Consumer behavior changes—more so in chronic care than in preventive care—help health systems primarily by driving better quality outcomes, as well as by preventing high-cost treatment utilization.

Chronic medication adherence and lifestyle changes as well as adequate prenatal care consistently drove positive care quality outcomes, such as reduced length of stay, readmissions, and mortality, with greater evidence of this available for chronic care behavior changes. These patient behaviors, as well as regular use of primary care, also demonstrated significant proof of preventing unnecessary high-cost hospitalizations and emergency department visits. Based on this evidence, health systems can leverage behavior change to improve quality of care and lower spend, particularly by encouraging chronic medication adherence and lifestyle changes among patients.

Additionally, while only one study cited the possibility of regular primary care use achieving downstream referrals (though we believe there is likely a correlation here), by driving quality through behavior change, health systems can also achieve an indirect impact of acquiring consumerist patients seeking high-quality care.

Breakdown of evidence-based behavior changes

Case in point

Study objective and parameters: To assess the impact of adhering to dietary guidelines for patients with heart disease, diabetes, or chronic kidney disease (CKD).

Behavior change impact: In addition to improving health for all studied patients, dietary guideline adherence prolonged dialysis-free time for CKD patients by around two to five years, drove 16% fewer readmissions (saving a mean projected cost of $234K per 100 patients per year), and lowered average length of stay by 38 days for heart failure patients (saving $79K per hospitalization).

Note: Our definition of “payers” for this research includes private health plans, including Medicare Advantage, as well as government payers like Medicare and Medicaid. The government/government stakeholders may have goals beyond those of Medicare and Medicaid, such as appealing to constituents and getting re-elected. We did not study the impact of behavior changes on these goals in this research. One study we analyzed that was applicable to government payers linked inadequate prenatal care to poorer continuity of care for infants given its correlation with increased rates of dropped Medicaid coverage.

Payers primarily stand to lower spend from behavior changes through members’ lower utilization of high-cost services. Evidence suggests this may happen across many of the behavior changes we examined, both preventive and chronic. The area with the greatest evidence was the impact of chronic medication adherence on private health plans.

Many studies have shown the link between chronic medication adherence and lower payer—often private health plan—spend. These studies found that medication-adherent members with chronic conditions often utilized less health care services, including high-cost inpatient and emergency department care. While preventive care changes also lowered payer costs, the magnitude of evidence for these behavior changes was much lower. It is notable that all the preventive care studies we found focused only on government payers.

Based on this evidence, payers should likely prioritize driving medication adherence among members with chronic conditions as a way of lowering spend.

While lowered spend was the primary impact identified, one study implied that chronic medication adherence—particularly for members with diabetes, high cholesterol, and high blood pressure—could also help with member acquisition and increased revenue for Medicare Advantage (MA) plans. Medication adherence in those three disease areas is a metric CMS uses to calculate Medicare star ratings, and high star ratings can differentiate MA plans for consumer members and affect annual bonus payments from CMS.

Breakdown of evidence-based behavior changes

Case in point

Study objectives and parameters: To assess if there is an association between medication adherence (in three categories: hypertension medications, cholesterol-lowering medications, and diabetes medications) and total cost of care among 20 Medicare Advantage health plans.

Behavior change impact: One percentage point increase in average Proportion of Days Covered (PDC, a commonly used measure of medication adherence) was associated with a total cost of care decrease between $21 and $46 (range across three disease categories) per member per year.

Consumer behavior change can help employers lower their costs, and evidence suggests they may do so across most of the behavior changes we examined, with the greatest evidence for chronic medication adherence.

Behavior changes—particularly chronic medication adherence—were proven to create a healthier workforce, which ultimately lowered employer costs. These include direct costs from lower benefit payments like health care and disability, and indirect costs from lowered employee absenteeism due to health care-related issues. Additionally, while not measured explicitly in studies, a healthier workforce is likely a more productive workforce, which also benefits employers.

Accordingly, given the acute financial pressures many employers face today, employers can leverage behavior change to drive savings.

Breakdown of evidence-based behavior changes

Case in point

Study objectives and parameters: To evaluate the impact of medication adherence on all-cause work loss, health care resource utilization (HRU), direct medical costs, and indirect costs (indirect costs computed as individual employee daily wage multiplied by total days of disability or medical-related work loss) over two years.

Behavior change impact: Over two years, medication-adherent patients had $10,214 lower per-patient medical direct costs and indirect costs compared to non-adherent patients, resulting from lower HRU, fewer days of medical-related absenteeism, and lower rates of work loss events (e.g., leaves of absence).

Pharmaceutical companies and pharmacies can primarily see increased revenues through behavior change, but only via regular screenings and chronic care management changes based on the evidence.

There is significant evidence linking chronic medication adherence with increased pharmaceutical company revenue, including through higher volumes of products dispensed. Additionally, studies indicate that regular chronic health monitoring and preventive wellness screenings are associated with higher pharmacy claims, benefiting pharmacies directly and pharmaceutical companies indirectly.

In fact, in response to the drop-in screening rates facilitated by the pandemic, many major pharmaceutical companies have launched marketing campaigns urging patients to keep current on screenings. This is evidence of the impact that regular screenings are believed to have on pharmaceutical companies, both in terms of revenue and drug product success.

In addition to pushing for screenings, pharmaceutical companies and pharmacies can prioritize driving medication adherence and regular chronic health monitoring as ways to improve not only patient outcomes but also bottom lines.

Breakdown of evidence-based behavior changes

Case in point

Study objectives and parameters: To benchmark medication adherence across 35 drug products to understand how adherence varies across different therapeutic categories and/or product characteristics.

Behavior change impact: If each drug product with the lowest medication possession rate (MPR) in a respective market were to see improved adherence to the level of its respective market’s average MPR, the drug products would see an average increase of 10% in dispensed quantity and associated revenue.

Evidence of the impact of patient behavior change on physicians is limited, but regular primary care and prenatal visits could help increase downstream revenue.

Surprisingly, we saw a lack of hard evidence for behavior change impact on physician goals, such as increasing patient loyalty. We believe that patient behavior change can have the ability to impact physician goals, however, we found that these effects have not been widely studied.

The studies we examined centered on preventive care behavior changes, particularly in primary care and prenatal care, and cited the ability of these changes to drive greater downstream referrals. Additionally, screening and chronic medication adherence behavior changes, along with prenatal care attendance changes, created a less complex patient mix.

While evidence of the impact of patient behavior change on physician-specific goals was limited, behavior change has been proven to impact health system goals, which often overlap with physician goals, including increased care quality.

In all, behavior change may be of strategic importance to physicians, but physician leaders need more evidence before making it an area of focus in their practice.

Breakdown of evidence-based behavior changes

Case in point

Study objectives and parameters: To examine the association between maternal prenatal care patterns and the subsequent use of well-child visits among a low-income population in New York.

Behavior change impact: Children born to mothers with adequate or intensive levels of prenatal care (as opposed to inadequate levels of prenatal care) were significantly more likely to have the necessary well-child visits (five or more) in their first 15 months of life, thereby driving pediatrician volumes and preventing higher volumes of sick-child visits.

Evidence of the impact of patient behavior change on other life sciences stakeholders outside of pharma was minimal. However, based on available evidence, device companies may be able to leverage behavior change to better communicate the value of their products.

We found limited direct evidence of the impact of behavior change on device manufacturers and suppliers. However, studies show that using devices as part of chronic health monitoring can help patients prevent disease progression and improve outcomes. As such, behavior changes related to chronic health monitoring can provide manufacturers with evidence of the efficacy of their products—and thus greater leverage when it comes to coverage conversations with payers. Additionally, one study linked increased primary care use with increased cancer screenings, which may impact supplier and device companies providing the equipment for such services.

More evidence is likely required for these stakeholders to make a case for driving behavior change in general, let alone prioritizing between behavior changes.

Breakdown of evidence-based behavior changes

Case in point

Study objectives and parameters: To evaluate the influence of home blood pressure monitoring (HBPM) on patients’ attainment of blood pressure goals.

Behavior change impact: Eighty-one percent of patients who did HBPM were likely to be aware/knowledgeable of their blood pressure goals, versus 70% of patients who did not engage in HBPM. Additionally, 64% of patients who engaged in HBPM were likely to reach their blood pressure goals in three months, versus 57% of patients who did not engage in HBPM. This study cited the importance of these outcomes for device companies in reimbursement conversations with payers.