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www.pathinstitute.comDirecting health practice to serve health priorities

Cognitive and Behavioral Patterns of Thinking and Action:

Health Personas Driving Consumer Preferences and Health Care Demand

Frederick H. NavarroPATH Institute Corporation

Directing health practice to serve health priorities


Consumer Subtype Prevalences and SpendingU.S. Adult Population (210 million)

$29

$93

$112$130 $138 $139

$157 $162

$245

$250

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

% o

f U

S A

du

lts

$0

$50

$100

$150

$200

$250

$300

Bil

lio

ns

Per

Yea

r

% Size

Spending


exercise

HealthLeaders “Fact File” December, 2006


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



$29

$93

$112$130 $138 $139

$157 $162

$245

$250

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

% o

f U

S A

du

lts

$0

$50

$100

$150

$200

$250

$300

Bil

lio

ns

Per

Yea

r

% Size

Spending


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 examplesFamily members responsible for their own health

Visited pediatrician in past year (adults with children, N=36,877)

39.7%

24.7%

9.4%7.6% 6.3%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

Stronglydisagree

Somewhatdisagree

Neither Somewhatagree

Strongly agree

Family responsible for own health

% Y

es


Cognitive examplesFamily members responsible for their own health

Dependent Claims (N=2,201 adults with at least one dependent claim)

$-

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

Stronglydisagree

Somewhatdisagree

Neither Somewhatagree

Stronglyagree

Family members take care of own health

To

tal a

ve

rag

e c

laim

s Rx

MD

Hosp

$2.3 million


Cognitive examples“Only deal with health problems when they come up”

Response Count

strongly agree 756somehwat agree 1647

neither 1016somewhat disagree 1930

strongly disagree 2948Total 8297



Statement: Deal with health only when problems come up

Response Count Rx claims Prof_claimsInpatient claims

Total Claims Per Response Total Demand

strongly agree 756 602.00$ 2,634.00$ 3,061.00$ 6,297.00$ 4,760,532$ somehwat agree 1647 626.00$ 2,316.00$ 3,085.00$ 6,027.00$ 9,926,469$ neither 1016 649.00$ 2,288.00$ 2,773.00$ 5,710.00$ 5,801,360$ somewhat disagree 1930 801.00$ 2,793.00$ 3,701.00$ 7,295.00$ 14,079,350$ strongly disagree 2948 964.00$ 3,417.00$ 3,806.00$ 8,187.00$ 24,135,276$ Total 8297

Statistical Sig. p<0.000 p=0.000 ns DifferenceDollar spread at extreme attitudes 362.00$ 783.00$ 745.00$ 1,890.00$ 19,374,744$



"Deal with health only when problems come up"

2948

19301647

1016756

0

500

1000

1500

2000

2500

3000

3500

Co

un

t

$3,000,000

$8,000,000

$13,000,000

$18,000,000

$23,000,000

$28,000,000

To

tal S

pen

din

g

Count

Total Demand

$19.3 million


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)

PATH Type 2 UCS

1.001.502.002.503.003.504.004.505.00

path type measures

5 =

Str

on

gly

ag

ree



PATH Type 3 UCS

1.001.502.002.503.003.504.004.505.00

path type measures

5 =

Str

on

gly

ag

ree


Unconscious cognitive structure (UCS)PATH Type 7 UCS

1.001.502.002.503.003.504.004.505.00

path type measures

5 =

str

on

gly

ag

ree


PATH Type 7 and PATH Type 8

1.001.502.002.503.003.504.004.505.00

path type measures

5 =

str

on

gly

ag

ree




$29

$93

$112$130 $138 $139

$157 $162

$245

$250

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

% o

f U

S A

du

lts

$0

$50

$100

$150

$200

$250

$300

Bil

lio

ns

Per

Yea

r

% Size

Spending


• 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


Wellness Activities by PATH Type

0%

50%

100%

150%

200%

250%

300%

350%

400%

Mu

ltip

e R

esp

on

se

Health Screening

Routine Physical

Attended Health Ed Class

Attended Wellness/ Fitnessclass

I am very involved in my health(Strongly Agree)

I don't plan ahead, I deal withhealth issues when they comeup (Strongly Disagree)Only seek care when really sickor injured (Strongly Disagree)

Attention to Nutrition & HealthyDiet (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

0%

50%

100%

150%

200%

250%

300%

350%

% e

xcee

d 1

00 d

ue

to m

ult

iple

res

po

nse

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

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

140.0%

% e

xc

ee

d 1

00

du

e t

o m

ult

iple

re

sp

on

se

s

Dermatitis

Osteoporosis

Respiratory conditions

Arthritis/ rhematism

Alzheimer's

Chronic Allergies

Heart Disease

All Cancers

Skin Cancer

Breast Cancer

Kidney Disease


Specialty Care Demand

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

PATH Types

Gastro- entorologist

ENT

Allergist

Cosmetic Surgery

Neurologist

Orthopedics

Oncologist

Cardiologist


Health Plan Loyalty/Retention Index(membership length, satisfaction, intent to switch, intent to recommend)

139

131

109 108

97 96 9693 90

100

80

90

100

110

120

130

140

150

PATHType 4

PATHType 7

PATHType 6

PATHType 1

PATHType 5

PATHType 8

PATHType 2

PATHType 9

PATHType 3

Total

Ind

ex o

f L

oyalty (100=avera

ge)


Est. Medical Costs Per Adult by PATH Type (N=51,000+, four health plan composite, adults)

$6,252$6,124

$8,457

$8,188

$7,262$7,122

$6,936

$6,469$6,363 $6,358

$7,000

$6,000

$6,500

$7,000

$7,500

$8,000

$8,500

$9,000

Avera

ge P

roje

cte

d S

pen

din

g


Rx Reimbursements by PATH Type N=13,296 Commerical Plan Members

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

% o

f ad

ult p

op

ula

tio

n

$300

$400

$500

$600

$700

$800

$900

$1,000

Avera

ge c

laim

pm

py

%

PMPY


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.

• 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.

From Abstract:


HealthLeaders “Fact File” September, 2008

Beginning recognition of cognitive impacts on health and demand


Summary

• CDH fails to understand health consumersEmpowerment = managementCDH primary focus = environment, not consumersSCT: health behavior is driven by many factorsCDH ignores individual differencesPath type psychology reveals UCS structure UCS patterns shape risk, demandCDH promise will require recognition of UCSCDH on verge!A focus on changing just three UCS


Questions/Comments

Frederick H. Navarro

PATH Institute CorporationDirecting health practice to serve health priorities

[email protected]

www.pathinstitute.com directing health practice to serve health priorities cognitive and behavioral...

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