From “0, 5, 10” to Big Data
A few months back, I attended a conference (you can read my recap and takeaways here) and was amazed to see how diverse the Corporate Health and Wellness industry has become. I saw everything from a tracker that counts reps on weight benches, to clothing that measures real-time biokinetics. Swimming in this sea of innovation, there were also traditional players providing core health and wellness programs – ones who lead the way to educate and engage in the early days of worksite wellness. It made me reflect about how far we’ve come as an industry. So, I decided to take a step back and reflect on how Corporate Wellness Programs have evolved over time.
When I think of worksite wellness, I think of behavior change and am reminded of the Hawthorne Effect (AKA the Disruption Effect). One of the best examples of The Effect, is focused on an experiment involving changing lights in a factory. When the factory added light, productivity increased. But, when they took the lights away, productivity increased…again. Why? Change was introduced and observed. It didn’t matter whether the workers could see better or not (not to say we don’t need lights to be safe and healthy). Rather, it demonstrated that introducing a change can act as a catalyst.
Early worksite programs focused on ergonomics and workplace “movement”. While most of this was born out of the need for reduction of lost time due to injury, it nonetheless introduced change that would encourage people to move and be more aware of their movements (presenteeism, anyone?). This was also a time when there was a cost shift to employers who wanted to attract talented employees, by offering robust healthcare packages. Into the early 1980’s, a tremendous amount of data was collected, and employers quickly learned – healthcare is EXPENSIVE! And, what lead to high-healthcare costs? Utilization at the wrong time.
In addition to changes to healthcare plans, the 80’s were the perfect storm: Americans had increasing ease of access to cheap and quick foods. More and more processed foods fueled longer days at the office, widening waistlines, and heavier healthcare cost centers. Television became an even bigger focus in daily life – the couch potato is born! The newly emerging sedentary lifestyle also lead to more prevalent ‘fad’ diets.
Companies saw the need to get employees up and moving. Encouraging people to take fitness classes, run tracks, and take the stairs started to trickle into basic programs. Campuses were beautified to encourage outdoor time and softball leagues were formed. In larger manufacturing settings, Occupational Health was heavily relied upon to be the catch-all for wellness. Unfortunately, employers were in a reactive state when it came to wellness, most of the time.
In the 90’s, programs started to evolve into more of an awareness campaign for healthy living. There was a focus on the “0, 5, 10” principle: eliminating tobacco (0), eating five fruits and veggies a day (5), and getting 10,000 steps day (10). This is what I jokingly call the “t-shirt era” of wellness. Just about any successful program or event had a $2 swag item. Usually a stress ball, koozie, or, in the “high-budget” programs, a t-shirt. I have personally witnessed organizations where the culture would do just about ANYTHING for a t-shirt. If only it were that easy to create lasting change!
While programs were built with good intentions, they were awkwardly promoted, usually by people standing in the hallways or cafeterias of your workplace, begging you to sign up to turn in your number of steps. In most cases, they were tracked in spreadsheets or very limited digital user interfaces. The administrative burden was just that: a time suck for someone who couldn’t devote their attention to fully engaging the workforce or handling complicated calculations.
Other initiatives during this time combined both changes in communication, and physical changes to worksites. Worksites were starting to either designate smoking areas or phasing them out completely. Communications usually encouraged taking the stairs and choosing the right meal at lunch. Some worksites that employed an onsite clinic, had a nurse or part-time NP promoting the importance of losing weight and your proper physical positioning at workstations.
“Challenges” were born out of these promotions and they have been a successful, though often poorly executed, promotional tool since the late 90’s. Don’t get me wrong, challenges are a great way to bring employees together in the spirit of camaraderie and, for those that are already healthy, a chance to win. Therein lay the problem: challenges were so top-heavy with healthy people that it ruled out chances of winning for the people who really needed to get moving. “Is this guy really walking 20k steps a day?” “Who has this kind of time to work out 2 hours a day?” These may be familiar sentiments from your inbox today. Early challenges eventually evolved into more even playing fields, but the timing seemed to be everything. 8 weeks? Too long. 3 weeks? Too short. Rules were too complicated, tracking was an issue, and reminding people about tracking was an even bigger issue.
In the 2000s, people began to adopt technology in ways that made the digitization of wellness a no-brainer – better interfaces, improved team experiences, and the ability to communicate via email with almost everyone in the population. Almost. There were still those issues with the “non-e”. You remember non-engaged populations, right? Back to the awkward politicking to gain engagement in your challenge – or better yet, giving out paper tracking logs and handing them to interns to put into the online platform.
With the integration of technology, came the opportunity of population health management. We were able to use data to identify populations, to see what was causing all the issues in our healthcare spend. Diabetes, Heart Failure, COPD, Asthma, and Arthritis were all leading the way in this analysis. Integrated health coaching and disease management were starting to take shape. Unfortunately, attempts to address these issues started with a claim’s stratification of risk, and then the robot calls to promote engagement. Nobody wanted to answer phone calls (they still don’t). These solutions were usually baked into a total wellness program; however, they became complicated and bulky to navigate. Employers who were paying a per employee per month (PEPM) fee were asking, “where are the results?” Seeing 2-5% engagement was a benchmark where 8% was golden. Non-participation was rampant.
Incentives for challenges started small. Usually the t-shirts were the big easy, but they eventually caught up to gift cards. Gift Cards turned into merchandise choice (big companies gave company swag in most cases). In the face of rising costs, employers were now being educated on “consumer-directed” health plans.
I’m not a benefits expert, but I am a consumer, and I was “directed” by several employers to this choice – mostly driven by my personal budget, not a preference for being a smarter consumer of healthcare. Offsetting this cost was seen as an opportunity to leverage your benefits. “Routine care” was usually always “covered.” If you used it, you would be rewarded. Sticky numbers like $1,000 or $1,500 looks good on paper. But in reality, it’s $57 over 26 pay checks. $57? Is that a reward? Was that meaningful enough for me to meet all these requirements, like answer the phone?
Now, I am a rewards expert, but I’ll just skim this subject and we can discuss this in more depth in another article. The point is, that rewards also needed to evolve and thus they have been. They have needed to shift back to what I call “Consumer-Directed Rewards.” This means exactly what it sounds like: the consumer determines how they want to be rewarded. Sure, given an opportunity to put money in my HSA, I’ll do that; but what I really like is ‘stuff’. I want to be able to use some of that money to acquire said ‘stuff’. Gift cards started to make an appearance around 2010 and merchandise in some cases. This created a whole new way to look at engagement and, most importantly, retention.
I recently saw a stat that 2.7 billion people in the world have smartphones. That’s 35% of the WORLD. Pew Research published that 81% of the population in the US has a smartphone. Take into account that 15% of the population is over the age of 65 and that means that just about everyone in your organization has a smart device. Robo calls are a thing of the past. Technology allows us to digitally coach participants.
What started to happen VERY recently (the last 4-5 years) was a surge of what I call “ancillary” services. These are far from ancillary in definition, but I call them this because organizations can now afford to offer separate and distinct services, to specifically address those conditions that are driving their costs. Diabetes? Yes, there’s a solution solely focused on that. Turns out they are good at what they do. Some of these companies are so good, they have decided to build their revenue around a pay for performance model. I like it when a company stands behind a product and takes the risk. Don’t you?
Where do those traditional wellness platforms stand today? They are catching up. Some models try to cover all of the services mentioned above. More dashboard-type platforms are opening to allow the administrator to make the decision that is right for their employees. By providing a gateway platform that services the traditional health and wellness programming (exercise, nutrition, challenges, education and a place to socially interact), employers can now connect employees to culture-fit programming for the rest of the wellbeing journey (coaching, DM, mental health, financial wellbeing etc.). These platforms have also progressed to be incentive engine powerhouses – adaptive, real-time, customizable and most importantly, reliable. At GoPivot we do in fact offer that true consumer driven experience to choose how you are to be rewarded.
As an industry, we are poised when new technologies and data sets emerge, giving us unique ways to engage with employees. Thus, making it ever easier to stay in direct contact to educate and retain employees in wellness programming. If we look back at this timeline, we have almost come full circle. We are in a time where employees are seeking to take better care of themselves. Less and less are we seeing people sneaking off campus or smoking in their cars. But we must continue that push, not only while they are on campus, but while they are at home. Smart wellness program design, communication, incentives and technology will all play a huge part as we adapt and grow. I’m excited to be a part of the ride.