Sustaining Engagement - Insights in Well-Being Improvement

8/8/2019 Sustaining Engagement - Insights in Well-Being Improvement

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INSIGHTS IN

WELL-BEINGIMPROVEMENT

Sustaining Engagement



IDENTIFY

NEEDS

CHANGE

BEHAVIORS

DELIVER

OUTCOMES

Proven communication and incentive

strategies for consistent success.

Innovations focused in behavioral

economics and social support.

Uniquely relevant, personalized

experiences and plans.

High engagement is created

and sustained through

collaboration.

CREATE

SUSTAINED

ENGAGEMENT


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OPPORTUNITY FOR IMPROVEMENT

Among more than 500 employers responding

to a recent survey on healthcare purchasing value,

58% cited a lack of employee engagement as the big-

gest obstacle to changing employee behavior related

to health.1 At the same time, two-thirds of respon-

dents said employees’ poor health habits were the big-

gest challenge to maintaining affordable healthcare

coverage.

The engagement problem is longstanding and has

spurred the growth of incentives, yet even with financial

lures, companies reported participation rates well below

50% for health risk assessments (43%) and biometric

screening (45%)—activities at the very beginning of most

programs. Without incentives, rates fell to 27 and 28%.2

Incentives improve participation, but dollars alone don’t

deliver sustained program engagement. The Healthways

Center for Health Research has studied incentive

evidence and best practices, and found:

• Incentives and disincentives can be effective at

improving participation and behavior change,

but they are not sufficient to improve long-term

outcomes.

• Incentives are more effective when provided on

an ongoing, periodic basis, and when their value

reflects the perceived difficulty of the action.

• Incentives must be coupled with well-designed

health and wellness programs and effective

communication to have the greatest impact.3

For program sponsors of all kinds, including health plans

and governments, driving sustained and substantial

participation in well-being efforts is a multifaceted

challenge. Organizations must think strategically about

supporting engagement in every aspect of solution

design and delivery and work collaboratively with

solution providers to achieve engagement goals.

Fostering an organizational culture that supports well-

being improvement and considering the perspectives

and personal needs of the population are as important to

successful engagement as well-planned communication

and incentive programs.

HEALTHWAYS APPROACH

Healthways approaches engagement as a critical

process, building on lessons learned in consumer mar-

keting. Our goal is to build awareness, interest, desire,

and action within the total population, creating a

demand for health and wellness that complements the

quality of the support we provide.

Our approach:

• Emphasizes full-circle customer collaboration,

bringing a solid understanding of the organization

and audience to all other activities.

• Employs a customized, comprehensive

communications campaign supported by an expertengagement marketing team and designed to

connect with each individual.

• Integrates smart incentives tailored to customer

population and priorities.

• Applies innovations in areas like behavioral

economics and social support to hold and keep

participant interest.

• Addresses organizational culture and workenvironment and its influence on engagement

success.

• Supports engagement with personalized

interventions that have intrinsic appeal.

Customer business objectives influence how we configure

every solution from the beginning. Specific engagement

objectives follow from those business objectives and are

Insights in Well-Being Improvement:


Healthways collaborates with customers to drive high engagement in well-being improvement,

strengthening proven communication and incentive strategies with unique audience and cultural

insight and building on innovations in behavioral economics and social support.



part of annual performance results for the Healthways

engagement marketing team.

Across our diverse customer base, with varying

solutions and incentive strategies, we consistently

achieve program engagement of 40% and higher

among eligible people, with many clients reaching 90%

participation and beyond.

DELIVERING A COMPREHENSIVE,

CUSTOMIZED COMMUNICATIONS

CAMPAIGN

With more than three decades of experience

engaging customer populations, Healthways

understands how to effectively communicate with

individuals to drive awareness and interest in well-

being programming.

Our communications strategy follows

these principles:

• Know the audience, and tailor accordingly

• Show organizational commitment—leadership

support and involvement

• Launch and launch again, renewing interest and

involving new participants

• Say it multiple times, multiple ways—different

messages and vehicles touch different people

• Involve program champions at all levels within the

population

• Be transparent—involve customers in engagement

strategy and results

• Keep messaging simple, clear, and action-oriented

• Focus on emotional connections

Healthways engagement marketing experts start by

working with customers to understand the population

we are working to engage. We discuss organizational

culture and attitudes toward health and wellness. We

look at population characteristics like location, job

function, and accessibility to segment the audience.

For example, we would recommend different messages

and vehicles for each of the following groups:

• Corporate office personnel – with ready access to

online communication and onsite leadership

• Blue-collar workers – in industrial facilities with

limited online access at work

• Remote sales teams – with online access and

greater management distance

After we define our audience, we map ou

communications strategy, building on an award-

winning communications campaign designed for

convenient customization.

Our “Today’s the Day” campaign features:

• Messaging – that shows members how they can set

goals and take small, incremental steps each day

that ultimately lead to sustained well-being—an

approach validated by behavior change science.

• Design – Visual elements and a gender-neutral

color palette with broad appeal, selected using

third-party research in design and color theory.

• Proprietary images – that reflect diversity in age,

ethnicity, and activities, with multiple options foreach image location.

• Confidence statements – on individual

communications that address privacy concerns,

establishing Healthways as a trusted, independent

third-party—a practice that increases the

likelihood of an individual sharing health

information.

• Multiple modes – emails, paycheck stuffers,

posters, brochures, onsite presentations,

newsletters, webinars, intranet banner ads, andmore—that get messages to everyone, more than

once.

Our dedicated marketing and creative resources serve

as an extension of customers’ internal communications

teams, with different levels of support based on

customer need. A marketing manager oversees the

process of tailoring campaign communications,

working collaboratively with customer contacts to:

• Determine the positioning of Healthways services

in line with organizational culture.

• Reflect customer brand standards and incorporate

customer logos, URLs, phone numbers, and

incentive offerings.

• Select specific messages and photography that

resonate with the target population, creating an

emotional connection.



Insights in Well-Being Improvement: Sustaining Engagement

• Choose campaign components and communication

channels.

Campaign components support different stages:

• Pre-launch – Building awareness and excitement

for launch and establishing well-being as a core

value.

• Launch – Increasing the message about

opportunities to enroll and engage in well-being

improvement programs.

• Ongoing – Creating an environment in which

participation is meaningful and health is a valued

asset.

Healthways experience has shown that involving

customer wellness ambassadors in different locations

and work groups within an organization benefitsengagement. These program champions might be

managers in particular locations, human resources

contacts, or interested volunteers at any level. Our

engagement marketing team periodically connects with

these ambassadors—for example, using monthly calls to

help plan, execute, and reflect on important elements o

our communications campaign.

Throughout a campaign, Healthways works with

customers to assess engagement issues and mak

changes or add elements as needed.

INCORPORATING SMART INCENTIVESOrganizations are increasingly employin

incentives to try to boost health and wellness program

engagement. An employer survey comparing th

use of incentives from 2008 to 2010 found growth

in incentive use across disease management and

wellness programs, but majority use (by more than

50% of respondents) only for the completion of health

risk questionnaires and biometric screening.4

Healthways has extensive experience working one

on-one with customers on incentive design. We havstudied the impact of incentives on engagement and

use that insight to make incentive recommendations.

gender-neutral

color palette

“Today’s The Day”

inviting, supportivetheme promotes

incremental,

achievable steps

easily co-branded confidence statement

addresses privacy

concerns

strategy/messaging

based on Prochaska

model for behavior

change

proprietary images

reflect diversity in age,

ethnicity and activities



Research conducted by the Center for Health Research

suggests that:

• Incentives help hesitant individuals overcome

perceived barriers to involvement and can prevent

attrition when offered on an ongoing basis.

• To motivate behavior change, incentives must be

large enough to create the tipping point between

contemplation and action. They are best connectedto simple, time-limited, discrete actions.

• Organizational commitment and communication

and timing of incentive are critical to program

success.5

We consider a customer’s past experience and

population in suggesting an incentive strategy, guided

by the following best practices:

•

Providing modest incentives at particularjunctures, extending beyond initial enrollment, to

boost engagement and outcomes.

• Offering incentives that are meaningful to the

customer population and appropriate to the

perceived difficulty of the action. Options include

cash awards, credit toward an individual’s health

insurance contribution, deposits to individual

health spending accounts, merchandise, gift

cards, and more. Financial penalties, in the form

of higher premiums or reductions in employer-

provided contributions, can also be effective.

Our interventions and engagement communications

are designed to easily incorporate customer-tailored

incentives, and we offer incentive administration and

tracking services.

APPLYING INNOVATIONS IN BEHAVIORAL

ECONOMICS

To increase both the effectiveness and efficiency

of incentives for customer populations, Healthwaysis incorporating new insights from the field of

behavioral economics, such as the use of nonfinancial

rewards and intermittent reinforcement.

An important and relevant concept in behavioral

economics is hyperbolic discounting—the tendency

for human beings to discount the value of something

because of its lack of perceived, immediate benefit. It’s

a primary reason why as many as 50% of individuals

with doctor-prescribed medication fail to take that

medication as prescribed.

HealthHonors, a Healthways company, developed a

proprietary system of personalized reinforcement

to help change this default behavior. The physician-

scientists who founded HealthHonors in 2005 set out

to build decision software that could address the lack

of medication adherence among their own diabetes and

glaucoma patients:

• Overcoming cognitive biases that inhibit healthy

behavior across populations.

• Using the idea of intermittent reinforcement—

varying the level and type of “incentive”

individuals receive with each interaction,

including some interactions without a reward.

Intermittent reinforcement is known to be more

effective in changing and sustaining behavior over

long periods of time.

• Learning from each individual’s pattern of

interaction to find the lowest economic threshold

necessary to sustain engagement.

The Dynamic Intermittent Reinforcement™ system

that HealthHonors created incorporates different types

of reinforcement that motivate different people:

• Economic reinforcement – in the form of a points

program to purchase rewards

• Noneconomic reinforcement – intrinsic types of

reinforcement that motivate individuals: messages

creating a sense of competition, providing

empathy and encouragement, building knowledge

and confidence, and strengthening an individual’s

feeling of social support.

HealthHonors “smart” software learns from

individual behavior patterns and creates customized

reinforcement strategies for each person. In contrast

to a typical incentive program offering $100 to every

person who completes an HRA, 10,000 participantsusing the Dynamic Intermittent Reinforcement system

could have 10,000 unique reinforcement schedules.

HealthHonors personal reinforcement plans have shown

measurable results, increasing medication adherence

by as much as 34.6% within disease populations while

reducing the overall incentive budget per participant.

Current software addresses compliance with prescribed

therapy for more than 39 disease categories.



Insights in Well-Being Improvement: Sustaining Engagement

A controlled study conducted within a large insurance

company population over a 14-month period focused

on members with type I or type II diabetes, at least

one diabetes-related prescription medication, and

suboptimal adherence to medications and a suboptimal

hemoglobin A1c (HbA1c) measurement. Members who

received personalized reinforcement plans, compared to

members who received the standard of care for diabetes,

showed significant:

• Improvement in adherence to medication

• Improvement in HbA1c and LDL cholesterol

measures

• Reductions in emergency room visits.

Healthways is currently using the Dynamic Intermittent

Reinforcement system within our Well-Being

Improvement Solution to help individuals improve

medication adherence behavior. We are working to

integrate the approach across other behaviors.

CAPTURING THE POWER OF SOCIAL

SUPPORT

Healthways is increasingly using the power of

social support to build engagement and augment

results in well-being improvement.

QuitNet® –

Researchers analyzing communication patterns

over 60 days among active participants in our

QuitNet® tobacco cessation program found 103,592

connections among 7,569 members. Higher

integration within the network was associated with a

higher likelihood of not smoking.6

MeYou Health –

Healthways founded MeYou Health in 2009 to

focus on opportunities emerging in the online and

mobile world for social interaction and engagement.

MeYou Health launched several consumer-focused

applications in 2010 that work to spread and sustain

involvement through online social connections,using established networks like Facebook.

SilverSneakers® –

The Healthways SilverSneakers® Fitness Program

has always excelled in helping older adults get

active and socially connected at participating

fitness facilities. That community is also now

thriving online. In 2010, SilverSneakers on Facebook

attracted more than 14,000 fans. Members

frequently encourage and congratulate each other on

well-being improvement as well as making referrals

to Medicare Advantage plans that offer the program.

MedNetworks, Inc. –

A new three-year partnership with MedNetworks,

Inc. provides Healthways with exclusive rights to

apply the social network mapping and analytics of

Dr. Nicholas Christakis to the field of population

health management. A physician, social scientist,and Harvard professor, Christakis is cofounder

of MedNetworks and a recognized authority with

significant published research on the impact of

social connections on health.

■ Healthways will work directly with Dr.

Christakis to identify and pilot aspects of

MedNetworks’ methods and technology

that can accelerate the adoption of healthy

behaviors in customer populations.

■ For health plans and physician provider

markets, Healthways is also the exclusive

distributor of MedNetworks provider

mapping capabilities, revealing patterns of

health influence and opportunities to improve

outcomes.

PARTNERING WITH CUSTOMERS TO

CREATE A SUPPORTIVE ENVIRONMENT

AND CULTURE

Findings from the Gallup-Healthways Well-Being

Index® support the connection between environ-

ment—work, home, and community—and well-being.

Our Well-Being Improvement Solution uses the Well-

Being Assessment™ (WBA), advancing the traditional

health risk assessment, to provide customers a more

comprehensive view of population well-being. That

view includes a clear picture of work environment and

organizational culture.

Based on aggregate WBA results, Healthways canrecommend strategies that enhance organizational

and environmental support for engaging in well-being

improvement. We ask our customers to take a leading

role in fostering a culture that supports engagement

and solution success.



A BETTER WAY

Sustained engagement in well-being improve-

ment must be a strategic process, involving close

collaboration between solution providers and

customer populations. The process begins with

an understanding of organization and audience.

Communications and incentives play an essen-

tial role in creating and maintaining participant

interest.

A comprehensive engagement marketing

campaign should:

• Make emotional connections to the target

audience using tailored messages and

multiple modes of communication.

• Communicate clear and achievable steps

to action.

• Show and build support at multiple levels

within an organization.

• Integrate smart incentives that appeal to

the customer population and are offered at

particular junctures throughout, well beyond

initial enrollment.

Understanding and addressing aspects of the

environment—work, home, and community—

can foster greater involvement in well-being

improvement. Underpinning success are

interventions that provide inherent value to the

individual: interventions focused on personal need

and priorities, based on behavior change science,

with an achievable, action-oriented approach to

results.

Healthways approaches sustained engagement

with all of these advantages and continues to

research and incorporate new levers for success,

including advances in behavioral economics and

social support.

REFERENCES12010 Employer Survey on Purchasing Value in Health Care Report, National Business

Group on Health/Towers Watson, http://www.towerswatson.com/united-states/

research/1345.2PwC Health and Well-Being Touchstone Survey Results, Pricewaterhouse Coopers,

June 2010, http://www.pwc.com/us/en/hr-management/publications/health-

wellness-touchstone-survey.jhtml.3Rula, E., Sacks, R., “Incentives for Health & Wellness Programs: Strategies, Evidence

and Best Practice,” Outcomes & Insights i n Health Management, Vol. 1, No. 3, 2009.4

PwC Health and Well-Being Touchstone Survey Results, Pricewaterhouse Coopers,June 2010.

5Rula, E., Sacks, R., “Incentives for Health & Wellness Programs: Strategies, Evidence

and Best Practice,” Outcomes & Insights i n Health Management, Vol. 1, No. 3, 2009.6Cobb, N.K., Graham, A.L., Abrams, D.B., “Social Network Structure of a Large Online

Community for Smoking Cessation,” AM J Public Health, Jul 2010; 100: 1282 – 1289.



©2010 Healthways, Inc. All r ights reserved.


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