1. THIRTEEN
COMMON PITFALLS
IN CONSUMER HEALTH ENGAGEMENT

3. WHEN WE SEE HEALTHCARE THROUGH
THE EYES OF THE CONSUMER...

4. TABLE OF CONTENTS
1 2 3 4 5 6 7

5. 8 9 10 11 12 13
LETTER TO OUR READERS
Those of us in healthcare have an awesome and inherent responsibility – the ability to support
others in living healthy lives.
And healthy living begins with healthy decisions. Whether it’s a decision to walk a few extra
steps each day, quit smoking, get a cancer screening or simply to take our medications as
prescribed – when we receive the right information at the right time, the right results often follow.
At Silverlink, we’re fortunate to have unique insights into the positive role that communications
can play in delivering the right health information at the right time. Every day, sometimes as
many as a million times a day, we communicate with consumers and support them in making
better decisions about their health. This is our passion!
Now, more than ever, we in healthcare need to re-learn how to reach people and engage them in
their health. In this book, we’ve compiled 13 common pitfalls that we often see in healthcare
communications. We hope it opens up a dialogue within your company, and ultimately, with
the healthcare consumer it is our privelege to serve.
George Van Antwerp Jan Berger, MD, MJ
GM, Pharmacy Solutions Chief Medical Officer
Silverlink Communications Silverlink Communications
Enabling Healthy Decisions Blog jan.berger@silverlink.com
Twitter: @gvanantwerp

6. “If you can’t measure it,
you can’t manage it.”
Specific
- The Balanced Scorecard by
Kaplan and Norton
Measurable
Attainable
Relevant
Timely

7. ONE
Pitfall: Not knowing how to declare success
Before you start a health engagement program, do you know what
outcome you are aiming for? That has to be step one.
Traditionally, marketers have struggled with measurement and how to
calculate the ROI (return on investment) of programs. The first step in
creating a communications program is to understand objectives and
how we will define and measure success. One measurement framework
we often begin with is SMART.

8. “The best way to drive loyalty is to
create consistently compelling
and authentic experiences.”
- Paul Adams, Think Outside-In Blog
http://www.thinkoutsidein.com/blog/about/

9. TWO
Pitfall: Limiting design based on company constraints
One mistake we’ve all made is designing outreach based on what is easy
to deliver. Instead, we need to put ourselves in the consumer’s shoes and
think about serving up great experiences. We need to assess the trade-offs
between ease of implementation and consumer experience as an important
design step.
To understand what the consumer will see and feel, ask yourself: When will
the message be received? How will it be interpreted? Is it easy to respond?
What questions will it create? And don’t forget, there’s not a perfect answer.

10. “Health literacy is about mutual understanding. Providers
(or anyone on the giving end of health communication)
and patients (or anyone on the receiving end of this
communication) each need to communicate in ways
the other can understand.”
- Helen Osborne, President, Health Literacy Consulting

11. THREE
Pitfall: Forgetting about health literacy
The majority of adults in this country have basic or below basic health literacy
skills. If you add in the complexity of our healthcare system, we have a
major communications challenge. Patients don’t always understand
provider’s instructions. As a result, they may have trouble sifting through
health information in order to take appropriate action. And often, patients
don’t know who to ask for help.
Take health literacy to heart. Help your patients understand by making sure
that all your health messages are clear, simple, and easy to follow.

12. “We have an expensive plethora of uncoordinated,
unlinked, economically segregated, operationally
limited micro systems, each interacting in ways
that too often create suboptimal performance.”
- George Halvorson, Chairman & CEO, Kaiser Permanente as
cited in “Why Now is the Time to Enact Health Care Reform.”

13. FOUR
Pitfall: Not understanding the entire process
A lot of times, we solve for one problem without fully understanding the
implications both upstream and downstream. Unless we understand
everything from the initial query through final outcomes along with all
of the steps in-between, it’s almost impossible to optimize engagement.
Don’t get stuck in your silo. Walk through the process as if your mother or
father or neighbor was experiencing it. Does it work? Where are the points
of conflict or confusion? Then think about what can be improved to make
the process seamless for the consumer.

14. “I was shocked to
learn there were 337
languages spoken in
America today. How
can I be the voice
of the customer if I
only know two and
only have one set of
experiences? People
are different. Ask
them. They love to
tell you why.”
- Ingrid Lindberg, Chief
Experience Officer, Cigna
Corporation

15. FIVE
Pitfall: Thinking you represent the consumer
“I would never do that.” Have you said that before? Of course. It’s an easy
pitfall. You think that you represent the people you are trying to influence.
Generally…you don’t.
We often ignore facts and instead base decisions on our own experiences.
In designing engagement programs, ignore your opinions and try to see
healthcare through the eyes of the consumer. Does the communication fit
within a consumer’s personal framework? Remember that marketing, like
treatment, needs to be evidence-based.

16. “Too many consumers make healthcare
decisions by looking through their windshield.
Appearance and proximity win if messaging
isn’t personalized.”
- Rob Webb, CEO of OptumHealth, from 8th Annual World
Healthcare Conference in Washington DC on 4/4/11

17. SIX
Pitfall: Creating generalized strategies
Have you ever received a ‘Dear Resident’ letter? Does it make you want
to engage? Of course not. We want to be important. We want people to
understand our needs.
Health is very personal. We need to personalize every communication
and make our outreach as timely and relevant as possible. To avoid being
“just another outreach,” use segmentation and personalization to create
passionate consumers.

18. “Health is a very emotional subject and
emotional decisions aren’t always
rational. We can convince ourselves
that we’ll quit smoking, eat better, or
workout ‘tomorrow’.”
- Peter Hayes, Healthcare Consultant, Principal
Healthcare Solutions

19. SEVEN
Pitfall: Assuming people are logical
Behavioral economics teaches us that people aren’t always logical and can
make irrational decisions. We react twice as strongly to a $100 loss than to
a $100 savings. We overestimate the likelihood of winning even though we
know the odds. And placebos work even when we know they are placebos!
So, as we design our outreach, we should understand the powerful tools
that behavioral science has to offer – nudges, social norm messaging,
active choice, and other core principles.

20. “Incentives are there
to shape specific
behaviors for a
specific group of
individuals. Thus it
is critical to think
about and design
the frequency, intensity
and duration of the
incentives to fit with
the desired behavior.”
- Lee Borlo and Joshua
Klapow, Ph.D. as cited in
“Using Employee Incentives
to Drive Wellness Programs.”
The World at Work, the Total
Rewards Association.

21. EIGHT
Pitfall: Forgetting about the ‘why’
Another aspect in designing health engagement programs is to understand
WIIFM (What’s In It For Me – with ‘me’ being the consumer). Sometimes,
the value proposition is clear and immediate. Other times, there is a delay
between action and reward.
One strategy to consider is the use of incentives. These can be carrots,
sticks, or intrinsic motivation. For example, we’ve even had a client give away
haircuts in a successful blood pressure program. There are lots of options,
but – incentives need to be tailored to the audience and the action.

22. “The local “ecology”
of health care—local
capacity, local social
norms and the current
payment environment—
profoundly influences
clinical decisions.”
- The Dartmouth Institute Brief:
Health Care Spending, Quality,
and Outcomes, 2/27/09

23. NINE
Pitfall: Not going local
Location…location…location. The local health environment is important to
understand. That means understanding the patient-physician relationship
and also the environment, and patterns of behavior and culture within the
local community.
This becomes critical in designing solutions. What branding do you use?
What tone? What incentives? What voice will resonate? Don’t make the
mistake that many multi-national companies make when they take a US
strategy abroad. Get local.

24. “People’s appetite for behavioral data is so big today
that there’s a danger of abuse. So design your study
carefully - if you do it right, it’s gold.”
- Kinney Zalesne, New York Times Best Selling Co-author, Microtrends

25. TEN
Pitfall: Blindly trusting survey data
We love survey data. But we have to be careful. Sometimes people don’t
know what they don’t know, and not every survey is of equal quality. And,
attitudinal responses can vary from actual behavior, especially in healthcare
where consumers say one thing but do another.
We need to carefully craft our research and experiments. In some cases,
it is valuable to get into the field and augment our attitudinal research
with observations and ethnographic research.

26. “We randomly assign people to placebos in cancer trials.
Surely, we can assign people to no intervention in a
marketing campaign.”
- Tom Davenport, President’s Distinguished Professor of Information
Technology & Management, Babson College; Best-selling author, Competing
on Analytics; Analytics at Work: Smarter Decisions, Better Results

27. ELEVEN
Pitfall: Not assigning a control group
The downside of data is that it can be misleading if you misunderstand
it. What does the data tell you? Does it indicate correlation or causality?
Is your sample size statistically valid? Do you have a randomly assigned
control group?
To really understand what works, you have to create a “champion”
intervention process and continually test “challengers” against it. To
succeed, you need to isolate variables to understand what impact each
has. And, never sit on your laurels. There is always room to improve.

28. “Good fortune is
what happens when
opportunity meets
with planning.”
- Thomas Edison

29. TWELVE
Pitfall: Not planning for scale
We’ve all been part of a project that works well for a pilot and then fails
when we try to launch it nationally. Why does this happen? We don’t plan
for scalability.
Post-hospital discharge is a great example of outreach that works at a
smaller scale. If we want to reach all recently discharged patients in a
timely manner, we need to think about augmenting nurses with technology.
When you think about your programs at scale, automate where possible.

30. “To move from today’s
one-off approach to
a more integrated
model, plans will
need to beef up
member profile data,
create cross-channel
oversight, and take
metrics to a new
level of granularity.”
- Elizabeth Boehm, Principal
Analyst, Forrester Research

31. THIRTEEN
Pitfall: Not integrating across channels
As you design communications, there are numerous ways to reach and
engage consumers. What channels can you use? How do you escalate
between channels? What’s the sequencing? And what are the variations
that are channel specific (voice, fonts, and branding, are a few).
The consumer sees all your outreach as a single brand. So be consistent,
emphasizing your brand and a passion for engagement. And, make sure
to build on each successful engagement. Learn what works, and seamlessly
move from one mode to the other.

32. At Silverlink, we get that health and healthcare costs – which are enormous, both in size and
significance – are actually the sum of millions of individual decisions. When one person decides
to smoke, another gets a cancer screening, a third abandons diabetes medication – these are
the individual behaviors that taken together make up the state of our nation’s health and the
costs associated with it.
That is why, when Silverlink set out to transform healthcare, we went right to the individual.
Our entire focus, our mission, and our method are about helping our clients move individual
people in small, healthier ways – the cumulative effect of which can save millions of lives
and billions of dollars.
To learn more about what makes Silverlink the leader in consumer health engagement, please
visit www.silverlink.com, email info@silverlink.com, or call 1.781.425.5700.