Brian Dolan, Rally Health’s chief strategy and partner integration officer, knows the value of a good story. This makes sense: His nearly 30-year career has covered many facets of the healthcare industry, from finance to employer coverage and clinical program development. For the last 10 years he has been focused on cracking the code of better provider and patient engagement. During this journey he has become convinced of the importance of focusing on the human element. And nothing’s more human than a good story, right?
At a recent panel appearance at the Wharton School of Business on the topic of “Helping Consumers Better Navigate the Healthcare System,” Dolan got to tell one of his favorites. “I dropped the Fried Chicken Man story on them,” he says. “It highlights the failure of the current healthcare system to understand the importance of a truly personalized engagement strategy. It never fails. Once people pause and contemplate whether the system accounts for ‘personal’ interests, concerns, and preferences, they begin to understand what’s missing.”
The Fried Chicken Man (a true story)
Dolan stumbled upon his personal “aha” moment when speaking with a nurse who was on the frontlines of patient engagement nearly 10 years ago. “The ‘Fried Chicken Man’ was somebody who had been cycling through the healthcare system a long time,” Dolan explains. “And through the lens of the healthcare machine, he was tagged as a high-cost, high-risk individual with several chronic conditions. This particular individual was dealing with diabetes, high blood pressure, and heart disease. On top of that he smoked and was obese. From a predictive-modeling standpoint, it wasn’t a matter of whether something bad was likely to happen, it was a matter of when. Clinical researchers had already written the story, based on thousands of people with similar clinical profiles.
“The traditional approach to helping patients with chronic conditions typically involves some combination of raising awareness, education, and support in navigating the system, largely based on what they ‘know’ about you. In short, we tell people what they’ve already been told by their doctor: That they need to change how they live their lives. Can you imagine why this wouldn’t work well? Can you imagine any other consumer experience where someone tells you what you need without first asking, ‘How can I help you?’”
In typical American healthcare fashion, Dolan says, this man met with a variety of doctors for 10-15 minutes a few times a year and was told the same things over and over: He needed to take his medications, lose weight, exercise, and quit smoking. “But this individual had not yet reached his ‘moment of need,’” Dolan says. “Unfortunately, that’s one of the challenges of engaging people in making better daily health decisions. The feedback loop between daily behavior and failing health is long. People don’t see the need to make better decisions until something goes wrong. So it was falling on deaf ears.”
“If you look at the way the existing healthcare system is designed,” he continues, “it’s obvious that it’s been designed to fail. We treat healthcare in this very episodic way, where you go see a doctor when something is wrong, and in the course of meeting with your doctor for maybe 10 minutes once or twice a year, we expect that’s going to change your life for the other 364 days. It’s just a flawed system.”
This suggests why the Fried Chicken Man wasn’t showing any improvement, despite years of treatment: The system saw him as a collection of risk data, not as a person.
“Instead of treating people as individuals,” Dolan says, “companies gather claims data, and they put you into a risk bucket — you’re a diabetic with high blood pressure, or whatever the case may be. And then they treat all those people the same way. Their recommendations are not personalized, they’re based on that clinical diagnosis, and they miss everything else, because they don’t ask about it.”
Things turned around for the man when a nurse well-trained in behavior modification got him on the phone. “She went through the usual process with this individual, and he told her up front, ‘Stop wasting your time, stop wasting my time.’ And finally she said, ‘Maybe you’re right, maybe there’s nothing I can tell you.’ And then she asked, ‘Is there something you’d like to tell me?’”
“This was such a profound moment,” Dolan says. In all his years of treatment, no one had ever asked this man what he was interested in or concerned about. “Why is that always the last course of action?” asks Dolan.
It turned out that yes, there was something this man was concerned about. “We learned that the only thing he enjoyed in life anymore — the only pleasure he had left — was eating fried chicken.” But the man’s health had deteriorated to the point where even that was at risk. “When he’d eat fried chicken, the next morning he’d wake up and not feel so good. The fried chicken was affecting his blood pressure, his glucose levels, and so on, but he couldn’t connect those dots.”
So when the nurse asked him if he was ready to try something different, it turned out he was, if only to get back to a place where he could eat fried chicken again. “That’s what opened the door for him,” Dolan says.
“Think about that,” he continues. “In any other industry, any other transaction, any store or business you walk into, what’s the first thing they ask you? ‘How can I help you?’ But in healthcare, it’s the last thing.” And as Dolan points out, research shows that 70 to 80 percent of healthcare expenses are related to patient behavior. “But we never ask the patient what they’re doing. We never ask, ‘If you knew you were at risk of blankety-blank, would you be willing to change your behavior?’ We never get to that dialogue.”
The problem as Dolan sees it is that the traditional healthcare system fails at the most important point: patient engagement. “The way health plans ‘engage’ their members is to send them stuff in the mail saying ‘You’re a diabetic, do you need help?’ People don’t respond to that. No one reads their mail anymore. It’s a waste of time and money. Or they get called during dinner, when the last thing people want is to pick up a 1-800, ‘I’m from your health plan’ phone call. So the ‘success rate’ in reaching people is less than 20 percent, and a response rate of 16 percent is considered ‘winning.’ So it’s very expensive, it’s wildly ineffective, and the best-case scenario is you’re getting somebody to speak to a nurse maybe four or six times a year.”
A different approach
Dolan joined Rally® in 2012. Even though it was a far-from-certain startup run by Grant Verstandig, a 20-something first-time founder and CEO, he was excited by the possibilities.
“Rally understands the need for an approach to healthcare that treats people as individuals,” Dolan says. “When I first met Grant his consumer approach to healthcare resonated with my own personal beliefs, based on my almost 30 years working in healthcare.”
What makes Rally different is a user-centered approach to everything. Dolan points to Rally’s Health Survey, which for most users is the starting point of their Rally experience. “We get to know people as individuals. We ask them: Are you making healthy nutritional choices? What are you doing about emotional stress management in terms of sleep, or things such as that? Do you need to access preventive care to identify an early risk? At traditional healthcare companies, that’s nowhere in the script.”
At Rally, “We learn what they’re interested in and concerned about,” he says. “We couple that with our clinical information, and therefore we have a much better chance of helping them form healthier habits. When you lead with what somebody’s already told you they’re interested in,” Dolan says, “odds are you’re going to get a better response rate.”
Summing up his message to the crowd that day at Wharton, Dolan says, “If 80 percent of healthcare costs results from daily behavior, then you have to design the system to have an ongoing relationship with the consumer. If it’s not designed around the consumer, and it’s not there for daily support, it’s a flawed system and it won’t fix the problem. Rally finds sustainable solutions to help people get the care they need more proactively, and forming behavior patterns that will lead to a healthier, more productive lifestyle. And that’s pretty awesome.”