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

Cognitive and Behavioral Patterns of Thinking and Action: Health Personas Driving Consumer Preferences and Health Care Demand Frederick H. Navarro PATH Institute Corporation

% of US Adults 20.0% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Type 1 Consumer Subtype Prevalences and Spending U.S. Adult Population (210 million) $29 Type 4 % Size Spending $93 Type 2 $112 Type 6 $130 $138 $139 Type 8 Type 9 Type 5 $157 $162 Unassigned Type 7 $245 Type 3 $250 $300 $250 $200 $150 $100 $50 $0 Billions Per Year

HealthLeaders Fact File December, 2006 exercise

Social Cognitive Theory Albert Bandera Individual as active participant Triadic reciprocality

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

Environmental factors

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

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

Cognitive examples Family members responsible for their own health Visited pediatrician in past year (adults with children, N=36,877) 45.0% 40.0% 39.7% % Yes 35.0% 30.0% 25.0% 20.0% 24.7% 15.0% 10.0% 9.4% 7.6% 6.3% 5.0% 0.0% Strongly disagree Somewhat disagree Neither Somewhat agree Strongly agree Family responsible for own health

Cognitive examples Family members responsible for their own health Total average claims $3,500,000 $3,000,000 $2,500,000 $2,000,000 $1,500,000 $1,000,000 $500,000 Dependent Claims (N=2,201 adults with at least one dependent claim) $2.3 million Rx MD Hosp $- Strongly disagree Somewhat disagree Neither Somewhat agree Strongly agree Family members take care of own health

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

Cognitive examples Only deal with health problems when they come up Statement: Deal with health only when problems come up Response Count Rx claims Prof_claims Inpatient claims Total 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

Cognitive examples Only deal with health problems when they come up Count "Deal with health only when problems come up" 3500 3000 2500 2000 1500 1000 500 2948 1930 $19.3 million 1647 1016 756 $28,000,000 $23,000,000 $18,000,000 $13,000,000 $8,000,000 Total Spending 0 $3,000,000 strongly disagree somewhat disagree somehwat agree neither strongly agree Count Total Demand

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

Path type Cognitive interactive patterns Health psycho-social domain Perceptions, preferences, priorities Self Family Health care environment

Focus on physical fitness Focus on nutritional fitness Commitment to the health of family members Tendency to put off seeking health care Degree of active healthcare information seeking and review Confidence in medical professionals to do the right thing Independent use of alternatives to medicine Planning for future health benefits Attentiveness to healthcare advertising Willingness to pay more for quality Concern with saving healthcare dollars Cognitive factors

Unconscious cognitive structure (UCS) 5.00 4.50 4.00 3.50 3.00 2.50 2.00 1.50 1.00 PATH Type 2 UCS 5 = Strongly agree do not seek care avoid care due to expense family takes care of health satisfiied with average family h... I like to decide about family health active competitive sports top physical shape very involved in my health use vitamins, herbs instead of... seek nutrition diet information do what parents did take things as they come info to choose options compare hospitals I count on others other makes family health deci... I make own decisions tried to save money shop more by price pay for high quality never use low priced doctor not worried about advertised se... pay attention to ads doctors nurses not good doctors don't know side effects path type measures

Unconscious cognitive structure (UCS) 5.00 4.50 4.00 3.50 3.00 2.50 2.00 1.50 1.00 PATH Type 3 UCS 5 = Strongly agree do not seek care avoid care due to expense family takes care of health satisfiied with average family he... I like to decide about family health active competitive sports top physical shape very involved in my health use vitamins, herbs instead of... seek nutrition diet information do what parents did take things as they come info to choose options compare hospitals I count on others other makes family health deci... I make own decisions tried to save money shop more by price pay for high quality never use low priced doctor not worried about advertised se... pay attention to ads doctors nurses not good doctors don't know side effects path type measures

Unconscious cognitive structure (UCS) 5.00 4.50 4.00 3.50 3.00 2.50 2.00 1.50 1.00 PATH Type 7 UCS 5 = strongly agree do not seek care avoid care due to expense family takes care of health satisfiied with average family he... I like to decide about family health active competitive sports top physical shape very involved in my health use vitamins, herbs instead of d... seek nutrition diet information do what parents did take things as they come info to choose options compare hospitals I count on others other makes family health decis... I make own decisions tried to save money shop more by price pay for high quality never use low priced doctor not worried about advertised se... pay attention to ads doctors nurses not good doctors don't know side effects path type measures

Unconscious cognitive structure (UCS) 5.00 4.50 4.00 3.50 3.00 2.50 2.00 1.50 1.00 PATH Type 7 and PATH Type 8 5 = strongly agree do not seek care avoid care due to expense family takes care of health satisfiied with average family health I like to decide about family health active competitive sports top physical shape very involved in my health use vitamins, herbs instead of drugs seek nutrition diet information do what parents did take things as they come info to choose options compare hospitals I count on others other makes family health decisions I make own decisions tried to save money shop more by price pay for high quality never use low priced doctor not worried about advertised ser... pay attention to ads doctors nurses not good doctors don't know side effects path type measures

Cognitive/ psychological view of person

Dynamics within person Cognitions that shape perception = sub type

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

Multipe Response 400% 350% 300% 250% 200% 150% 100% 50% 0% Wellness Activities by PATH Type PATH Type 8 PATH Type 7 PATH Type 9 PATH Type 6 PATH Type 4 PATH Type 5 PATH Type 3 PATH Type 1 Unassigned PATH Type 2 Health Screening Routine Physical Attended Health Ed Class Attended Wellness/ Fitness class I am very involved in my health (Strongly Agree) I don't plan ahead, I deal with health issues when they come up (Strongly Disagree) Only seek care when really sick or injured (Strongly Disagree) Attention to Nutrition & Healthy Diet (Strongly Agree) Active or Competitive sports (Strongly Agree) Exercise 4+ days per week

Health Risk Conditions and PATH Types Sach/Scarborough HealthPlus, 2001, N=93,400 % exceed 100 due to multiple response 350% 300% 250% 200% 150% 100% 50% 0% PATH Type 2 PATH Type 4 PATH Type 9 PATH Type 7 PATH Type 1 PATH Type 5 PATH Type 3 PATH Type 6 PATH Type 8 Poor attention to nutrition Low physical activity Migraines Weight Problem Chronic back pain Depression Smoking (4+ days per week Sleeping Problems High Cholesterol Hypertension

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% 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% PATH Type 7 PATH Type 4 PATH Type 9 PATH Type 3 PATH Type 6 PATH Type 1 PATH Type 5 PATH Type 2 PATH Type 8 Dermatitis Osteoporosis Respiratory conditions Arthritis/ rhematism Alzheimer's Chronic Allergies Heart Disease All Cancers Skin Cancer Breast Cancer Kidney Disease

Specialty Care Demand 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Gastro- entorologist ENT Allergist Cosmetic Surgery Neurologist Orthopedics Oncologist Cardiologist PATH Type 7 PATH Type 4 PATH Type 1 PATH Type 9 PATH Type 6 PATH Type 8 PATH Type 3 PATH Type 5 Unassigned PATH Type 2 Total PATH Types

Health Plan Loyalty/Retention Index (membership length, satisfaction, intent to switch, intent to recommend) 150 Index of Loyalty (100=average) 140 130 120 110 100 90 139 131 109 108 97 96 96 93 90 100 80 PATH Type 4 PATH Type 7 PATH Type 6 PATH Type 1 PATH Type 5 PATH Type 8 PATH Type 2 PATH Type 9 PATH Type 3 Total

$9,000 Est. Medical Costs Per Adult by PATH Type (N=51,000+, four health plan composite, adults) Average Projected Spending $8,500 $8,000 $7,500 $7,000 $6,500 $8,457 $8,188 $7,262 $7,122 $6,936 $6,469 $6,363 $6,358 $7,000 $6,252 $6,124 $6,000 Type 4 Type 7 Type 9 Unassigned Type 6 Type 3 Type 8 Type 1 Type 2 Type 5 Total

Rx Reimbursements by PATH Type N=13,296 Commerical Plan Members 20% 18% 16% 14% 12% 10% 8% 6% 4% % of adult population 2% 0% PATH Type 7 PATH Type 9 PATH Type 6 PATH Type 5 PATH Type 8 Unassigned PATH Type 3 PATH Type 4 PATH Type 1 PATH Type 2 $1,000 $900 Average claim pmpy % PMPY $800 $700 $600 $500 $400 $300

HealthLeaders Fact File September, 2008 CDHP enrollees use more services: especially diagnostic

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.

HealthLeaders Fact File September, 2008 Beginning recognition of cognitive impacts on health and demand

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

Questions/Comments Frederick H. Navarro PATH Institute Corporation fnavarro@pathinstite.com