Cognitive and Behavioral Patterns of Thinking and Action Health by raz34238

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									           Cognitive and Behavioral Patterns
               of Thinking and Action:
           Health Personas Driving Consumer
          Preferences and Health Care Demand


                                                       Frederick H. Navarro
                                              PATH Institute Corporation
                                    Directing health practice to serve health priorities




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                                   Consumer Subtype Prevalences and Spending
                                                           U.S. Adult Population (210 million)
                       20.0%                                                                                                    $300

                       18.0%                 % Size
                                             Spending                                                                           $250
                       16.0%
                                                                                                                         $250
                       14.0%




                                                                                                                                       Billions Per Year
                                                                                                                                $200
      % of US Adults




                                                                                                                 $245
                       12.0%
                       10.0%                                                                                                    $150
                                                                                            $157       $162
                       8.0%
                                                                  $130 $138 $139                                                $100
                       6.0%                            $112
                       4.0%               $93
                                                                                                                                $50
                       2.0%
                                $29
                       0.0%                                                                                                     $0




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Directing health practice to serve health priorities
HealthLeaders “Fact File” December, 2006




                                                       exercise




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Directing health practice to serve health priorities
                            Social Cognitive Theory
      • Albert Bandera
      • Individual as active participant
      • Triadic reciprocality




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Directing health practice to serve health priorities
                            Social Cognitive Theory
      • Triadic reciprocality
               – Personal factors
                        • Cognition (perceptions, expectations, preferences,
                          priorities, intentions)
                        • Biology (age, gender, weight, blood pressure,
                          genetics)
               – Environmental factors
                        • Family, accessibility, communications, information,
                          finances, wellness promotion
               – Behavioral factors
                        • Physical capabilities, exercise, diet, care seeking

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 Environmental
 factors




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Directing health practice to serve health priorities
                                   Consumer Subtype Prevalences and Spending
                                                           U.S. Adult Population (210 million)
                       20.0%                                                                                                    $300

                       18.0%                 % Size
                                             Spending                                                                           $250
                       16.0%
                                                                                                                         $250
                       14.0%




                                                                                                                                       Billions Per Year
                                                                                                                                $200
      % of US Adults




                                                                                                                 $245
                       12.0%
                       10.0%                                                                                                    $150
                                                                                            $157       $162
                       8.0%
                                                                  $130 $138 $139                                                $100
                       6.0%                            $112
                       4.0%               $93
                                                                                                                                $50
                       2.0%
                                $29
                       0.0%                                                                                                     $0




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www.pathinstitute.com
Directing health practice to serve health priorities
                            Social Cognitive Theory
      • Triadic reciprocality
               –Personal factors
                        • Cognitions, perceptions, expectations, preferences, priorities,
                          intentions
                        • Age, gender,                 weight, blood pressure, risk
                             factors
               – Environmental factors
                        • Family, accessibility, communications, information, finances, wellness
                          promotion
               – Behavioral factors
                        • Physical capabilities, skills,    diet, exercise, care seeking


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Directing health practice to serve health priorities
                                      Cognitive examples

                            Family members responsible for
                                   their own health
                              Deal with health only when
                                  problems come up




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Directing health practice to serve health priorities
                                        Cognitive examples
                     Family members responsible for their own health
                                                       Visited pediatrician in past year
                                                            (adults with children, N=36,877)
                                45.0%
                                               39.7%
                                40.0%
                                35.0%
                                30.0%
                                                              24.7%
                        % Yes




                                25.0%
                                20.0%
                                15.0%
                                                                               9.4%
                                10.0%                                                           7.6%
                                                                                                              6.3%
                                5.0%
                                0.0%
                                              Strongly       Somewhat         Neither          Somewhat   Strongly agree
                                              disagree        disagree                           agree
                                                             Family responsible for own health


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Directing health practice to serve health priorities
                                                   Cognitive examples
                     Family members responsible for their own health
                                                                      Dependent Claims
                                                             (N=2,201 adults with at least one dependent claim)
                                             $3,500,000
                                                                                 $2.3 million
                                             $3,000,000                                                     Rx
                      Total average claims




                                             $2,500,000
                                                                                                            MD
                                                                                                            Hosp
                                             $2,000,000

                                             $1,500,000

                                             $1,000,000

                                              $500,000

                                                   $-
                                                          Strongly   Somewhat       Neither     Somewhat      Strongly
                                                          disagree    disagree                    agree        agree

                                                             Family members take care of own health

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Directing health practice to serve health priorities
                                      Cognitive examples
                  “Only deal with health problems when they come up”


                                            Response            Count
                                            strongly agree       756
                                            somehwat agree      1647
                                            neither             1016
                                            somewhat disagree   1930
                                            strongly disagree   2948
                                            Total               8297




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Directing health practice to serve health priorities
                                      Cognitive examples
                  “Only deal with health problems when they come up”

Statement:                            Deal with health only when problems come up
                                                                                    Inpatient    Total Claims
Response                                      Count     Rx claims    Prof_claims     claims     Per Response
strongly agree                                 756     $    602.00   $ 2,634.00    $ 3,061.00   $     6,297.00
somehwat agree                                1647     $    626.00   $ 2,316.00    $ 3,085.00   $     6,027.00
neither                                       1016     $    649.00   $ 2,288.00    $ 2,773.00   $     5,710.00
somewhat disagree                             1930     $    801.00   $ 2,793.00    $ 3,701.00   $     7,295.00
strongly disagree                             2948     $    964.00   $ 3,417.00    $ 3,806.00   $     8,187.00
Total                                         8297
Statistical Sig.                                         p<0.000       p=0.000         ns         Difference
Dollar spread at extreme attitudes                     $   362.00    $    783.00   $   745.00   $     1,890.00




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Directing health practice to serve health priorities
                                      Cognitive examples
                  “Only deal with health problems when they come up”

                           "Deal with health only when problems come up"
                                  3500                                                   $28,000,000
                                               2948
                                  3000                        $19.3 million              $23,000,000




                                                                                                       Total Spending
                                  2500
                                                       1930
                   Count




                                                                                         $18,000,000
                                  2000                         1647
                                  1500                                                   $13,000,000
                                                                       1016
                                  1000                                             756
                                                                                         $8,000,000
                                    500

                                        0                                                $3,000,000

                                      e          e         ree          er          e
                                   gre        gre       ag          it h        gre
                              i sa       i sa        at           ne           a
                             d         td          w                       gly
                        ngly      w ha       m  eh                  str
                                                                        on               Count
                      o
                   str        me          so                                             Total Demand
                           so
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Directing health practice to serve health priorities
                            Social Cognitive Theory
      • Triadic reciprocality
               –Personal factors
                        • Cognitions, perceptions, expectations,
                          preferences, priorities, intentions
                  • Age, gender, weight, blood pressure
               – Environmental factors
                        • Family, accessibility, communications, information, finances, wellness
                          promotion
               – Behavioral factors
                        • Physical capabilities, skills, diet, exercise, care seeking




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Directing health practice to serve health priorities
                                                               ®
                                                       Path type
      • Cognitive interactive patterns
      • Health psycho-social domain
      • Perceptions, preferences, priorities
               – Self
               – Family
               – Health care environment




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Directing health practice to serve health priorities
      Cognitive factors




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Directing health practice to serve health priorities
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                                                                                                        e ve to pe ily ...
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Directing health practice to serve health priorities
                                                                                                              ek , h ve ca ort
                                                                                                                  nu er d in l sh s
                                                                                                                       tri bs m ap
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                                                                                                             ta                      i
                                                                                                                m inv phy ve s alth
                                                                                                          se ins ol si                    p




Directing health practice to serve health priorities
                                                                                                              ek , h ve ca ort
                                                                                                                  nu er d in l sh s
                                                                                                                       tri bs m ap
                                                                                                                          tio in y e
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                                                                                                                         tri ow th d ers
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                                                                                                          vi ve to pe ily e...
                                                                                                            ta ry p tit h
                                                                                                               m in p iv ea
                                                                                                           se ins vo hys e s lth




Directing health practice to serve health priorities
                                                                                                              ek , h lve ica po
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                                                                                                                                                                  1.50
                                                                                                                                                                  2.00
                                                                                                                                                                  2.50
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                                                                                                             ta                                i          a
                                                                                                                m ry in ph ve s lth
                                                                                                                   in          v        ys            p
                                                                                                              se s, h olve ica orts




Directing health practice to serve health priorities
                                                                                                                  ek er                 d ls
                                                                                                                      nu bs in hap
                                                                                                                           tri ins my e
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                                                                                                                                ed             d io
                                                                                                                                      to ec ns
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                                                                                                                                                                                       PATH Type 7 and PATH Type 8




                                                                                                                                  o p av i o n
                                                                                                     no n                                        e           s
                                                                                                         t w ev p mo mo
                                                                                                              o r er              ay r e                n
                                                                                                                 rie us fo by ey
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                                                                                                                       ab ow ig ric
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                                                                                                            do do y                         tis          c
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                                                                                                                  or                    en            se
                                                                                                                      s rs
                                                                                                                        do nu tion r...
                                                                                                                             n' rs
                                                                                                                                t k es to a
                                                                                                                                    no n                  d
                                                                                                                                        w ot s
                                                                                                                                           si go
                                                                                                                                                de o
                                                                                                                                                                                                                     Unconscious cognitive structure (UCS)




                                                                                                                                                    ef d
                                                                                                                                                       fe
                                                                                                                                                          ct
                                                                                                                                                              s
                                   Consumer Subtype Prevalences and Spending
                                                           U.S. Adult Population (210 million)
                       20.0%                                                                                                    $300

                       18.0%                 % Size
                                             Spending                                                                           $250
                       16.0%
                                                                                                                         $250
                       14.0%




                                                                                                                                       Billions Per Year
                                                                                                                                $200
      % of US Adults




                                                                                                                 $245
                       12.0%
                       10.0%                                                                                                    $150
                                                                                            $157       $162
                       8.0%
                                                                  $130 $138 $139                                                $100
                       6.0%                            $112
                       4.0%               $93
                                                                                                                                $50
                       2.0%
                                $29
                       0.0%                                                                                                     $0




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Directing health practice to serve health priorities
      • Cognitive/
        psychological
        view of person




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Directing health practice to serve health priorities
   • Dynamics within person
   • Cognitions that shape perception



                                                       = sub type




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                                                       Path types
      •      Health behaviors
      •      Health risks and disease
      •      Patient satisfaction
      •      Health care demand and spending




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                                                                Health Screening

                             Wellness Activities by PATH Type
                                                                Routine Physical
                           400%
                                                                Attended Health Ed Class
                           350%

                           300%                                 Attended Wellness/ Fitness
        Multipe Response




                                                                class
                           250%
                                                                I am very involved in my health
                                                                (Strongly Agree)
                           200%
                                                                I don't plan ahead, I deal with
                           150%                                 health issues when they come
                                                                up (Strongly Disagree)
                           100%                                 Only seek care when really sick
                                                                or injured (Strongly Disagree)
                           50%                                  Attention to Nutrition & Healthy
                                                                Diet (Strongly Agree)
                            0%
                                                                Active or Competitive sports
                           8
                 TH e 7

                           9

                           6
                 TH e 4

                           5
                 TH e 3

                           1



                           2
                 T H n ed

                                                                (Strongly Agree)
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              P A Ty



              P A Ty

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                                                                Exercise 4+ days per week
              PA




              PA




               U




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Directing health practice to serve health priorities
                                            Health Risk Conditions and PATH Types
                                                Sach/Scarborough HealthPlus, 2001, N=93,400
 % exceed 100 due to multiple response




                                         350%                                         Poor attention to nutrition
                                         300%                                         Low physical activity
                                                                                      Migraines
                                         250%
                                                                                      Weight Problem
                                         200%                                         Chronic back pain
                                         150%                                         Depression
                                                                                      Smoking (4+ days per week
                                         100%
                                                                                      Sleeping Problems
                                          50%                                         High Cholesterol
                                          0%                                          Hypertension
                                                     2

                                                     4

                                                     9

                                                     7

                                                     1

                                                     5

                                                     3

                                                     6

                                                     8
                                            T H pe

                                            T H pe

                                            T H pe

                                            TH e

                                            T H pe

                                            T H pe

                                            T H pe

                                            T H pe
                                                  pe
                                         PA Typ
                                         P A Ty

                                               Ty

                                               Ty



                                               Ty

                                               Ty

                                         P A Ty

                                         P A Ty

                                               Ty
                                            TH
                                         PA



                                         PA

                                         PA



                                         PA

                                         PA




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Directing health practice to serve health priorities
                                                   Reported Disease Conditions by PATH Type
                                                     Sachs/Scarborough HealthPlus USA Survey, 2000, N=61,000
        % exceed 100 due to multiple responses


                                                 140.0%

                                                 120.0%
                                                                                                   Dermatitis
                                                 100.0%                                            Osteoporosis
                                                                                                   Respiratory conditions
                                                 80.0%
                                                                                                   Arthritis/ rhematism
                                                 60.0%                                             Alzheimer's
                                                                                                   Chronic Allergies
                                                 40.0%
                                                                                                   Heart Disease
                                                 20.0%                                             All Cancers
                                                                                                   Skin Cancer
                                                  0.0%                                             Breast Cancer
                                                             7

                                                             4

                                                             9

                                                             3

                                                             6

                                                             1

                                                             5

                                                             2

                                                             8
                                                                                                   Kidney Disease
                                                    T H pe

                                                    T H pe

                                                    T H pe

                                                    T H pe

                                                    T H pe

                                                    T H pe

                                                    T H pe

                                                    T H pe
                                                          pe
                                                 P A Ty

                                                 P A Ty

                                                 P A Ty

                                                       Ty

                                                 P A Ty

                                                       Ty

                                                 P A Ty

                                                 P A Ty

                                                       Ty
                                                    TH
                                                 PA




                                                 PA



                                                 PA




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Directing health practice to serve health priorities
                                                       Specialty Care Demand
      70.0%

      60.0%
                                                                               Gastro- entorologist
      50.0%                                                                    ENT
      40.0%                                                                    Allergist
                                                                               Cosmetic Surgery
      30.0%
                                                                               Neurologist
      20.0%                                                                    Orthopedics
                                                                               Oncologist
      10.0%
                                                                               Cardiologist
        0.0%




     Ty d
          7

          4

          1

          9

          6

          8

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          2

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PA Ty

PA Ty

PA Ty

PA Ty

PA Ty

PA Ty

PA Ty



PA ssi
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PA




                                                            PATH Types



www.pathinstitute.com
Directing health practice to serve health priorities
                                              Health Plan Loyalty/Retention Index
                                            (membership length, satisfaction, intent to switch, intent to recommend)
                                     150
    Index of Loyalty (100=average)




                                            139
                                     140
                                                    131
                                     130

                                     120
                                                            109      108
                                     110
                                                                                                                       100
                                     100                                       97       96       96
                                                                                                          93      90
                                      90

                                      80
                                           PATH PATH PATH PATH PATH PATH PATH PATH PATH                                Total
                                           Type 4 Type 7 Type 6 Type 1 Type 5 Type 8 Type 2 Type 9 Type 3




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Directing health practice to serve health priorities
                                      Est. Medical Costs Per Adult by PATH Type
                                                 (N=51,000+, four health plan composite, adults)
                                  $9,000
     Average Projected Spending




                                           $8,457
                                  $8,500
                                                      $8,188
                                  $8,000

                                  $7,500                       $7,262
                                                                        $7,122
                                                                                 $6,936                                                  $7,000
                                  $7,000

                                                                                            $6,469
                                  $6,500                                                             $6,363 $6,358
                                                                                                                       $6,252
                                                                                                                                $6,124
                                  $6,000
                                                                    ed




                                                                                                                                        l
                                           4

                                                    7

                                                           9




                                                                                 6

                                                                                          3

                                                                                                     8

                                                                                                            1

                                                                                                                     2

                                                                                                                                5

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                                                                         Ty

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Directing health practice to serve health priorities
                                    Rx Reimbursements by PATH Type
                                                       N=13,296 Commerical Plan Members
                              20%                                                                $1,000
                              18%
                                                                                          %      $900
    % of adult population




                                                                                                          Average claim pmpy
                              16%                                                         PMPY
                              14%                                                                $800

                              12%
                                                                                                 $700
                              10%
                                                                                                 $600
                               8%
                               6%                                                                $500
                               4%
                                                                                                 $400
                               2%
                               0%                                                                $300
                                                  7


                                                  9


                                                  6


                                                  5


                                                  8




                                                  3


                                                  4


                                                  1


                                                  2
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                            PA


                                   PA


                                   PA


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                                    U




www.pathinstitute.com
Directing health practice to serve health priorities
HealthLeaders “Fact File” September, 2008




                                                       CDHP enrollees use
                                                         more services:
                                                          especially
                                                          diagnostic




www.pathinstitute.com
Directing health practice to serve health priorities
Disease Management & Health Outcomes, 2007

Parente, S., Christianson, J., & Feldman, R. (2007, August).
   Consumer-Directed Health Plans and the Chronically Ill.
   Disease Management & Health Outcomes, 15(4), 239-248.
    From Abstract:
           • CDHP enrollees with chronic illnesses assign higher ratings to
             their plan than do other CDHP enrollees (p < 0.07).
           • They are more likely than other CDHP enrollees to use
             informational tools (p < 0.05),
           • more likely to anticipate spending all of their savings account
             dollars (p < 0.05),
           • and more likely actually to spend more than the deductible
             (particularly for prescription drug expenditures [p < 0.05]).
           • Compared with other CDHP enrollees whose spending
             exceeds the deductible, enrollees with chronic illnesses spend
             significantly more on prescription drugs.


 www.pathinstitute.com
 Directing health practice to serve health priorities
HealthLeaders “Fact File” September, 2008




                                             Beginning recognition of cognitive
                                              impacts on health and demand
 www.pathinstitute.com
 Directing health practice to serve health priorities
                                                       Summary
      • CDH fails to understand health consumers
        Empowerment = management
        CDH primary focus = environment, not consumers
        SCT: health behavior is driven by many factors
        CDH ignores individual differences
        Path type psychology reveals UCS structure
        UCS patterns shape risk, demand
        CDH promise will require recognition of UCS
        CDH on verge!
        A focus on changing just three UCS


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Directing health practice to serve health priorities
                                 Questions/Comments


                                   Frederick H. Navarro
                                PATH Institute Corporation
                       Directing health practice to serve health priorities

                                              www.pathinstitute.com
                                                       fnavarro@pathinstite.com




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