Adherence: Why Most Virtual Behavioral Change Programs Fail (And How To Fix It)

by | Jul 29, 2021

The race to reduce or reverse chronic diseases and reduce the resulting healthcare costs associated with these conditions is a marathon, not a sprint.

Chronic diseases such as heart disease, diabetes, and obesity for the most part take years to manifest into full-fledged health problems. If we’re considering the problem logically, then the solutions to these problems should also be long term.

And this is what healthcare professionals will tell their patients when they’re diagnosed with a chronic disease. For example, they may prescribe Metformin to a patient with pre-diabetes with the warning that if they don’t make lifestyle changes in diet and exercise, they stand a high risk of (up to 90%) developing diabetes.

The patient may take it to heart and start a diet and exercise regime, faithfully sticking with it – for a while.

What happens next is no surprise – most people are guilty of it.

They quit and revert to the past behavior that got them in trouble in the first place. This is the problem of adherence to health change programs.

Even though the patient knows that if they start doing the things they did before, risking not only quality of life, but their very lives, they still fail to adhere to their health program.

The problem of adherence is why chronic diseases are the number one killer in the U.S. today and contribute to the lion’s share of healthcare costs.

We’re going to dive into the problem of adherence to health behavior change programs and what can be done – both to improve health outcomes and lower healthcare costs for patients, employers, and insurance providers.

The Rise Of Behavioral Change Programs

The toll chronic disease has taken in terms of quality of life, morbidity, and healthcare costs is staggering:

  • Chronic disease kills 1.7 million people per year
  • 90% of the U.S.’s healthcare budget ($3.8 trillion) is spent on chronic diseases

Chronic disease costs employers $2 billion per year1A major move in recognition of and response to this growing epidemic was the passing in 2008 of the Mental Health Parity and Addiction Equality Act (MHPAEA). This act increased reimbursement and demand for behavioral health services.

As a result, the use of telehealth services boomed. Behavioral health providers sought to use health coaching and monitoring to help patients manage the harmful lifestyle choices that were causing these chronic diseases.

Later, as the internet, cell phones, smart technology, AI, and machine learning all coalesced to create the most powerful information platform humans have ever had access to, these services came into their own.

Using biometric data, health coaching, real-time monitoring, and interactive education, behavioral health programs became the perfect weapon in the fight against chronic disease.

They could monitor daily blood glucose levels, diet plans, exercise routines, and emotional wellness while giving coaching and support.

But even with these powerful tools at their disposal, there was still one nagging fly in the ointment, a wrench in the gears keeping people from fully realizing their health goals – adherence.

The Problem Of Adherence

Adherence is just a clinical term for sticking to something. That something we’re referring to here is a digital behavior change program.

Before the behavioral change industry came along, a doctor would prescribe medication and tell their patient that they needed to make some lifestyle changes and send them on their way.

These would usually be: quit smoking or drinking, eat healthier, and exercise. See you at your next checkup.

It’s no surprise that studies have shown that at best, only 55%2 of people with chronic diseases adhered to their treatment plans. Some studies had numbers as low as 20%.

While behavioral change programs have shown great success, the problem of adherence persists.


Solving The Adherence Puzzle

Even with the amazing technology built into the latest behavioral change platforms and access to health coaches, the adherence problem remains a hurdle to creating better health.

Basic human stubbornness and ingrained habits play a large part, but the root of the adherence problem is ignored. This root has two parts:

  • Emotional health challenges
  • Self-administered programs

You can have the most intuitive app, knowledgeable health coaches, deep learning AIs and real-time monitoring, but if the patient’s emotional health isn’t addressed, put simply, they aren’t going to want to make the changes.

This is largely due to the emotional barriers to making positive health changes.

Many behavioral change programs offer emotional health coaching and services, but they don’t emphasize emotional and mental health and coordinate the critical role it plays in overall health.

Secondly, most behavioral health change programs are self-administered. That means the client is the one who has to make contact with the service. If they decide they don’t feel like participating – they don’t participate.

Failing to address these two shortcomings negates all the gee-whiz technology any system builds into its platform.

To be successful, the program has to address these two chokepoints.

Album Health’s Approach To Behavior Change

When we were building AlbumHealth’s digital behavioral health platform, we sought to strike directly at the root of the adherence problem.

We recognized the critical role emotional health plays in overall health and that without emotional health, participants are less likely to engage in healthy behaviors.

Depression, anxiety, and stress are the most common emotional health issues, affecting as many as 40 million adults each year3. These are also barriers to creating and maintaining healthy habits while contributing to unhealthy behaviors such as drug and alcohol abuse, a sedentary lifestyle, and eating disorders.

That’s why even though we employ data integration, health analytics, health management, and health engagement, we’re the only behavioral change program that places mental and emotional health at the forefront.

Our EHIP (Emotional Health Intervention Program) helps participants learn behaviors and strategies to improve emotional health working in tandem with our Digital Emotion Health Program e-learning program.

But providing these resources isn’t enough. That’s why we’re also the only program that practices active engagement from start to finish.

While other programs are self-administered, our health coaches actively engage with their clients reducing adherence problems and increasing engagement, adherence, satisfaction, and effectiveness.

Our results define the effectiveness of this approach:

  • More than 2 million health engagements
  • $1.7 million claims reductions
  • $6 million saved in MSK claims
  • 20% YOY savings over a 5-year period
  • 84% adherence
  • 94% user satisfaction
  • 100% of target health goals achieved

It’s not enough to provide a slick user interface, capable health coaches, deep real-time data, and educational resources.

You must address, coordinate & monitor emotional and mental health to drive total health. Without this focus, the problem of adherence will prevent clients from sticking with the program and achieving their health goals. Supporting this focus is taking an active role in a client’s health journey, and teaching health skills along so our participants can “stick with it.”

It is our mission to not only reduce and reverse chronic disease; we must treat the entire person, providing a full-spectrum health ecosystem addressing emotional, mental, and physical health changes for better health outcomes.

Find out how we’re fighting the battle against chronic disease and poor emotional health by reading one of our blogs or exploring our website.

See why we believe in “Creating better health, together”.