, those programs can work for everyone, seniors included.
As it turns out, a growing number of older adults are not only comfortable with the idea of going online, or integrating technology into their daily routines; many already do it. According to Pew Research Center, nearly half of seniors report that they have high-speed broadband connection at home. More than three of every four use a cellphone. And admit it; you’ve received a Facebook friend invite from at least one parent, aunt, or uncle. It’s not only because they miss you (though you really should visit more). It’s because 84% of internet users 50 and over use social networking sites.
These seniors aren’t just familiar with how social networks work; they understand how they can build social connectedness through them. They make up one third of all online and social media users, with more than 8 million individuals spending more than 20 hours a week online — a number that continues to grow.
But technology — and technology-enabled healthcare — must meet two requirements for seniors. First, the technology has to meet them where they live: in their homes and daily routines. Second, the technology should work intuitively, and if possible, right out of the box. Seniors will follow simple instructions and tutorials, but won’t waste their time learning something that seems completely foreign to them. They won’t tolerate something that complicates their personal health care; the technology must actively simplify treatment, or make it more accessible.
The wireless scale included with the Prevent program is a prime example. We equip Prevent scales with cellular chips, so participants don’t need to go through the process of connecting the scale to a wireless network or programming it through the Prevent platform.
Instead of creating barriers for seniors, Prevent’s technology lowers them.
Like all Prevent participants, the seniors in our Humana pilot were able to access lessons and complete them at home, on their own schedules. These seniors averaged 30 engagement touch points every week with Prevent. That’s more than our average participant under 65. And it’s much more than in-person programs tend to produce.
Think only urban seniors can adapt to this type of innovation? The seniors in our pilot were located mainly in suburban or rural areas of Florida and Georgia.
In the parade of stereotypes of older Americans, the grandmother befuddled by her new piece of technology may be surpassed only by the perpetually distrustful grandfather (or vice versa, depending on your family). American seniors have spent the last 60+ years being sold something. They’ve heard every promise in the book, and watched as consumer products have disappointed customers in every conceivable way. They feel like they’ve seen every advertising trick in action. And they probably have.
A digital health offering making pie-in-the-sky promises to improve their health with a quick and dirty weight loss program doesn’t play to this audience. Seniors are suspicious of products that seem “too good to be true.” Today’s seniors are more informed, better educated, and more autonomous than prior generations of older adults. They can smell bull from a pretty good distance, and don’t react well when being sold too aggressively.
Companies in the digital health space have to pay special attention to the credibility of their information, privacy issues, and trust when working with the senior market.
Prevent is designed to build trusting relationships by fostering small group interaction, personalized outreach and education, and sensitivity to distinct lifestyles. We believe that when trust is established, engagement increases. With Medicare Advantage plans, we start establishing trust with our marketing materials (more on those efforts in a future whitepaper), and build on that relationship once participants enroll in Prevent.
Even during enrollment, some Medicare Advantage members harbor healthy skepticism that a digital program can positively impact their health. “I decided to try it, but with low expectations of the outcomes,” said one participant. Another wrote, “I’m an introvert, and not very likely to ask for help, or share a lot of personal information.” This is where relationship-building came in. The Prevent coaches had to be particularly responsive and adaptive to the mindsets of senior participants.
When we evaluate coach applicants for Prevent, we zero in on one quality in particular: empathy. This attribute was even more fundamental for those coaching senior participants. Rose and Suzanne — two of our coaches who worked with Humana members — spent extra time with these participants, working to understand their fears (logistical or personal), and obstacles to success. The outcomes in our the Humana pilot surely bore out this success. So did answers to some survey questions following the program: “Suzanne quickly determined what type of support I needed, and provided it,” wrote one participant. “She was an effective, thoughtful listener, and highlighted some tools I hadn’t yet used, helping me understand their benefits.”
Remember how 84% of seniors are using social networking sites? That played out in our pilot, too. Prevent Seniors communicated with their peer groups at rates significantly higher than the average Prevent user. And in surveys, seniors cited the group dynamic and support they received from fellow participants as a critical in their success.
“Establishing trust” sounds like a truism for any company, working with any population of users. But working with a senior population, we learned that this strategy wasn’t simply the cost of entry. It was, in some cases, the biggest driver of meaningful health outcomes.
The final insight is also the one that seems the most intuitive — seniors respond to clarity. Like their fictional contemporary, Sgt. Joe Friday of Dragnet, they want just the facts (ma’am). They don’t have time for a company to dance around the main point — especially when it comes to their health. Just cut to the chase.
And the main point for them isn’t what you might think it would be. Seniors in the Prevent pilot were much more interested in the program’s specific health benefits than the general idea of losing weight. For these participants, the prospect of being able to run with a grandchild in the backyard was a more important health outcome than fitting into a smaller size. Materials that spoke to connection, community, quality of life, and independence were always more effective.
Achievable, relevant goals that are clearly communicated from personal health coaches have significant impact on senior participants — regardless of the channel through which they’re communicated.
Prevention at Scale
Medicare Advantage plans are in a position to help contain the explosion of chronic disease related health costs that the massive influx of seniors could set off. The key will be to offer benefits that engage their members and lead to better health.
So, how do we deploy a scalable, effective behavior change program for up to 22 million American seniors who already have prediabetes? The results we’ve achieved with users 65 and older indicate that digital tools can, and should, be part of the equation. As we continue to enroll seniors through Prevent — those in Medicare Advantage, or via employers and other health plans — we’re building an ever-growing evidence set to help us determine how to generate the best possible health outcomes for this population. In the coming weeks, we’ll be talking more about these insights. But for now, we know that the following three principles are fundamental for any innovative benefit being deployed in Medicare:
- Seniors embrace tech, as long as it doesn’t complicate their lives.
- Trust is on us, and we earn it through building relationships.
- Clarity is crucial, from explaining programs to making promises.
Nail each of these principles and you’ve got yourself a benefit that seniors — and Medicare — can actually benefit from.