© 2016 Enroll America | StateOfEnrollment.org COVER MISSOURI COALITION | 05.12.16 Beyond Awareness: Using Audience Insights to Facilitate Behavior Change Among Late Adopters
Feb 19, 2017
© 2016 Enroll America | StateOfEnrollment.org
COVER MISSOURI COALITION | 05.12.16
Beyond Awareness: Using Audience Insights to Facilitate Behavior Change Among Late Adopters
© 2016 Enroll America | StateOfEnrollment.org
Who We Are
© 2016 Enroll America | StateOfEnrollment.org
© 2016 Enroll America | StateOfEnrollment.org
Audience insights
Changing behavior
Building a responsive communications plan
CAC story: Removing barriers for the Hispanic/Latino community
Health insurance literacy and motivation
Agenda
© 2016 Enroll America | StateOfEnrollment.org
Audience insights
© 2016 Enroll America | StateOfEnrollment.org
© 2016 Enroll America | StateOfEnrollment.org
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
© 2016 Enroll America | StateOfEnrollment.org
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
© 2016 Enroll America | StateOfEnrollment.org
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%
© 2016 Enroll America | StateOfEnrollment.org
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
© 2016 Enroll America | StateOfEnrollment.org
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
© 2016 Enroll America | StateOfEnrollment.org
Changing behavior
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© 2016 Enroll America | StateOfEnrollment.org
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
© 2016 Enroll America | StateOfEnrollment.org
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
© 2016 Enroll America | StateOfEnrollment.org
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
Based on the work of Dr. BJ Fogg, Stanford University
© 2016 Enroll America | StateOfEnrollment.org
CHANGING BEHAVIOR
B =BEHAVIOR
MMOTIVATION ABILITY
TTRIGGER
All three must be present to create a desired behavior.
A
Based on the work of Dr. BJ Fogg, Stanford University
© 2016 Enroll America | StateOfEnrollment.org
Building a responsive communications plan
© 2016 Enroll America | StateOfEnrollment.org
© 2016 Enroll America | StateOfEnrollment.org
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
© 2016 Enroll America | StateOfEnrollment.org
BUILDING A RESPONSIVE COMMUNICATIONS PLAN
Motivation curve
TRIGGERSSUCCEED
TRIGGERS FAIL
MO
TIVA
TIO
N
ABILITY
LOW
HIG
H
HARD EASY
Based on the work of Dr. BJ Fogg, Stanford University
© 2016 Enroll America | StateOfEnrollment.org
BUILDING A RESPONSIVE COMMUNICATIONS PLAN
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
Based on the work of Dr. BJ Fogg, Stanford University
© 2016 Enroll America | StateOfEnrollment.org
BUILDING A RESPONSIVE COMMUNICATIONS PLAN
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
© 2016 Enroll America | StateOfEnrollment.org
BUILDING A RESPONSIVE COMMUNICATIONS PLAN
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
© 2016 Enroll America | StateOfEnrollment.org
BUILDING A RESPONSIVE COMMUNICATIONS PLAN
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!
© 2016 Enroll America | StateOfEnrollment.org
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”?
© 2016 Enroll America | StateOfEnrollment.org
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
Based on the work of Dr. BJ Fogg, Stanford University
© 2016 Enroll America | StateOfEnrollment.org
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.
© 2016 Enroll America | StateOfEnrollment.org
Removing barriers for Hispanics & Latinos
© 2016 Enroll America | StateOfEnrollment.org
© 2016 Enroll America | StateOfEnrollment.org
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
© 2016 Enroll America | StateOfEnrollment.org
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
© 2016 Enroll America | StateOfEnrollment.org
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.
© 2016 Enroll America | StateOfEnrollment.org
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
© 2016 Enroll America | StateOfEnrollment.org
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
© 2016 Enroll America | StateOfEnrollment.org
Health insurance literacy and motivation
© 2016 Enroll America | StateOfEnrollment.org
© 2016 Enroll America | StateOfEnrollment.org
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
© 2016 Enroll America | StateOfEnrollment.org
HEALTH INSURANCE LITERACY AND MOTIVATION
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
© 2016 Enroll America | StateOfEnrollment.org
HEALTH INSURANCE LITERACY AND MOTIVATION
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
© 2016 Enroll America | StateOfEnrollment.org
HEALTH INSURANCE LITERACY AND MOTIVATION
Strategies to create health-literate messages
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
© 2016 Enroll America | StateOfEnrollment.org
HEALTH INSURANCE LITERACY AND MOTIVATION
Strategies to create health-literate messages
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
© 2016 Enroll America | StateOfEnrollment.org
HEALTH INSURANCE LITERACY AND MOTIVATION
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
© 2016 Enroll America | StateOfEnrollment.org
HEALTH INSURANCE LITERACY AND MOTIVATION
Strategies to motivate consumers
To motivate someone to action, find out what motivates them
© 2016 Enroll America | StateOfEnrollment.org
HEALTH INSURANCE LITERACY AND MOTIVATION
Strategies to motivate consumers
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
© 2016 Enroll America | StateOfEnrollment.org
HEALTH INSURANCE LITERACY AND MOTIVATION
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…
Strategies to motivate consumers
© 2016 Enroll America | StateOfEnrollment.org
HEALTH INSURANCE LITERACY AND MOTIVATION
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.
Strategies to motivate consumers
© 2016 Enroll America | StateOfEnrollment.org
HEALTH INSURANCE LITERACY AND MOTIVATION
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…
Strategies to motivate consumers
© 2016 Enroll America | StateOfEnrollment.org
HEALTH INSURANCE LITERACY AND MOTIVATION
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.
Strategies to motivate consumers
© 2016 Enroll America | StateOfEnrollment.org
Step 2
Step 3
Step 1
HEALTH INSURANCE LITERACY AND MOTIVATION
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
© 2016 Enroll America | StateOfEnrollment.org
Final thoughts
© 2016 Enroll America | StateOfEnrollment.org
© 2016 Enroll America | StateOfEnrollment.org
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
© 2016 Enroll America | StateOfEnrollment.org
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
© 2016 Enroll America | StateOfEnrollment.org
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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
© 2016 Enroll America | StateOfEnrollment.org
U
Contact Us
Tony Zagora, [email protected]
Brandy Geers, [email protected]
Diane Webb, Health Literacy [email protected]
Gustavo Valdez, [email protected]