A Winning Proposition: How Playing Games Can Change Patient Behavior

December 2, 2015

// By Aron Ezra //

Aron Ezra color headshotA specialty outpatient clinic was struggling with a problem common to many health care providers: Patients weren’t showing up for their appointments. The problem was particularly severe for this clinic, where the no-show rate was close to 50 percent. Doctors weren’t able to bill unless the patient showed up, and long stretches of the day went by without patients—or revenue.

The clinic administrators tried everything to combat the problem. They double-booked appointment slots, but the no-shows didn’t follow a pattern. Sometimes both patients showed up, leading to long wait times. Or both didn’t show, leaving slots empty. Everyone was unhappy.

Do Penalties Work?

So administrators decided to charge patients for not showing up. While penalizing people somewhat reduced the no-show rate, it had some big drawbacks. It upset patients, many of whom felt they had legitimate personal reasons for missing their appointments. And if getting patients to pay their bills can be a challenge, you can imagine what it was like to get annoyed patients to pay a no-show fine. Patient retention started to become a problem.

When I met with the clinic administrators, they admitted they were in trouble. The clinic was bleeding money. If they couldn’t solve the no-show problem, the clinic was at risk of going under.

I encounter versions of this problem all the time. Hospitals can’t get their patients to log into their electronic medical records. Employees refuse to fill out a health-wellness assessment. Doctors struggle to get patients to take their pills. A study in the New England Journal of Medicine found that the problem of people in the U.S. mismanaging their medication leads to more than $100 billion every year in avoidable health care costs. Wow.

Getting patients to follow their doctors’ instructions is a moral imperative, and it’s also a financial one. Health care costs now eat up more than 17 percent of the U.S. G.D.P. McKinsey found that more than two-thirds of the nearly $3 trillion a year in health care costs in the U.S. are heavily influenced by consumer behaviors.

So how can we change our patients’ behavior?

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