WithMe Health’s Engagement Model: The Science of Motivation, the Art of Empathy

Nick Palefsky - VP of Operations

Managing health, whether for yourself or a loved one, is inherently stressful. It is high-stakes and complicated. For many, it can be overwhelming. We have heard from members: "My doctor speaks in terms I don't understand," "my specialist is 50 minutes away and I can't take off work to see them," "I have joint pain and my meds make me tired and thirsty."

Stress triggers a “fight or flight” response that makes it hard to think rationally and process complex information, which is exactly what is needed when it comes to making decisions about our health. Each difficulty a person encounters in tolerating, accessing, or altering medication further aggravates this response. Think high copays, difficult scheduling, long commutes, missing work, competing expenses, etc.

Health concerns don’t exist in a silo. They exist in the middle of messy, complicated lives alongside other events that also cause stress.

Kids get sick. People lose jobs. Rent is due. A car needs repairs.

This broader context is why effective medication management requires a customer-centric approach that goes well beyond basic customer service. It requires an engagement model that enables our team, called Guides, to build trusted relationships with our members and partner with them to navigate what may be a stressful medication journey.

Improving health outcomes requires making members feel supported and equipped to make a change, so they can perceive the benefit to outweigh the burden. This requires our Guides to identify a specific change, motivate the member to make it, equip them to do so (facilitating this with whatever capabilities we can deploy), and then incentivize them to get started. This is aligned with Stanford Professor BJ Fogg’s behavior change model, which states that Behavior Change = Motivation + Ability + Trigger.

Our role in “nudging” the member towards the desired behavior is not possible without first developing a trusting relationship. Developing this relationship is the central tenet of our engagement model and the goal that underpins our every interaction with members. It informs the content of our conversations and the way in which we measure our team’s performance. Members need to trust us to trust our advice, our information and our support. They need to trust us sufficiently to share information about their lives that offers the insights needed to help them overcome barriers to change.

Trust is the foundation and starting point for our engagement model. It is called MEDS, which stands for Meet, Evaluate, Decide, Support.

Underpinning this model is a set of tools and techniques rooted in behavioral economics and psychology, brought to life by our human-led, tech-enabled team of Guides.

Our Guides are highly trained and certified pharmacists, pharmacy technicians, and customer care representatives who are assigned to interactions according to the level of expertise required. A member with a complex poly-pharmacy profile needs a pharmacist, while a copay question can be referred to a customer care technician. All members have access to all tiers of support, depending on the nature of their need. This gives us tremendous flexibility to respond to concerns ranging from the most simple to the most complex.

The core techniques deployed by our team are empathy to build trust and a connection, the bio-psycho-social model to learn about a member's entire context, choice architecture to lay out clear choices for members to make an informed decision, and Robert Cialdini's influence techniques to help members transition their choices into lasting behavior change.

MEDS is structured as a phased cycle, wherein each phase’s duration may be as brief or as long as is appropriate for the member. A member may pass through four phases in one interaction, and then restart the cycle in a future interaction, or may spend the first interaction only on the “Meet” phase.

MEDS: How it works

Meet: Whether the call is outbound or inbound, the approach is the same: the WithMe Guide introduces themselves to the member and establishes the reason and goal for the call. The tone is empathetic and patient, with an emphasis on listening and reflecting the members feelings as the basis for building trust.

Sometimes the need is simple and can be resolved in a single call. But particularly for members with more complex care needs, episodic or “one-off” solutions will not improve their health outcomes. For these members, we aim to both address immediate concerns and to open the conversation in order to gain a more holistic understanding of their lives. ‘Opening the conversation’ can mean depth - we learn a lot about a single aspect of the member’s life - or breadth - we know their cats’ names by its end. Both are successful first steps to building trust and our understanding of the member

This introduction is also an opportunity for our Guides to inform members of the ways in which they can help and other WithMe resources that may be relevant.

Evaluate: The Guide invests time in understanding the reality and history of the situation, including the member’s physical, emotional and social context. This is an opportunity to log important facts, symptoms and test results pertaining to the member’s medical history, as well as gain an understanding of what barriers exist that prevent the member from achieving their goal and what would motivate them to take action towards it. Our Guides make special note of any contextual barriers to making optimal health decisions, such as lack of transportation to see a provider or financial challenges that force a tradeoff between medication and daily expenditures.

Guides also note what motivates the member. One tool we use to elicit this information is to ask “the miracle question.” For example, “If a miracle happened overnight and you woke up and were not experiencing joint pain, what would you notice? What would those around you notice?” A member might reply, “I'd be able to walk my dog one mile and chase my 3 year-old.” This concrete information about what the member wishes were true is incredibly useful in motivating change that brings them closer to that ability.

Decide: Leveraging information gained in the evaluation, our Guides use the Choice Architecture framework developed by Richard Thaler and Cass Sunstein to clearly lay out each option along with its pros, cons, and impact on the member's goal. Our Guides keep an eye on the known emotional traps or contextual barriers to health that may prevent a member from taking action and tailor the plan to help resolve these issues.

Support: Once the member has chosen a path, we move into the Support phase to create a clear plan of action, resolve any barriers, assess a member's readiness to change and commit to following up.

To ensure the member is successful with their plan, we help to address outstanding barriers. This can include helping to close gaps in care, such as contacting the provider on behalf of the member to follow-up on specific concerns. We can reduce financial barriers by helping members to enroll in or seek out programs that make medications more affordable. We can arm them to better navigate the system by simplifying explanations of complex medical and insurance terms. Sometimes the problem is environmental - for example, packages are regularly stolen in their neighborhood. In this case, we can identify alternative delivery options.

Enduring behavior change not only requires knowing which choice is optimal, but also having the mindset and motivation to act on that choice. As a result, our Guides’ ability to assess the member’s readiness to change is critical.

In addition to active listening, a helpful tool to make this assessment is “scaling questions,” such as, “On a scale of 1-10, 1 being not at all ready and 10 being ready to go, how ready are you to start walking 3 times a week?" Equally as important is the follow-up question, "You said a 6, what would it take to get you to a 7? What would cause you to go down to a 5?" The member’s answers uncover remaining barriers to action and also reveal what would motivate them to move further up the continuum.

Once the member's barriers are resolved and they are committed to change, the Guide and member agree on clear next steps including follow-up method and frequency, or “cadence”.

Quality over quantity

To measure engagement in its truest sense requires focusing on the quality, not quantity, of interactions.

Frequency of interactions, number of clicks - none of these help us achieve the objective of improving health outcomes. Listening does, and it is central to all stages of MEDS.

Not only is listening at the heart of establishing a trusted relationship, but it is the best way to identify barriers to change and arm us to overcome them. Our Guides’ performance metrics are aligned with these values. Guides are not assessed based on “average call length.” Instead, we have developed a rigorous set of rubrics to measure the quality of each interaction and enable us to coach our Guides to build mastery in all aspects of the model.

Behavior change is hard, at the best of times

Often, we are not asking members to change their behavior at the best of times. We are asking when they are busy and stressed and overwhelmed. We are asking them to process complex information and to make informed decisions about their health, and then act. These asks require more than support. They require people - a team - that can be trusted and who are armed with the resources and training to take these circumstances into account and help members succeed despite them.

Employers, ask yourselves:

Is your members’ experience with their prescription benefits plan a priority?

If so, are your members happy with it today?

Do your members have a team focused on their holistic health who proactively reach out before issues arise?

When change is needed, do they have a trusted partner to help them in a reasonable and respectful manner?

In a world where there is fierce competition for the best talent, offering a benefit employees love is paramount to attracting and retaining your most important asset, human capital.