Research from the Christensen Institute reveals the messages, models, and metrics that healthcare leaders need to innovate successfully.
“We might all be in the same storm, but we’re not in the same boat.”
Ann-Somers Hogg, senior research fellow-healthcare at the Christensen Institute, uses this quote to illustrate the importance of drivers of health (DOH)—and to explain why her organization prefers this term over social determinants when describing the “societal, population-level structures that influence health outcomes.”
HealthLeaders spoke with Hogg as part of her ongoing research at the Institute—founded by disruptive innovation pioneer professor Clayton Christensen—which links DOH to Business Model and Jobs to Be Done Theories while highlighting stakeholder success stories. HealthLeaders’ takeaways include the importance of message, metrics, and business models for DOH success.
In a May 2022 white paper for the Christensen Institute, Hogg provides three reasons why DOH does a better job of capturing human need:
- “[T]here are multiple competing definitions for SDOH, all suffering from a high level of complexity and the exclusion of the individual’s perspective.”
- “[T]he causal drivers of people’s health and life outcomes … are drivers, not determinants set in stone.”
- “[T]he limiting nature of the word ‘social’ — given that that DOH also spans the “social, environmental, and economic systems that influence how people live, work, play, pray, and age.”
Speaking with HealthLeaders, Hogg says: “As I was doing the research, something didn’t sit right with me.” So, she asked herself: “How do we think about the term [social determinants of health] through the eyes of consumer? Healthcare struggles because the consumer lens is not ingrained in the service model.”
Hogg continues: “If we are seeking to address drivers of health, we must use language that resonates, and social determinants of health doesn’t. Research from The Health Initiative uncovered that people found the phrase confusing, alienating, and demeaning.”
The Health Initiative’s co-founders have written more extensively about these findings, which are based on focus groups with urban and rural North Carolina voters.
Hogg adds: “That’s not to say that some drivers of health are not determined. However, there are other drivers that we can use our agency to impact, and that other entities have the ability and necessity to address.”
These entities include the 84 organizations Hogg studied in her latest DOH research, from community, faith-based and government organizations to providers, payers, and payviders to startups and the enablers that “support others’ ability to address DOH.”
The position that DOH are not simply determined leaves room for two important realities: that better outcomes are possible, and that healthcare can play a role in achieving them.
Enter Jobs to Be Done, an innovation theory that the Institute has applied to multiple industries and initiatives, including healthcare and DOH. Jobs Theory posits that people “hire” products or services to not only achieve functional goals but meet the social and emotional needs that help them make progress in life. “We call this progress the ‘job’ they are trying to get done, and understanding this opens a world of innovation possibilities.”
“Jobs to Be Done has a couple of applications in DOH,” says Hogg. “In conducting the research, one of our questions was what jobs were health care leaders hiring DOH for, and why did they incorporate DOH into their business models?”
Hogg found that healthcare leaders seek one of three types of progress:
- Job 1: “When the current system is about reacting to illness, help me capture the market opportunity to keep people healthy and out of the hospital, so I can make a profit.”
- Job 2: “When the current system is about reacting to illness, help me focus on people’s health, so I can help them treat the root causes of their problems and live better lives.”
- Job 3: “When our financial future is evolving and the way we get paid is going to change, help me design a transition plan so I can remain financially viable and continue to serve the community.”
Hogg’s research also noted: “The jobs that led health care executives to hire DOH, or to incorporate them into their business model, informed the business models they built.”
Metric innovation: Humana
So which payers are executing DOH well?
“The first I think of is Humana, its Bold Goal, and new success measures,” says Hogg.
Humana launched its Bold Goal in 2015—a population health strategy articulated currently as “Addressing the needs of the whole person,” to be achieved by “[c]o-creating solutions … for our members and communities.”
As noted in the Christensen Institute’s white paper: “This goal required Humana to establish new measures of success. To assess the impact and effectiveness of its DOH efforts, Humana started using the CDC’s Healthy Days measure, a four-question, self-reported questionnaire where individuals assess the number of mentally and physically unhealthy days they had over the last 30 days.”
When Humana applied its Bold Goal to Medicare Advantage (MA), individuals and communities reported fewer unhealthy days in 2020 and during the height of the pandemic:
- 2.4% change in physical unhealthy days for MA enrollees.
- 2.2% change in overall unhealthy days for Bold Goal MA communities.
- A decline in unhealthy days across Humana populations, ranging from -6.3% for low-income subsidy members to -2.7% for dual-eligibles.
- Progress across multiple Bold Goal communities.
- Communities with fewer unhealthy days in 2020 versus 2015 included San Antonio, Baton Rouge, New Orleans, and Knoxville.
Hogg’s research notes: “By tracking the impact of its DOH efforts on the outcomes that matter to individuals, Humana is able to target and iterate interventions to improve both individual and community QoL [quality of life].”
Speaking with HealthLeaders, she adds: “What sets them apart is how they measure success thorough consumers’ eyes” as opposed to conventional quality measures.
“Traditional measures may be precursors,” adds Hogg, but whether a person can play with their two-year-old grandchild tells a broader story. “Healthy Days reflects self-reported consumer data and looks at multiple aspects of health,” which she believes is a better way to measure the impact of DOH efforts.
Innovators versus incumbents
The Christensen Institute notes that the most innovative business models effectively incorporate DOH by:
- Addressing consumer/customer needs for progress
- Creating payment models that support these needs
- Measuring what matters to those they serve
- Linking disparate ecosystems
Examples from the Institute’s research show that the organizations that most effectively address DOH innovate their entire business models: value proposition, resources, profit formula/priorities, and processes.
“[O]ld business models can’t deliver on a new value proposition. Traditional business models impede progress toward a healthier future for people and a financially sustainable one for organizations.”
Traditional ways of describing the drivers of health as social determinants may do the same.
Laura Beerman is a contributing writer for HealthLeaders.