‘How Patients Think’: Filling In Big Data’s Gaps
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A new book by Andrea LaFountain, CEO of Mind Field Solutions, looks at the science of patient behavior to answer the questions that big data cannot. LaFountain stopped by the [email protected] Show on Sirius XM channel 111 to talk about the book, How Patients Think: A Science-Based Strategy for Patient Engagement and Population Health.
How Patients Think: A Science-Based Strategy for Patient Engagement and Population Health by PhD. Andrea LaFountain
An edited transcript of the conversation follows.
[email protected]: In this age of technology and big data, why is there still that disconnect between healthcare providers and patients?
Andrea LaFountain: You kind of answered the question. Big data can be great, but it can also be an enemy depending on how we use the data. There’s an overreliance on what we call “claims data.” We look at the activities of the patient. We can see whether they are visiting the doctor or filling prescriptions, but it doesn’t give us the explanation behind the activities that we’re seeing. That’s what’s missing.
The data can show us the results of their decision. It doesn’t tell us why they are making the decision. So we can look at the data, and we can see that 26% of women with breast cancer stop taking their treatment early.
We can see that very clearly in the data. But how are they making that decision? That is not available in the data. So we speculate and we kind of impose our reasons why we think they are making that decision without actually getting into the scientific reasons behind why they are making those decisions.
[email protected]: Is the problem with taking medication and taking it all the way to the end of the prescription?
“We can look at the data, and we can see that 26% of women with breast cancer stop taking their treatment early…. But how are they making that decision? That is not available in the data.”
LaFountain: That’s definitely a major problem. But for some diseases, good health outcomes require more than just taking medication. When you think of diabetes, for example, we have to monitor diet and exercise as an integral component of that. In fact, we did research with over 1,000 patients with Type 2 Diabetes in the United States and some people actually believe that they are managing their diabetes well just because they take their meds every day.
Now the fact that their diet is completely out of whack in terms of being able to maintain good sugar levels and the fact that they are not exercising isn’t on their radar in terms of good diabetes management. The way that the classic diabetic patient looks at disease management, it’s all about the logistics of the disease and not about the outcomes of the disease.
[email protected]: You have a remarkable statistic in the beginning of the book: $2.2 billion spent on healthcare back in 2008 and $1.2 billion wastage that could be eliminated. I think the majority of people understand that there is a level of waste within the healthcare system, but understanding the magnitude will frustrate a lot of people out there.
LaFountain: And rightly so. We do need to tackle that. The wastage is coming from a couple of different places. One, it’s where we spend money targeting support programs to people who don’t need the support. The vendors, to be honest, are really at the root cause of this problem. Vendors say that they have patient support solutions. You might have even experienced some, where you have a health coach phone you.
I’ve experienced that through my husband’s employer, a coach calling me. I’m as fit as a fiddle. I don’t need a health coach and she’s asking me, “What do I want to change about my health?” I said nothing. Now we still spent nine sessions of telecoaching on the line. I did it because I wanted to get some competitive intelligence as to what was contained in the program.
My husband was also called and offered into a diabetes program. He’s not diabetic. If he were, he would be taking the measures himself. That’s who are consuming a lot of resources there that we don’t need to spend. Now on the other hand, these vendors are telling these large employers, “We’ll take the top 20% of your employees.” Or if they’re brave enough, they’ll say, “We’ll take the top 40%.” But it’s the bottom 20% that drives 80% of the cost.
“If you can’t change behavior in the patients who need to make the behavior change, then you shouldn’t be in the business of behavior change, period.”
United Healthcare published some statistics a couple of years ago. The bottom 22% of their patients drive 79% of their cost of care, but yet nobody wants to provide the additional support services to that 20%. The reason is, they say, they are beyond behavior change. Well, if you can’t change behavior in the patients who need to make the behavior change, then you shouldn’t be in the business of behavior change, period.
[email protected]: The behavior change aspect of it is very interesting because as you alluded to before, there’s a piece of behavior that nobody has been able to seemingly figure out to this point. Going back to something we said a while ago, if you’re prescribed a certain amount of medication that is either preventative or designed to cure you of something, whatever it is, the doctors want you to take it to whatever level that is. I’m sure that there is a significant amount of people who will take 75% of a prescribed medication, and that other 25% is not used. Or there is the other issue with the prescription itself being more than needed in the first place.
LaFountain: The typical number that’s thrown around is 48% of patients are not taking medications as prescribed. Now it’s up as much as 75% in conditions like asthma. With asthma, patients have a misconception that it’s an acute condition. You treat it when you feel the symptoms and don’t treat it when you don’t feel the symptoms. That’s not the right way to manage asthma.
Another interesting piece of research we did at Mind Field Solutions was with ADHD and parents of children age six to 12. The biggest factor there was when parents did not understand that it was a biochemical basis behind ADHD, then they didn’t treat beyond six weeks. When they knew that it was biochemical, then they treated with pharmacological medication. That’s a very rational way to think. So what we need to do is we need to find out, do they understand correctly that it’s a biochemical condition? Because if they think it’s behavioral, it doesn’t make sense to them to go with a biochemical solution. So we need to figure that out.
“It’s a huge battle. It would be easier if people rallied around a common cause, and that common cause needs to be health outcomes.”
Now we have a diagnostic tool in ADHD that with one question, we can figure that out. We ask the parent, “How much do you agree with this statement: