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The 4 Game Changers in Employee Wellness - eBook Transcript

Employee Wellness Needs a Game Changer

According to a recent RAND Corp. Study, 92% of employers with 200 or more employees have had a wellness program for five or more years.

And yet there's a growing sense within the employer community that these programs haven't reached their potential. In working with employers across the USA for more than 8 years, we've identified four common themes:

  • Wellness program leaders want to reach the whole population, especially the ones who aren't showing up today.
  • They want their participants to start moving biometrics in the right direction - this year.
  • They want to see changes in physical activity and weight loss that continue all year long.
  • And all of these improvements have to be made using the people, technology and budget that's already in place.

In other words, employee wellness needs a game changer. Let's talk about these four elements in detail.

#1 Full Participation

Wellness leaders know they have to reach the whole population in order to change population health.

Studies have shown that nonparticipants tend to have more health risks and costs than participants - so the people that your program is not reaching today are exactly the ones you most need to reach.

You're looking for at least 90% participation in the HRA and screenings. 95% is better. Remember, we have to reach the ones who are avoiding the program today.

How are wellness programs doing today? Typically, they are paying $150 or more in incentives for the HRA and screenings, but they are only getting participation of 65% or 75%.

The current strategy of paying people to do HRA's and screenings is consuming the incentive budget and not delivering the numbers we need.

Full participation without paying more in incentives? That's a game changer.

#2 Biometric Improvements

Biometrics are the test of whether your program is really changing the health of your participants.

If a participant finds they have high blood pressure, high cholesterol or high blood glucose at the screening - we want them to work with their doctor to improve those numbers, as soon as possible.

The goal is clinically significant improvements in biometrics within 90 days after the screening.

But most wellness programs are not structured this way. They target only the high-risk participants for telephonic outreach from the wellness vendor. Incentives (if any) are based on participation. Biometrics are not re-taken until the next year - so results are hard to measure.

A wellness program where participants work with their doctors and show clinically significant improvements in biometrics within 90 days? That's a game changer.

#3 Sustained Lifestyle Change

Lifestyle habits are the biggest driver of chronic disease in advanced countries today.

Changing daily behaviors around physical activity and BMI is a critically important task for employee wellness programs.

Good lifestyle habits require a significant and ongoing time commitment from participants - it takes time and effort to eat healthy and be active every day.

However, most wellness programs are deploying lightweight, short-term programs that are inadequate to tackle this major priority. Often they are 8-week programs for physical activity and weight loss, based on self-report data and without meaningful incentives.

In most cases, they are only able to show short-term improvements in physical activity and weight, and only for the small slice of the population that participates.

High levels of physical activity and moderate weight loss that continue throughout the year? That's a game-changer.

#4 Scales Up Easily

It's easy to design a wellness program that works for a small number of participants. The program could include lots of face to face, one-on-one interaction and coaching for every single employee. Data could easily be managed in Excel - or even on paper.

But a program like that can never be a game-changer. It simply doesn't scale up to serve the hundreds or thousands of employees in most self-funded workplaces. If we want to change the health of the whole organization, the program has to work for 10,000 participants as well as it works for 100 participants.

To make a program scalable, it has to work using the existing staff, technology and budgets. That means it can't involve labor-intensive processing of paper forms and FAXes. It can't require increased one-on-one coaching and interaction. It can't require buying activity tracking devices for every employee and kiosks for every worksite. It can't ask physicians to change the way they practice medicine. It can't require your organization to change the way payroll and HR systems work.

Scaling up to full participation while using the staff, technology and budget you already have? That's a game changer.

The Sum is Greater Than the Parts

When all 4 Game Changers work together, it can transform a wellness program.  They work best when they're working together.

For example, full participation in an HRA or screening isn't enough. After the HRA and screening, the participants have to actually make changes in lifestyle and improve their biometrics.

In the same way, a program that produces biometric improvements and lifestyle change for only a few participants isn't a game changer. It has to scale up and include full participation.

A program that addresses biometrics or lifestyle, but not both, is only a partial solution. Many high-risk participants need both medical treatment and lifestyle change to lower their risk level. And many participants can avoid the need for medication later if they change lifestyle today.

Game Change Example

Many game-changing innovations turn out to be a new combination of several things that already existed.

For example, the iPhone was not the first to have email, a touchscreen, apps or music.

The iPhone was a game-changer because it brought together all four of those features into one integrated design. And Apple was able to produce the iPhone at large scale - with over 700 million produced as of 2015.

Here at Extracon, we think employee wellness is on the verge of the same kind of breakthrough.

When wellness programs bring together full participation, biometric improvement, sustained lifestyle change, and the ability to scale up easily - they will achieve unprecedented levels of results and success.

What's left is to bring them into an integrated program design. Let's talk about how to do it.

How to Do It: Participation

The first step is full participation in the HRA and Screening. Let's get the bad news out of the way first. We recommend moving from an incentive approach to a penalty approach for HRA's and Screenings.

We've seen wellness programs move from HRA participation in the 20% range to HRA participation in the 90% range just by moving from a $150 incentive to a penalty of about the same size. Nobody likes penalties, but they are the best means we have to motivate full participation.

The second step is to offer incentives for meeting biometric standards. For most programs, this means blood pressure, cholesterol, glucose, BMI, and cotinine (a metabolite of nicotine that shows tobacco use).

The third step is to offer incentive alternatives. For those who don't meet the initial standard, make sure your alternative standards are based on clinically significant biometric improvements and sustained lifestyle change - not just participation in coaching or classes.

This approach is a balance of carrots and sticks. By using penalties for HRA and Screening, you preserve your incentive dollars for what really matters. And you're spending incentive dollars for results, not just for participation.

How to Do It: Biometric Improvement

To improve biometrics, the wellness program has to work within Physicians' existing treatment process, collect updated biometrics from physicians, and reward improvements in biometrics for those who don't meet the initial standard.

For most participants, at the first visit the physician will retest the biometrics and confirm the screening results. Then, he or she will prescribe a medication and schedule a followup visit. At the followup visit, the physician will retest and confirm that the medication is working to improve the employee's levels.

Then the employee earns their incentive based on the improved biometrics. If you're looking for clinically significant improvements in biometrics - that's where you want to put the incentive.

The wellness program also has to work with special cases. In some cases the screening value was an anomaly, and the biometrics are OK as verified by the physician. And sometimes, the employee has a medical condition that makes it unreasonably difficult or medically inadvisable to meet the improvement target.

How to Do It: Biometric Improvement & Tech

We recommend using a smartphone app to securely collect updated physician biometrics and simplify administration of alternative standards and special cases.

The app should from the maker of your wellness portal, so it's secure and trusted. It should send the data directly to the wellness portal, where incentives and deadlines are calculated and applied automatically.

The app design should be simple and intuitive - and it can be better than the paper forms used by most outcomes-based wellness programs today.

In the Exam Room, patient hands doctor the smartphone to enter biometrics & sign the form.

The App uses the phone'scamera to scan in Lab Reports arriving later by mail.

How to Do It: Sustained Lifestyle

Sustained lifestyle change requires frequent goals throughout the year. The incentive research is clear that one big annual goal is not as motivating as a series of smaller goals during the year.

We recommend quarterly targets. Participants can choose a goal of 500,000 steps (about 5,000 steps a day) or 5 lbs of weight loss.

Quarterly targets are near enough to motivate behavior, but not so frequent as to cause problems for your payroll department.

The choice of physical activity or weight loss allows the employer to accommodate a wide range of participant needs and limitations.

Another approach is to set quarterly physical activity goals for all employees (regardless of weight), with an additional alternative of weight loss for those who are overweight. This works well for organizations that don't want to tie an incentive directly to BMI.

Incentives for lifestyle change require accurate measurement of activity and weight. However, most organizations don't have the budget to buy wearable activity trackers for every employee and weight kiosks for every worksite.

We recommend using a smartphone app to automatically collect accurate step data, and allow participants to submit photo-validated weights.

The app should come from your portal vendor so it's secure, trusted and integrated with the portal for incentive administration.

Biometrics & Lifestyle: Examples

Designing for all 4 Game Changers means you're providing the right action plan and the right incentives for a variety of different participants. Here are 3 examples:

Nancy discovered at the biometric screening that her LDL cholesterol was higher than the recommended levels. She already lives a healthy lifestyle, and her other biometrics are excellent. To earn the full reward under the wellness program, she will work with her doctor to treat the high cholesterol. No other changes needed.

Jen has a BMI over 30, but all of her other biometrics are still in the healthy range. To earn the full reward under the wellness program, she will need to change lifestyle habits to include more physical activity and/or losing a moderate amount of weight. With these changes, she's much less likely to need medication later in life.

Bill has a BMI over 30, and also has high blood pressure and elevated blood glucose. To earn the full reward under the wellness program, he will need to work with his doctor to treat his high blood pressure and blood glucose levels. He will also need to change lifestyle to be more active and /or lose a moderate amount of weight.

This makes sense, because for most high-risk participants it takes a combination of medication and lifestyle change to really impact health outcomes.

How to Do It: Scalability

We recommend using a cloud-based Portal to connect the data from HRA's, screenings, and Apps. This approach allows you to administer programs and incentives based on real-time data from a variety of sources.

Participants can see their incentive status and their next steps on incentive dashboards - so they won't have to call or email your office with questions.

This approach allows you and the participants to stay on the same page, and allows the participants to feel in control of the process.

The portal approach is more secure and more scalable than keeping track of incentives on spreadsheets or other desktop tools.

We recommend that you design your process around the 85% of working adults with a smartphone and internet access in their household. That's the approach that works best for the vast majority of your workforce.

A paper process misses out on all the benefits of tailored, step-by-step presentation of participant status and next steps based on real-time data. Wellness programs are complex, multi-step processes that don't map well onto paper forms.

Once you've designed your process, we recommend that you handle the exceptions as exceptions:

  • If you have onsite clinics, you can take updated biometrics at the onsite clinic.
  • If you have onsite fitness, you can take updated weights at the fitness center.
  • You can allow employees to send in paper forms along with their check for a small paper processing fee.


4 Game Changers in Employee Wellness: Full Participation, Biometric Improvement, Sustained Lifestyle Change, and Scalability.

They Work Together: It takes all four, working together, to transform your program. Don't design for one or two at the expense of the others.

Incentives Matter: Make sure your incentives actually reward the outcomes you're trying to achieve.

Leverage Existing Technology: design for the 85% of your population with internet access and a smartphone in their household.

About the Author

Jesse Hercules is the President of Extracon Science, a leading health promotion company. Mr. Hercules is a frequent speaker and writer on health promotion topics, including speaking at the American Journal of Health Promotion's annual conference, and the American Heart Association's annual Worksite Wellness Conference.

About Extracon

Extracon creates wellness portals for employers and resellers - including Health Assessments, Online Programs, Team Challenges, Apps and Incentives. The portals can also manage the data from Biometric Screenings, Onsite Classes, Onsite Programs and Events, and Coaching Programs.

Extracon clients move from disconnected data in Excel, fax and paper to seamless online administration through the portal. They can run a variety of programs with content and communications sent automatically. They can incorporate wearable devices, smartphones and kiosks into their programs.

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