Beyond Awareness: Using Audience Insights to Better Plan for and Facilitate Behavior Change Among...

© 2016 Enroll America | StateOfEnrollment.org

COVER MISSOURI COALITION | 05.12.16

Beyond Awareness: Using Audience Insights to Facilitate Behavior Change Among Late Adopters


Who We Are



Audience insights

Changing behavior

Building a responsive communications plan

CAC story: Removing barriers for the Hispanic/Latino community

Health insurance literacy and motivation

Agenda


Audience insights



State of Enrollment – The Challenges We Face

AUDIENCE INSIGHTS

Shift from general awareness to targeted outreach

Complexity of audience backgrounds

Fluctuating state of healthcare (real and perceived)

Conflicting messages

Potential uncertainty, need for clarity


Remaining uninsured

AUDIENCE INSIGHTS

Percentage of Uninsured U.S. Adults, by Subgroup(Q1, 2016 – Gallup-Healthways Well-Being Index)

Q4 2013 %

Q1 2016 %

Change %

National adults 17.1 11.0 6.1

18 to 25 23.5 14.8 8.7

26 to 34 28.2 18.5 9.7

35 to 64 18.0 10.7 7.3

65+ 2.0 1.6 .4Whites 11.9 6.4 5.5

Blacks 20.9 11.4 9.5

Hispanics 38.7 28.3 10.4

Less than $36,000 30.7 20.0 10.7

$36,000 to $89,999 11.7 8.2 3.5

$90,000+ 5.8 2.9 2.9


The uninsured and eligible for Medicaid or CHIP are likely to be poor, a person of color and working

AUDIENCE INSIGHTS

NOTES: Numbers may not sum to subtotals or 100% due to rounding.SOURCE: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion decisions as of January 2016 and 2015 Current Population Survey data.

Distribution by Income:

Distribution by Race / Ethnicity:

Distributionby Family Worker Status:

Uninsured and Eligible for Medicaid and CHIP = 8.8 Million

200%+ FPL 18%

100-199%FPL 32% Below

Poverty51%

Hispanic31%

White 43%

Black16%

Other Non-Hispanic 10%

At least one

Full-Time Worker in Family 57%

Only Part-Time Workers In Family 17%

No Workers in Family

26%


Reasons For Being Uninsured Among Uninsured Adults, Fall 2014

AUDIENCE INSIGHTS

NOTES: Includes uninsured adults ages 19-64.SOURCE: 2014 Kaiser Survey of Low-Income Americans and the ACA.

When asked in their own words, the remaining uninsured said that the main reason they were without insurance was…

48%

6%

3%

3%

7%

6%

12%

4%

12%

Too expensive

Don’t need it

Opposed to the ACA/Prefer to pay penalty

Don’t know how to get it

Immigration Status

Told they were ineligible

Unemployed/Work doesn’t offer/Not eligible at work

Don’t know/refused

Other reason


Why uninsured?

AUDIENCE INSIGHTS

Fine can be cheaper than premiums

At some point told they were ineligible

Opposed to the “mandate”

Fear about submitting application due to mixed immigration status


Changing behavior



Using audience insights in building a responsive

communications plan

CHANGING BEHAVIOR

Now, it’s about more than awareness – it’s

about facilitating change in behavior


CHANGING BEHAVIOR

Behavior happens when three elements come together at the same moment.

B =BEHAVIOR

Desire or willingness to do something

MMOTIVATION

Having the means or skill to

do something

AABILITY

Influence which causes

an action

TTRIGGER

Based on the work of Dr. BJ Fogg, Stanford University


Were youprompted to do it at theright timeand in theright way?

CHANGING BEHAVIOR

In other words,

B =BEHAVIOR

Do you want to do it?

MMOTIVATION

Do you have the ability to

do it?

ABILITY

TTRIGGER

A



CHANGING BEHAVIOR

B =BEHAVIOR

MMOTIVATION ABILITY

TTRIGGER

All three must be present to create a desired behavior.

A



Building a responsive communications plan



BUILDING A RESPONSIVE COMMUNICATIONS PLAN

Triggers

Also known as: cues, prompts, calls to action, requests

Triggers can lead to a chain of desired behaviors

Heavily dependent upon timing – right place, right time



Motivation curve

TRIGGERSSUCCEED

TRIGGERS FAIL

MO

TIVA

TIO

N

ABILITY

LOW

HIG

H

HARD EASY




Motivation curve

MO

TIVA

TIO

N

ABILITY

LOW

HIG

H

HARD EASY

1

2

3

FACILITATORHigh motivation, Low ability

SPARKLow motivation,

High ability

SIGNALHigh motivation,

High ability




For example…

MO

TIVA

TIO

N

ABILITY

LOW

HIG

H

HARD EASY

TACTIC:Instead of creating your own event that she has to find time to attend, seek to meet her where she is. Attend a presentation with a group she meets with regularly already (playgroup, booster club, etc.) with assisters on hand to answer questions.

DESIRED BEHAVIOR: Will a 34-year old mom come to my enrollment event?

M

A

T

She knows she is required to have insurance and has a lot of questions HIGH

Her schedule is hectic and she feels it’s one more thing she has to try and fit in

LOW

TYPE OF TRIGGER: FACILITATOR Seek to increase ability by making the task simpler



For example…

MO

TIVA

TIO

N

ABILITY

LOW

HIG

H

HARD EASY

TACTIC:Provide free food to entice him to the event; Partner with educators and advisers to offer incentives for attending the event and learning more

Is healthy and thinks he doesn’t need health insurance LOW

An event is taking place on campus to educate and enroll graduate students

HIGH

TYPE OF TRIGGER: SPARK Increase motivation by prompting people to take actions that they wouldn’t otherwise intend to take

DESIRED BEHAVIOR: Will a 26-year old graduate student come to my enrollment event?

M

A

T



Take baby steps

Effective triggers for a small behavior can lead people to perform harder behaviors.

What triggers can you put in the consumer’s path to get to the next step?

Step 2

Step 3

Step 1

MEETING

Learns about Marketplace, has immediate access to assister to ask questions

APPOINTMENT

Schedules appointment with assister to look at options when it’s convenient for her

SIGN UP

Schedules follow-up session with assister to sign up and GETS COVERED!


Step 2

Step 3

Step 1

BEHAVIOR CHANGE EXERCISE

Let’s practice!ActivityBreak into groups of 3-45 minutes to discuss5 minutes to report

Define desired behavior.

Remember – think in baby steps!

Assess consumer’s motivation and ability.

List triggers you can use to increase low motivation or ability and prompt them to do desired behavior.

What tells them to “do it now”?


ID best times and places to reach them

Define the behavior you

want your audience to do

CHANGING BEHAVIOR

B =BEHAVIOR

MMOTIVATION

AABILITY

Reach people when motivation

is high

Make target behavior easier

to do

Offer the right resources;

Connect people to in-person help;

Follow up

ID steps they need to take to get there

TTRIGGER

Offer ways for consumers to easily

perform desired behavior

Plan outreach activities that

are responsive to motivation

and ability

Putting it all together



CHANGING BEHAVIOR

Remember…

Learn how much they can save? ► Cost calculator (via healthcare.gov)

Find/schedule in-person help?► Searchable database by ZIP code (via healthcare.gov)► Bringing assisters to presentations/outreach events

Find information?► Multichannel presence online and offline (social media, community

partnerships, mix of paid and earned media)

Attend a meeting? ► Go where they are instead of creating standalone events

Share information?► One-click social share buttons► Having extra printed materials► Connecting with network of community partners

THINK IN BABY STEPS:

Big leaps almost always fail. What triggers can you put in the consumer’s path to get to the next step?

SEEK TO SIMPLIFY:

Easier to affect ability than motivation. Focus first on making tasks easier. Is it easy for consumers to:

DEFINE YOUR AUDIENCE AND WEAR THEIR SHOES:

Know who you need to reach and think about the barriers they face to get covered. Decide how to remove those barriers.


Removing barriers for Hispanics & Latinos



HISPANIC/LATINO BARRIERS TO GETTING COVERED

BARRIERS AFFECTING ABILITYA

BARRIERS AFFECTING MOTIVATIONM

Language

Lower levels of education and literacy

Limited time because of work, family

Decreased emphasis on preventive care

Fear because of mixed immigration statuses

Unfamiliarity and misinformation


REMOVING BARRIERS LIMITING ABILITY

For example…

MO

TIVA

TIO

N

ABILITY

LOW

HIG

H

HARD EASY

What tactics would you use to overcome these barriers and increase ability to connect to reliable information?

DESIRED BEHAVIOR: Get reliable information so they can understand what’s required, the benefits of being covered and where they can go for help.

T TYPE OF TRIGGER: FACILITATOR Seek to increase ability by making the task simpler

ALow or no ability to speak, understand EnglishLower levels of education and literacyTime is limited because they tend to work a lot and spend free time with family


REMOVING BARRIERS LIMITING MOTIVATION

For example…

MO

TIVA

TIO

N

ABILITY

LOW

HIG

H

HARD EASY

What tactics would you use to overcome these barriers and increase ability to connect to reliable information?

Decreased emphasis on preventive careFear because of mixed immigration statusesUnfamiliarity and misinformation

TYPE OF TRIGGER: SPARK Increase motivation by prompting people to take actions that they wouldn’t otherwise intend to take

M

T

DESIRED BEHAVIOR: Get reliable information so they can understand what’s required, the benefits of being covered and where they can go for help.


OUR TRIGGER: WEEKLY RADIO SHOW EN ESPAÑOL

Boletín de Acción Comunitaria(Community Action Bulletin)

• Meet them where they are• Speak in their native language• Share timely information in a

culturally relevant way • Speak peer-to-peer


Language Entirely in Spanish; On Spanish language station

Lower levels of education and literacy

Certified assister is host of the program.

Limited time because of work, family Can listen wherever they are, even at work

Decreased emphasis on preventive care Focus on benefits, unforeseen costs

Fear because of mixed immigration statuses Clarity provided by peer

Unfamiliarity and misinformation Weekly timing provides info on ongoing basis

BROADCASTING TO REMOVE BARRIERS

A

A

A

M

M

M


Health insurance literacy and motivation



HEALTH INSURANCE LITERACY AND MOTIVATION

Your role as an assister

People are better persuaded by the reasons they themselves discovered, than those that come

from the minds of others.

‒ Blaise Pascal



Your role as an assister

Create a supportive environment:You can create an environment where change can occur ‒ helping consumers realize their motivation and achieve their goals

Be an advocate:You can empower consumers to make positive decisions about health and health insurance



Strategies to create health-literate messages

70%

use “HealthCare.gov” instead of “Health

Insurance Marketplace”

50%

use “fee” instead of “penalty” or

“individual shared responsibility

payment”

100%

use “doctor” instead of “primary care provider” or

“health care professional”

70%

use “financial help” instead of “tax credits”

Use consumers’ words:Use simple, everyday languageExplain need-to-know words




Instructions 1. Replace each

difficult word with a common word.

2. Give a simple explanation for need-to-know words that can’t easily be replaced.

Difficult word Common word or explanation

Annually

Eligible

Co-payment

Reimburse

Utilize

Specialist

Excluded services

Yearly, each year

Qualify, able

A fixed amount you pay at the time you get a health care service

A doctor who gives health care for a specific medical problem

Use

Pay back, refund

Health care services that are not covered and not paid for by your insurance plan




Give clear action stepsFocus on what the consumer needs to do

Example: is my doctor in-network?

1 Get your insurance card 2 Call your

insurance company at the number on your card

3 Ask if your doctor is in your network



Strategies to motivate consumers

To be an advocate: Be accepting

Help clarify goals

Avoid arguing and confrontation

Support their ability to change

Affirm strengths, accomplishments, and efforts to change




To motivate someone to action, find out what motivates them




What do you know about HealthCare.gov?

How are you currently getting health care?

You know your situation best. What do you see as your biggest barrier?

To get consumers to talk, ask open-ended questions, which:

Usually start with “what,” “who,” or “how”

Invite descriptive, informational answers



It sounds like you are feeling…Reflect their feelings

Listen to what the consumer is saying

Identify the underlying emotion

Verbally reflect the emotion

Reinforce any statements they made about taking a positive health behavior

I understand you are having trouble with…




I can tell you really care about your health.Examples of reflecting feelings:

“I go for long walks everyday. I eat my fruits and vegetables. I feel like I’m doing everything right, so I don’t need health insurance. I’m not happy about having to pay for health insurance or pay a fee!”

“There’s just so much to think about. I’m afraid I’ll make the wrong decision.”

It’s clear to me that this is hard for you but also very important to you.




What I’m hearing is…Summarize what the consumer has said

Gather together what has already been said

Make sure you understand their thoughts and actions

Prepare the consumer to move onIt sounds like you’re saying…




It sounds like you’re having some trouble with your application. Example of summarizing

Consumer: “I’ve tried to enroll on HealthCare.gov on my own and kept getting an error message. The call center didn’t help me.”

Let’s see how I can help you.



Step 2

Step 3

Step 1


Let’s practice!

ActivityBreak into groups of 31 assister, 1 consumer, and 1 observer

Assister: Asks an open-ended question to get the consumer to talk about a problem

Consumer: Talks for 1 minute to answer the question

Observer: Keeps time for 1 minute

Assister: Reflects feelings using statements, not questions

Consumer: Clarifies if the assister didn’t reflect your message correctly

Observer: Checks to make sure the assister only reflects – no questions are asked

Assister: Summarizes what was said and prepares to move on


Final thoughts



FINAL THOUGHTS

Tips to remember…

Always know your consumer and think about the process of getting covered from their POV

Plan your communications activities around identifying and removing or reducing barriers

Ask what you can do to make each step in the process easier

Focus on baby steps for long-term change

Guide people in creating structured behavior – they rarely know how or what to do without help

Trust that tiny habits grow naturally – one success leads to another success


FINAL THOUGHTS

Tips to remember…

Next time you work with a consumer:

Use everyday words

Give clear action steps

Ask open-ended questions

Reflect feelings to acknowledge the consumer’s emotions

Summarize what the consumer said


2 31

TO LEARN MORE

Resources

BJ FOGG’S BEHAVIOR CHANGE MODEL

http://www.behaviormodel.org/

COVER MISSOURI ASSISTER GUIDE

COVER MISSOURI YOUTUBE

https://www.youtube.com/ CoverMissouri


U

Contact Us

Tony Zagora, [email protected]

Brandy Geers, [email protected]

Diane Webb, Health Literacy [email protected]

Gustavo Valdez, [email protected]

mailto:[email protected]




Beyond Awareness: Using Audience Insights to Better Plan for and Facilitate Behavior Change Among...

Healthcare

Transcript of Beyond Awareness: Using Audience Insights to Better Plan for and Facilitate Behavior Change Among...