In this webinar, you will learn: How we approach intervention campaigns: a framework The science of behavior change and how it can be applied to increase the probability of desired outcomes How Altarum’s ACE Measure can help predict consumer behaviors and design successful intervention campaigns Speakers: Ryan Rossier, Medullan Chris Duke, Altarum Josh Klapow, ChipRewards

1. Insight. Action.
Measure.
Getting People to Act: Driving Engagement
through insight, personalization, and behavioral
science
August 19, 2015
© Medullan, Inc.

2. 2page
Your Guides Today
Ryan Rossier
VP, Product Innovation
Ryan leads the product innovation team at Medullan. His
expertise includes market research and analysis,
program management, agile delivery excellence, and
lean start up.
Josh is the Chief Behavioral Scientist at ChipRewards. Dr. Klapow is
a licensed clinical psychologist and works extensively to
communicate the role of behavioral science in a wide range health
and wellness topics.
Josh Klapow, PhD
Chief Behavioral Scientist
Chris Duke, PhD
Director, Center for Consumer Choice in Health Care
Dr. Duke is the Director of Altarum Institute’s Center for
Consumer Choice in Health Care, and conducts
research into how patients can make decisions to get
maximum value out of their health care.

3. 3page
Today’s topics
Recap and background: Insight. Action. Measure
ACE Measure: increase the probability for action
The science of behavior change
Applying the science to achieve outcomes
Q&A
1
2
3
4
5

4. 4page
MEDULLAN ACTIVATE
Insight. Action. Measure.
INSIGHT
OUTCOME
& LEARNING
RIGHT
PEOPLE
RIGHT INTERVENTION,
RIGHT TIME
RIGHT
REFINEMENTS
1
2
3
ACTION
MEASURE

5. 5page
MEDULLAN ACTIVATE
Insight. Action. Measure.
INSIGHT
OUTCOME
& LEARNING
RIGHT
PEOPLE
RIGHT INTERVENTION,
RIGHT TIME
RIGHT
REFINEMENTS
1
2
3
ACTION
MEASURE
Actionable insights identify the right
opportunities and the right people to target

6. 6page
MEDULLAN ACTIVATE
Insight. Action. Measure.
INSIGHT
OUTCOME
& LEARNING
RIGHT
PEOPLE
RIGHT INTERVENTION,
RIGHT TIME
RIGHT
REFINEMENTS
1
2
3
ACTION
MEASURE
Get people to take action with the right intervention at
the right time (relevant and receptive)

7. 7page© Medullan Inc.
The Altarum Consumer
Engagement (ACE) Measure
Chris Duke PhD
Director, Center for Consumer Choice in Health Care
Altarum Institute

8. 8page
How can we leverage engagement?
When we understand an individual’s personal level of
engagement, there are many opportunities for intervention.
We can segment similar people to understand:
– Who is more or less likely to have health problems?
– How can we message to different segments
appropriately?
– How can we provide self-awareness to each
segment?
– How can we set appropriate health goals?
But how can we identify individuals’ level of engagement?

9. 9page
• Altarum Institute developed the ACE Measure in 2014.
– Survey of 3 primary domains and 12 questions.
– Validated against many health outcomes and behaviors.
– Published manuscript available here:
http://link.springer.com/article/10.1007%2Fs40271-015-0131-2
• ACE was developed with several goals:
– Scientifically validate a measure of engagement
– Capture modern forms of engagement, like web resources
– Capture complexity of engagement with multiple domains
– Licensing agreement does not require financial payment
Introducing the ACE Measure

10. 10page
ACE Measure Domains
• Commitment: Everyday health behaviors
– Highly predictive of health outcomes and medical adherence.
• Informed Choice: Preference for learning about health
– Highly predictive of researching health, shared decision-making.
• Navigation: Experience and savvy using healthcare
– Highly predictive of comparing cost and quality information.
• Individuals’ may be high on one domain and low in
another.

11. 11page
0
.2.4.6.8
5 10 15 20 25
Commitment
Commitment
also predicts
healthy control
of:
• Cholesterol
• Blood pressure
• Smoking
• Glucose
5 10 15 20 25
Commitment Score
80%
60%
40%
20%
0%
Likelihood of not being
clinically obese.
Commitment & Healthy Outcomes
© 2014 Altarum Institute

12. 12page
How are we using ACE?
• A healthcare organization is customizing patient
messaging based on patient ACE scores.
– Understand who needs help in specific areas
– Set appropriate goals for engagement and health
• A hospital has providers talk patient through ACE
scores in the hospital.
– Understand patient strengths and weaknesses
– Assign extra resources for specific patient deficits
– Set appropriate goals for engagement and health
© 2014 Altarum Institute

13. 13page
• Patients took an engagement survey and were called by
a health coach following a hospitalization.
• Coaching message was segmented into four levels to be
achievable to each level of engagement.
• Results?
– Survey engagement increased
– Medical adherence increased
– Readmissions declined, saving an average of $1872 per person
Full study: http://www.ncbi.nlm.nih.gov/pubmed/19514801
Case study: Tailored health coaching

14. 14page© Medullan Inc.
The Business of Behavior
Change
When success depends on doing
Josh Klapow Ph.D
Chief Behavioral Scientist
ChipRewards

15. 15page
Proprietary & Confidential
• The individual becomes the center
of the “universe”
• Individual actions drive
engagement across markets
• What someone does or doesn’t do
on any given day is quantified
• How can this be unified?
Source: Oliver Wyman
Healthcare: A Personalized Marketplace

16. 16page
Proprietary & Confidential
The Common Denominator

17. 17page
Proprietary & Confidential
BEHAVIOR
The Common Denominator

18. 18page
Proprietary & Confidential
Behavioral Science: An empirical approach to
understanding, evaluating and changing
human behavior.
What is Behavioral Science?

19. 19page
Proprietary & Confidential
Behavioral Science: An empirical approach to
understanding, evaluating and changing
human behavior.
What is Behavioral Science?

20. 20page
Proprietary & Confidential
• Learning Theories (Skinner/Pavlov)
• Health Belief Model (Rosenstock)
• Theory of Reasoned Action (Ajzen & Fishbein)
• Social Cognitive Theory (Bandura)
• Transtheoretical Model (Prochaska & DiClemente)
• Information/Motivation/Behavioral Skills Model
(Fisher & Fisher)
Models of Behavior Change

21. 21page
Proprietary & Confidential
Probability
of Behavior Change
(likelihood, not guarantee)
Heuristic

22. 22page
Proprietary & Confidential
The Application

23. 23page
Proprietary & Confidential
- PTO days
- Charity donations
- Company merchandise
- Payroll deposits
- Merchandise
- Gift cards
- Real-time travel
- Activities & events
- Notifications
- Virtual badges
- Achievements
- Discounts
- Special offers
- Savings & benefits
- Premium reduction
- HRA / HSA / FSA
contributions
- Annual exams
- Preventive screens
- Condition management
- Generic conversion
- Rx compliance
- Mail-order Rx
- Eligibility changes
- EMR system data
- DM/Wellness vendors
- Onsite health events
- Remote participation
- Medical purchases
- Grocery purchases
- Self-reported activity
- Quiz completion
- Evaluator reporting
Actions Data Sources Consequences
Consequence Rules
Behavior Change at Scale

24. 24page
Proprietary & Confidential
Case Study 1

25. 25page
Proprietary & Confidential
 Targeted segment of 745 eligible employees from large, national employer.
 Self-insured health benefit plan with historical cost increases ≥10% annually
 10 year history of wellness initiatives with limited ROI
 On-site fitness and gym memberships
 HRA’s and biometrics with incentives
 Annual physical with PCP with incentives
* Reeves, J., Kapp, B. (2013). Improved Cost, Health, and Satisfaction With a Health Home Benefit Plan for Self-Insured Employers and
Small Physician Practices, Journal of Ambulatory Care Management Vol. 36, No. 2, pp. 108–120.

26. 26page
Proprietary & Confidential
Patient
Health
Information
Registry and Cost
Management
Systems
ChipRewards
PCP Delivery
System – P4P
Medical
Homes
Care Plan -
Patient
Guidelines /
Incentives
Care
Coordination
Team- Coaches,
Case Managers,
M.D. Medical
Director
ChipRewards Role
 Connected to all sources of information
 Automated tracking behavior and processing rules
 Communicate consequences to plan administrator
12 Compliance Rules
Selected examples:
 Complete Health Risk Assessment
 Establish care with PCP
 Follow PCP Treatment Plan
(Specialist Referral, Laboratory/Medication)
 Report Emergency Room (ER) / Urgent Care Visit
 Timely Report of Inpatient Discharge to PCP
 Participate in Health Management Program
Member Consequences
 1st violation: written warning issued.
 2nd violation: 100% increase in the employee
contribution to premium
 3rd violation: Termination of participation in preferred plan
Platform

27. 27page
Proprietary & Confidential
Hedis Measures % Measures Improved %
A1C in past year 84.4% A1C 90.1%
BP in past year 92.6% BP 94.2%
LDL C in past year 75.6% LDL C 88.1%
T C in past year 76.4% T C 89.5%
Disease Controlled % Utilization Improvement %
Diabetes Mellitus 64.5%
Hypertension 81.8% Lower ER Visits/1,000 -7%
Hyperlipidemia: LDL-C 75.6% Lower Hospital Days/1,000 -48%
Hyperlipidemia: T C 76.4%
After 24 months, total medical costs were 23% lower than the baseline year.

28. 28page
Proprietary & Confidential
Case Study 2

29. 29page
Proprietary & Confidential
 Incented stair usage promotion was one component of a larger
health and wellness incentive program
 Program to increase stair usage among 216 employees in a
single 8 floor building
 Employees swiped their employee ID cards at readers on the
doors at the entrance and exit of the stairwells which
automatically awarded points to individual reward accounts
*Schumacher et al. (2013). Boosting workplace stair utilization: A study of incremental reinforcement.
Rehabilitation Psychology, 58(1), 81-86.

30. 30page
Proprietary & Confidential
 Stair-taking behavior increased by over 600%
 New stair-takers increased by 66.4%
 Substantial overall gains were immediate and sustained
over a 6-month period
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Percentage of Employees Using Stairs
0
50
100
150
200
250
300
350
Average Number of
Times Stairs Used Per Day
39
301
Baseline With Incentives Baseline With Incentives

31. 31page© Medullan Inc.
Final Thoughts

32. 32page
MEDULLAN ACTIVATE
Insight. Action. Measure.
INSIGHT
OUTCOME
& LEARNING
RIGHT
PEOPLE
RIGHT INTERVENTION,
RIGHT TIME
RIGHT
REFINEMENTS
1
2
3
ACTION
MEASURE

33. 33page© Medullan Inc.
Questions?

34. 34page
Join us for the next in our 3 part series
#1 INSIGHT
Finding Actionable
Insights
Aug 5, 2pm
#2 ACTION #3 MEASURE
Getting Members
to Act
Aug 19, 2pm
Measuring
Effectiveness
Sep 9, 2pm
See info.medullan.com/webinars for more details.

35. 35page© Medullan Inc.
Thank you!
Chris Duke
chris.duke@altarum.org
Josh Klapow
josh.klapow@chiprewards.com
Ryan Rossier
rrossier@medullan.com

36. 36page
Better Lives
I N N O V A T I O N
F O R
We improve the healthcare experience
through human-centered digital solutions

37. 37page

38. 38page
www.chiprewards.com
ChipRewards | What We Do
A configurable solution that
merges science, technology,
people and processes to
optimize the probability that
targeted behaviors occur.
Behavioral
Science
Enhanced
Utilization &
Outcomes
User
Experience
Engagement &
Loyalty