home email us! sindicaci;ón

Adapting Einstein’s Formula to Health Management

by Scott MacStravic

Albert Einstein used the formula E = MC2 to describe the conversion of mass into energy, later demonstrated with the atomic bomb.  A similar formula applies to health management (HM), whether applied to consumers paying for their own services, employees, commercial insurance plan members or government plan beneficiaries.  The difference is that the terms are different:

  •     “E” represents effectiveness/efficiency if HM programs
  •     “M” represents motivation in HM participants
  •     “C1” reflects participants’ capability and confidence, self-efficacy
  •     “C2” reflects participants’ consciousness of how/when to act

While a wide range of interventions have been used to promote HM participant “compliance” or “adherence” to medication and lifestyle regimens, they all can be categorized as aiming to achieve increases in motivation, capability or consciousness.  Many focus on just one of these, some on two, and a few on all three.  But experience has shown that the best results are achieved when all three are affected by HM programs, rather than relying on one or two.

For example, a recent report on a diabetes disease management program, used with significant effect by HealthMedia, Inc. of Ann Arbor, Michigan, identified nine keys to success in promoting diabetes patients’ adherence to medications:

  •     Improving patients’ depression and stress coping skills
  •     Fitting adherence into individual patients’ daily routines
  •     Understanding and addressing each’s adherence barriers
  •     Helping them feel accountable for adherence
  •     Strengthening their relationships with providers
  •     Bolstering their confidence in medications and themselves
  •     Moving them toward intrinsic vs. extrinsic motivations
  •     Focusing on their life quality benefits vs. sponsors’ gains
  •     Understanding and communicating with each as an individual

[K. Wildenhaus “Improving Medication Adherence: The Missing Link to Better Outcomes” HealthMedia.com Aug 16, 2007 (webinar + slides)]

All nine of these essentials deal with one or more of the “MC2” factors.  Improving coping skills, fitting adherence into daily routine, addressing barriers, bolstering their self-confidence – all relate to participants’ capabilities.  Fitting adherence into daily routines, strengthening relationships with providers (physicians, pharmacists, nurse coaches), and dealing with them as individuals — all relate to promoting their consciousness of what and when to act.  And helping them take ownership/accountability, strengthening provider relationships, moving them toward intrinsic motivations, and recognizing their unique personal benefits – all relate to promoting their motivations.

Addressing the changes in or reinforcements of participants’ personal and unique levels of motivation, capability and consciousness required for success is first a helpful basis for planning specific steps in an HM intervention.  It is also a useful focus for evaluating the immediate effects of intervention elements – are there noticeable changes in one or more of these three essentials as each reports them.  Unless one or more of these cognitive/emotional factors are increased, or at least reinforced by HM efforts, there is likely to be little if any effect.

By focusing on all three MC2 factors, HM sponsors can also create a “paper trail” that will enable or reinforce conclusions that their HM interventions are responsible for changes noted in participants’ health status, healthcare, disability and workers compensation insurance expenses, absences, productivity, performance, and overall economic impact.  If changes in one or more of these factors are noted after implementing efforts aimed at changing them, then are linked to changes in behavior, health status, and subsequently in desired economic impacts, sponsors can be much more confident that the HM interventions actually produced the impacts noted than if they only measured the impact per se.

By evaluating the particular impact that HM interventions have on motivation, capability and consciousness, sponsors and providers can also learn which of these three factors make how much difference in achieving necessary enrollment, participation, and completion of each intervention, and to each of the many dimensions of cost savings and performance improvement.  This will enable continuous “tweaking” of the HM interventions, themselves, and improvement of the predictive modeling methods used to identify and target prospects for particular kinds of interventions.

This is equally true with identifying the particular types of motivation, capability and consciousness dimensions, such as the nine examples identified by HealthMedia in its diabetes medication adherence program, that make the most difference to results.  Continuous improvement in our understanding of MC2 factors is needed to increase and maintain positive returns on investment from HM interventions in general, and to this key component of the solution of our healthcare cost crisis.

No comments yet »

Your comment

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <code> <em> <i> <strike> <strong>