In this post you will learn the 5 primary pitfalls coaching and care management teams encounter with engagement programs, and how to address each one.
Co-Founder & CEO at Nudge
June 26, 2018
Ineffective Member Outreach and Enrollment Model
(i.e. The “Outreach-To-Engagement” Step In The Engagement Continuum)
Ultimately engagement programs either leverage an inbound or outbound approach to enrolling members. “Inbound” meaning that individuals are discovering and opting into participate or are self-enrolling on their own. “Outbound” meaning that dedicated resources are being allocated to reach out to eligible members (based on risk or condition) in hopes that they may want to participate.
More often than not the outbound approach more closely resembles peppering members with phone calls in hopes that someone may be open to the idea of connecting to a nurse or practitioner. Traditionally this process is not particular iterative, making it a pure numbers game. The more calls you make, the more chances you'll have to enroll members.
In one instance we recently encountered an organization whose team was calling the same target members every few months with the exact same call script, and was surprised they weren’t getting better results.
Anyone with experience in consumer engagement or marketing knows that there is attrition at every step of a process flow, and reaching out to a COLD audience will result in even lower conversion rates compared to those that could be considered WARM leads.
Luckily, predictive analytics have removed the guesswork from the outreach process meaning that you can narrow your focus to engaging the RIGHT members - i.e. those that may actually be interested in some type of coaching or interventional program… because a lot of people are NOT.
It was found that approximately 60% of the population fall within the Precontemplation, Contemplation, or Preparation stages of change (based on the Transtheoretical Model), meaning that approximately 60% are NOT ready for interventional opportunities.
Here’s the thing, most organizations are stretching their resources and team thin through the use of a shotgun approach for outreach when it would actually be more cost effective (time, money, people, etc.) to channel their team’s focus to those that that are more likely to say “yes” to learning more about a program or connecting with a nurse/coach/etc.
Engagement Focused Outreach
Remember, it’s not just about attracting as many people as possible - it’s about attracting the RIGHT people as that will avoid the frustration of low contact rates and “false positives”, those that are reached on the first attempt never pick up subsequent calls.
The idea behind engagement-focused outreach is that rather than hiring large teams to perform traditional outreach methods, such as telephonic or snail mail, we introduce a system in which we can funnel those within the target population down to those most likely to engage in programming: those in the Action Stage of readiness.
Ultimately, these individuals are most likely to say “yes” when asked if they’d be interested in learning more about a program that is being offered.
As a result, we aren’t just looking at program “fit” as being those at risk or with a certain condition, but ALSO those within a certain stage of change who are truly ready to participate.
By focusing our resources on members who are ready to engage we can optimize the efficiency of our care management and coaching resources, while developing further strategies for those who are not ready.
This touch*point Podcast Episode on Measurement and ROI Is A Great Bonus Resource For A Deeper Dive into Implementing an Effective Measurement Strategy.
Failure To Humanize And Personalize The Member Engagement Experience
(i.e. Making Sure The Program Feels Like it Was Designed Specifically For Your Target Audience)
In working with partners over the past few years we’ve seen a direct correlation between the amount of face-to-face time they have with participants and the length of time a program participant is willing to engage.
In other words the more we humanize the experience, the more successful the initiative.
In most cases, programs that suffer from steep attrition early on are the ones who have tried to deploy highly scalable programs at the expense of humanization. As a result, everything feels robotic and participants ultimately never feel accountable. There is a reason mobile health apps and devices generally have notable attrition - technology alone isn’t enough to engage the average person.
While there are undoubtedly opportunities for machine learning, chatbots, and other innovations within population health management, everything we’ve seen from our data is that human accountability is the key driver of long term engagement in most populations.
Technology alone CAN be a motivator and properly activate SOME people, but that is a rare instance. Most people require a more empathetic approach to behavior change.
In fact, we’ve seen that those using health tracking apps with professional support were 3.3x more likely to still be engaged in health tracking after 120 days versus those tracking alone.
In our experience, the key to a successful initiative is the way in which the consumer, technology, and professional support are woven into a seamless participant experience built around accountability and support.
Onboarding In Partnership
Ultimately if you are leveraging a fully-remote, scalable population health (or remote coaching program) where participants self-onboard, then you are undoubtedly going to encounter pitfalls engaging a majority of participants.
Part of the issue stems from simple framing. While we live in a tech-enabled world, technology can be intimidating and actually deter some individuals from enrolling, and in other instances, someone may encounter questions on how they are expected to participate or whether the program is really “for them.”
Some of this may sound obvious, but is often overlooked and highlights the importance in “matching” for effective engagement, and how everything from framing to touchpoints and feedback need to be contextualized for a participant to be effective.
Remember, there is a reason most consumer health tracking devices end up in drawers as generic messages to “drink more water” or “get more steps” lack the requisite contextualization and eventually fail to properly activate or motivate users.
Keep communication concise (the length of a Tweet for example) and relevant to participants in order to keep them around for a longer period of time.
Webinar On Key Elements of Masterful Onboarding
This Red Hot Healthcare Podcast On Designing Healthcare Experiences Is A Great Bonus Resource For A Deeper Dive The Total Consumer Experience
Failure to Properly Define Program Expectations
(i.e. what does engagement team expect from participants and vice versa)
I work with a lot of organizations on their outreach and engagement strategies and one of the most common pitfalls I see regularly is a failure to properly set program expectations for participants up front.
This pitfall actually entails 2 specific elements that both can wreak havoc to any type of remote engagement program.
How To Engage
This sounds obvious, but a program won’t get very far if members aren’t properly educated on how their coach, nurse, or care manager expects them to engage.
Think about when you were back in school and the teacher handed out your textbooks. He or she didn’t simply expect you to teach yourself the material - they assigned specific chapters and pages for you to read followed by respective exercises for you to complete.
In other words, they coached you through the material.
The use of technology is population health initiatives is no different. It’s critical that participants are properly instructed on how they are expected to engage...
- What items should they focus on?
- How often should they be communicating?
- If health tracking is incorporated, what specific items do we have them tracking initiatially?
What They Should Expect From Coaches & The Population Health Team
Teams are sometimes so focused on setting expectations for their participants that they completely overlook what expectations participants should have of them.
Asynchronous communication (like SMS or in-app messaging) can and should be a powerful tool for engagement as it allows you to more seamlessly fit within the lifestyle of participants, however, it can also open the door to logistical pitfalls within a program as participants are able to communicate 24 hours a day.
If parameters aren’t established from the beginning then there is potential for frustration when a user’s question isn’t answered immediately at 2 AM in the morning. If you aren’t intending to deliver 24-hour-a-day service then you are going to want to set some constraints early on.
Establishing A “Rules of Engagement” Document
It is for this reason that we always encourage our partners create an internal document outlining the rules of engagement.
In this we suggest you include the following items:
- What’s it for?
- What is it NOT for?
- What do you expect from participants?
- How quickly will coaches or PHM team respond to participants?
Team Is Ineffective At Communicating With Participants
(i.e. Team Not Trained On How To Turn Data Into Meaningful Asynchronous Touchpoints)
While the majority of industry professionals are great at working with patients or members “knee-to-knee” there is a common misconception that THAT experience translates over to engaging someone remotely… in most cases it does NOT.
VERY FEW industry professionals were ever trained on how to properly engage someone remotely so it’s impractical to expect someone to naturally be proficient at this. Remote engagement programs require someone to feel comfortable analyzing data and being able to provide concise, contextualize feedback to participants through remote modes of communication.
This can be unique and as such we generally see practitioners overcompensate for the lack of face-to-face time by sending lengthy messages to their participants. As a result they end up breaking some of the cardinal rules of remote engagement and potentially disengaging some of their participants.
Alternatively we also regularly see communication protocols that more closely resemble outreach instead of any type of true conversation. Let me put it this way - peppering a person with messages is NOT engagement.
Adopting a Systematic Approach to Remote Engagement
Over the past couple of years we’ve witnessed that effective remote communication is comprised of multiple factors that are regularly used to activate and prompt a discussion with participants - remember, it takes 2 to engage.
There are generic “touchpoints” which are any general points of contact with a member or patient, and then there what we consider “nudges”, which are more targeted.
Not all “touchpoints” need to be formal “nudges” but we generally encourage weaving these in more regularly to ensure programming doesn’t seem robotic. We’ve identified the key elements of an effective “Nudge”:
- Use member name
- Reference real data
- Tie to personal reason why
- Give a specific positive
- Suggest a specific change or reason to continue
- End with appropriate encouragement
- Use your name
Our Chief Science Officer, Dr. Steve Feyrer-Melk, was kind enough to share some example of how he weaves together these elements to deliver an effective nudge...
Charles, your consistency is rock solid. your commitment to lifestyle is true. I remain concerned about your sleep BUT see that during the past 6 days most were in the healthy zone. What did you do different? Dr. Steve
Karen. I see your activity has been consistent for 3 months. Keep that up Karen! I want to monitor nutrition better so would you consider tapping in your protein intake? Dr. Steve
Hello Thomas, I noticed the average sleep in the past few days has not been as consistent. Give me an update if you have a moment. Is your new position impacting your personal time?
Note that in all instances Steve ended his “nudge” with a simple question in hopes that he could prompt a quick response from his patients when they had a minute of free time.
Inability to Keep Members Engaged to Attend Coaching Calls
(i.e. sliding call attendance after initial session(s))
Anyone running remote engagement or coaching programs understands the difficulty associated with keeping participants engaged in a remote environment. How can you expect to change someone’s behavior when you are struggling to get them to attend sessions?
This problem is exacerbated in outbound programs, such as chronic care management, in which care teams are actively recruiting members to enroll. In these instances getting someone on the phone once may be sheer luck and getting their attention again is wishful thinking.
Those that do express interest are then funneled into an evergreen engagement protocol through which they may receive regular telephonic or text-based support. The issue is that we are constantly competing for mindshare.
If your team’s engagement program relies heavily on infrequent telephonic or web-based sessions, then you know that the journey is littered with opportunities for a participant to disengage.
Luckily there are ways in which we’ve seen organizations combat declining engagement and call attendance in both outbound and inbound coaching and engagement programs.
Schedule Messages With Recorded Videos
There are two primary concerns we witness with remote programs: maintaining the human element and staying relevant to participants.
The most effective engagement protocols now take a hybrid approach, combining regular asynchronous sessions with more frequent asynchronous communication through SMS or email.
Luckily, innovation in video conferencing and telemedicine has made it easier than ever to deliver face-to-face support, which has regularly been recognized as being essential to driving long term engagement.
To streamline the communication workflow and improve efficiency we’ve witnessed a new evolution with the use of video that is efficient, effective, and asynchronous. While video conferencing is standard within the majority of programs, those using systems like ZOOM have discovered that by occasionally recording and sending simple 1-3 minute feedback clips to participants, care teams have been able to significantly reduce the amount AND duration of face-to-face sessions.
As a result, the standard 2-prong approach to remote engagement (synchronous and asynchronous touchpoints) has been redefined to more closely resemble the following engagement matrix.
That said, if we can’t get participants to attend sessions then these efforts are futile.
It’s for this reason that we’ve witnessed the positive effects of integrating scheduled messages and reminders into the communication workflow to combat declining call or session attendance.
Numerous studies have illustrated the benefit of incorporating asynchronous reminders (text or email) to improve call or session attendance, and our learnings from work with our partners is similar.
One of our partners shared that by incorporating a scheduled message into their communication workflow they had been able to increase session attendance by approximately 50%. This came in the form of scheduling a message to be delivered within 24-hours of the scheduled session simply reminding the participant of their upcoming session.
This is all to say that the evolution of asynchronous communication has allowed organizations to enhance their remote engagement offerings by increasing their face-to-face time with participants and adopting more effective touchpoint strategies.
Webinar On Scheduling Member Messages & Reminders