Incite Sustainable Change with a Data-Driven Wellness Program
By Patricia Fuller, PhD, Director of Wellness Engineering
A data-driven wellness program is designed to address the needs of your organization’s employee population at all levels of risk and across all domains of modifiable wellbeing. With holistic interventions that not only inform but also lead to sustainable change, BKS-Partners strives to engineer wellness programs that are tailored to each client. Our decades of experience have taught us that plug-and-play wellness programs alone don’t lead to the cultural change that drives a measurable and sustainable return on investment (ROI). By tailoring the approach to allow choice, build competence, create community, and leverage emerging technology, our clients benefit immediately from the discretionary effort exerted by employees who feel safe and valued both physically and financially.
Traditional wellness programs are interventions that facilitate health maintenance, disease prevention or lifestyle improvement. Adopted initially by large employers in an effort to lower medical costs, they were often limited to biometric screening events and health risk assessments. Data consistently demonstrates that “knowing your numbers” leads to improvement in health risks, but ROI for the interventions is difficult to quantify as cost reductions are not immediate (think years rather than months) and participation is often lackluster. With healthcare costs outpacing inflation (See Figure 1),1 quantifying the ROI for traditional approaches appeared insignificant. Participation in and enterprise energy for wellness programs under the traditional model do not appear to deliver on the oft-quoted ROI of 3:1.2
Traditional Wellness Programs
Traditional wellness programs typically relied on two relatively static data points to define success: the percentage of participation and the population at low risk. According to research conducted by the University of Michigan, participation grows from approximately 50% of the population and increases to 75%-85% over a three year period. Employee populations initially fall into the following risk profiles.3
Figure 3 below shows a sample of the laboratory tests and health risks that are typically measured during a biometric screening event. The reference range is the level at which the laboratory test or health behavior indicates risk as determined by the National Institutes of Health (NIH).4
Fast forward to today; so many of the things we do create a data footprint. Bernard Marr in his book Data-driven HR, focuses on the data informatics change that has been called the Internet of Things (IoT). “The IoT refers to the everyday objects – such as smart phones, smart TVs, Fitbit bands, etc – that can be connected to the Internet, collect and transmit data, and be recognized by other devices…the crucial part of IoT… machine-to-machine connections means the devices can talk to each other.”5 With the explosion of data generated by IoT, it’s even more challenging to determine what health related data are meaningful to drive lasting and measurable health improvement.
Gaps in Care
While these interventions are highly successful in identifying risks and coaching toward the appropriate next steps, our data tells us that non-compliance with follow up, whether with a physician or by consistently refilling a prescription, can be as high as 87%. In an actual employer example, the potential savings from closing these gaps in care relative to the following four conditions could yield savings in excess of $3 million.6
Realizing the potential savings from closing these gaps, requires that employees seek and remain compliant with treatment. Barriers to employee compliance with care, within an employer’s control, include structuring medical plans that address the cost of maintenance medications and creating ready accessibility to care. Beyond plan structure, creating a corporate culture with sufficient flexibility and trust to nurture employee engagement yields even greater gains in productivity, revenue and profitability.
Remote monitoring devices, artificial intelligence and voice activated tools are setting the stage for the future of health and wellbeing data integration and engagement. The Wall Street Journal recently reported that Amazon “…is positioning Alexa, its artificial-intelligence assistant, to track consumers’ prescriptions and relay personal health information, in a bid to insert the technology into everyday health care….Alexa can now transfer sensitive personal health information using software that meets health-privacy requirements under federal law.”7
Glucose monitoring device manufacturer Livongo, analyzed medical claims of 3,474 members enrolled in their tech-driven program that included utilizing a portable glucose monitoring device and real time coaching for program participants. When readings were out of range, a diabetes response specialist called or texted in minutes to provide real time feedback. Program participants were compared with 12,065 diabetics not enrolled in the program or utilizing the device in the years before and after the program was launched. According to the study, the program saved the two large self-insured employers $83.06 per member per month on healthcare costs. In addition, blood glucose data over a one-year time frame revealed a reduction in mean HbA1c from 7.8 percent to 6.9 percent.
In 2010, Gallup concluded that wellbeing is not limited to health risks. Wellbeing results from the interplay of the five modifiable realms of wellbeing that include career (later redefined as purpose), financial, social, community and physical wellbeing. The authors further note that increasing wellbeing in any one of the five areas leads to increases in the other four.8 Employers often address each of these realms through continuing professional education, retirement savings plans, and community events, yet few consider these initiatives to be part of a wellness program. The tendency is to narrowly define wellness programs within the physical realm and to limit data points to metrics related to health risk assessments, biometric screening events and medical claims. While this information can target interventions, what is the secret sauce that takes a wellness program from identifying health risks to empowering employees to seek and remain compliant with care? How can an employer create a culture that supports sustainable health behavior change?
Our strategy is to expand wellness beyond physical wellbeing. By including all five of the realms of modifiable wellbeing, participation automatically increases as it gives employees choice. Giving employees autonomy in the participation decision, increases their engagement across all domains. The principal data points measuring the success of a wellbeing program then become turnover rate, net promoter score and employee engagement. An engaged employee population values their workplace and exercises the discretionary effort that leads to world class business results.
Four studies, cited in a report released in December 2018, establish a connection between investment in wellness programs and high performing companies. In each of these studies, the market performance of companies scoring high on various health indices including the C. Everett Koop Award, the HERO Scorecard, and the Corporate Health Achievement Award (CHAA), unilaterally outperformed the S&P 500 index.9
Is your wellness program too narrowly defined?
Consider expanding it across all five areas of modifiable wellbeing. Wellness programs are initiatives employers do for employees, not to them. Next generation wellness programs will increasingly rely on new devices, technology and real time interventions to drive sustainable health improvements.
1 Claxton, G., Rae, M., Levitt, L., Cox, C. (2018, May). How have healthcare prices grown in the US over time? Retrieved March 21, 2019, from https://healthsystemtracker.org/chart-collection/how-have-healthcare-prices-grown-in-the-u-s-over-time/
2 Berry, L. L., Mirabito, A. M., Baun, W. B. (2010, December). What’s the hard return on employee wellness programs? The Harvard Business Review.
3 Edington, D.W. (2009). Zero Trends: Health as a serious economic strategy. Ann Arbor, MI: Health Management Research Center, University of Michigan.
5 Marr, Bernard, (2018). Data-driven HR, London, UK; Kogan Press.
6 BKS Springbuk clients, February 2018.
7 Evans, Melanie. (2019, April). Amazon Wants You to Use Alexa to Track Health Care, The Wall Street Journal.
8 Rath, T., Harter, J. (2010). Wellbeing: The five essential elements. New York, NY, US: Gallup Press.
9 Putnam-Farr, N., Dhar, R., Tam, G. et al. (2018). Employee wellbeing: Looking beyond health care cost savings to measure business performance gains, Optum Inc. White Paper.