By Eric Zimmerman, Chief Marketing Officer, RedBrick Health
A recent survey of employers with more than 500 employees confirmed what many of us expected to see—a continuing rise in outcomes-based incentives programs.1 Our own survey research shows a strikingly similar trend among employers with more than a thousand employees: Many are moving to outcomes-based designs.2
It seems like a logical assumption is being made here—outcomes-based models that tie rewards to key behavioral and biometric results are likely to produce better biometric outcomes.
But is there evidence to back up that assumption?
We recently reviewed the year-over-year program results of over 80 reward designs that reached nearly 500,000 individuals. We divided the sample into four reward design types:
Here’s what we found. Engagement levels were positively associated with improved biometric outcomes. So were reward levels. (In fact the two are highly correlated, so it’s likely the effect of rewards is really the lift they create in engagement.) However, we could find no statistical evidence that participants in outcomes-based models achieved better outcomes than those in other models.2 That’s not to say it isn’t there—we just didn’t see it in this large sample.
So the answer according to this analysis is no, outcomes-based designs do not produce better outcomes than participation-based designs. That may be a relief to those who’ve felt pressure to join the trend toward outcomes-based reward designs, but were concerned about backlash.
The takeaway: If you’re going to focus on one thing, focus on what gets you real engagement in your population, whatever that might be. It’s engagement that gets you results.
1Gene Baker, G., Dermer, M., & Wolfsen, Brad. (2015, April 29). 2015 bswift Benefits Study Preview: Wellness and Incentives [Webinar]. Retrieved from http://ebn.benefitnews.com/media/newspics/ebn_bswift_042915.mp4
2RedBrick Health, Analysis of results by reward design, 2013 to 2014.
Part 3 of a 3-part series
By Nathan Barleen, Director of Research, RedBrick Health
In parts 1 and 2 of this series, we presented the case for choice for engaging individuals in their health and the role choice can play for those with chronic conditions. In this post, we’ll talk about how different segments of consumers respond to different options when offered in a choice-based health management model.
Choice allows individuals to exercise their preferences. Traditional and online merchants have studied the differences between customer segments for years. Merchants know that different marketing approaches and product types appeal to different individuals. In order to maximize sales, they often organize choices in a way designed to appeal to each segment of their audience.
Consumer engagement in wellness activities can be approached the same way. We set out to learn how different types of individuals choose to engage in wellness programs. We found that some characteristics of our consumers, like age, location, company type and geographic region, were predictors of how these individuals responded to wellness program options.
When we controlled for differences in incentives and communication we found some interesting patterns with respect to who chooses phone coaching, who selects a virtual coaching experience, and who prefers simply tracking daily habits.
It takes more than apps and wearables to reach all segments of the population
Given the choice, most of our participants selected a digital form of health engagement, but some opted for the support of a live coach. We found that those who chose to work with a live coach were more likely to be:
In contrast, our digital users (including our virtual coaching users) tended to be younger, work in a white-collar setting, and live in mid- to upper-income suburban or exurban neighborhoods. Our self-trackers (including those who chose to sync a phone app or wearable device) were our youngest users, and most likely to live in higher income and urban areas.
Seem like an intuitive finding? Maybe so. However, it’s important to recognize that the risk and healthcare cost distribution within many working populations skews toward those that, based on our research, prefer the live coaching option.
That’s a core reason why we believe that a best practice population health model offers choice, including the options to work with a coach, use a virtual coaching app or track daily activity with integrated devices. Limiting engagement options may make the path to wellness more difficult for some consumers—and some may not get on the path at all.
By Dr. Jeff Dobro, RedBrick Health Chief Medical Officer
The upward trajectory of healthcare costs has given rise to a debate about the value of annual health screenings. Are they really necessary? Do they surface enough potential medical issues to outweigh the costs of screening an entire population?
At RedBrick, we’ve screened hundreds of thousands of consumers across the organizations we serve. This experience, along with the evidence we’ve gathered, has convinced us that periodic health screenings as part of a workplace health and wellness program make sense.
Screenings can help to:
We recognize that the USPSTF and other professional organizations have very specific recommendations based on each individual’s specific health status and risks that differ from a yearly screening, yet highly personalized screenings are not practical or cost effective for large populations. Identifying common and costly risks is the first step toward increasing the overall health and well-being of your population.
Find out about RedBrick’s screening options here.
June 24th, 2015
Karin Bultman, RedBrick’s vice president of market development, participated on a recent panel at the Health Access Summit. The following is based on her presentation titled “It’s How You Say It” – Strategies for Optimizing Health Communication and Engagement. Karin offered the audience the top 10 things RedBrick’s learned about crafting engaging health communications so audience members could consider them for their own programs.
We know you invest a lot of time and money communicating health and wellness initiatives to your consumers. But are those messages helping you meet your goals? How do you ensure your communications are effective, engaging, and inspiring your consumers to better health?
The recently retired David Letterman made the Top-10 list an institution. We’re continuing the tradition with our own list, Top 10 tips for creating engaging consumer health communications:
And the number 1 tip for communications that engage and inspire consumers…
Have your own tip to share? We’d love to hear it.
At RedBrick Health we like to do what works, rather than what’s traditional. And—as it turns out—choice works. Visit the post to learn more.
Part 2 of a 3-part series
By Dr. Jeff Dobro, Chief Medical Officer, RedBrick Health
In part 1 of this series, we presented the case for choice for engaging individuals in their health. We found that by putting the person back into the personalization—letting individuals select their own healthy activities and way to interact—we were able to find equivalently strong impact on health results regardless of the choice between live coaching, virtual (or digital) coaching, and self-tracking.
In part 2 we focus on the segment of the population with chronic conditions—a group that can comprise up to 20% of the typical working population and drive up to 80% of total healthcare costs.
A traditional health management stratification design would focus on recruiting these high-risk, high-cost individuals into intensive phone coaching, and specifically into a disease management intervention. At RedBrick, we do condition management, but we let consumers choose where to place their focus. Why? Choice allows them to exercise their preferences and taps their intrinsic motivations—like improving appearance, living longer to see their kids and grandkids grow up, boosting energy, or fitting into a smaller size—that encourage engagement.
And, as it turns out, given the choice, 80% of those with a chronic condition choose to focus their coaching experience on a lifestyle issue—like nutrition, exercise, weight loss or stress. And we let them. By using a whole person approach we avoid the pitfalls of treating people as disease states, risk factors or body parts. We start with what’s relevant for them and consistent with preferences and intrinsic motivations.
Is this “choice architecture” driven approach clinically defensible? We think so. Key clinical topics are covered on every coaching call: Medication compliance and condition monitoring, working effectively with your doctor, self-management plans, health education and overall well-being. We make sure to weave in a call with a nurse to review their condition in detail during at least one out of four coaching sessions And, somewhat paradoxically, by letting people choose their focus, we end up coaching three times as many people on issues that are still highly relevant to their condition, and four times as many people in total. Using our small steps approach, we build upon each small success and drive a much broader level of clinically-relevant results than a standard disease management approach.
As it turns out, health improvement isn’t a linear process. Lifestyle habits affect chronic conditions, and a change in a chronic condition will, in turn, impact day to day lifestyle behaviors. Getting more active reduces weight, which helps mitigate blood pressure, elevated cholesterol and diabetes. Psychologically, making a single, small improvement builds self-efficacy and making consistently healthier choices helps re-shape self-perception.
When it comes to helping individuals better manage chronic conditions, start with choice.
In part 3 of this series, we’ll explore how different populations respond to different engagement modalities—and why to avoid a “one-size-fits-all” approach.
May 15th, 2015
Part 1 of a 3-part series
By Eric Zimmerman, Chief Marketing Officer, RedBrick Health
At RedBrick, we’ve been saying for years that creating consumer ownership of health means providing strong, data-driven guidance, but ultimately letting consumers make choices. This idea may sound logical, but surprisingly it flies in the face of conventional health management models. Conventional wisdom says use risk data to identify and stratify populations and select the intervention for the consumer. Those at higher risk get phone coaching. Chronic illness? Disease management. Everyone else? Offer low cost portals, newsletters, self-trackers.
While it seems logical to stratify populations by risk level and to focus the more costly interventions on those at higher risk, the approach leaves someone out of the decision process: The consumer. But can a choice-based model produce real outcomes?
We recently completed a large-scale study to find out.
Our study focused on nearly 50,000 consumers whose baseline biometrics placed them at elevated risk due to either elevated Body Mass Index (BMI), blood pressure or non-HDL cholesterol. We defined success as year-over-year clinically-meaningful improvement in these objective measures.
Instead of following the traditional health risk stratification model, we used data to offer a bounded set of pre-prioritized choices, applying a core principle of behavioral economics called choice architecture. We recommended three personalized focus areas—like stress, nutrition or a health condition—but didn’t limit people to focusing on their highest risk or chronic condition. And we let individuals decide how they’d like to engage. They could choose a convenient digital coaching (online) option within their chosen focus, they could opt for the use of a digital daily activity tracker that connects to popular apps and wearable devices or they could take advantage of the opportunity to work one-on-one with a behaviorally trained coach on the topic of their choice.
Conventional wisdom would suggest that the more resource intensive phone coaching would produce superior results. However, we found a different, and somewhat surprising, result: When consumers were allowed to choose their intervention focus and modality, they achieved clinically meaningful improvements at almost identical rates. Live phone coaching worked. So did digital (online) coaching. As did online self-tracking with connected apps and devices. No modality outperformed the others.
What does this finding mean? Our view is that it means choice works: It produces better engagement and stronger personal commitment. It lets people start where they are, rather than where a risk-streaming algorithm suggests they should be. In other words, it puts the person back into the personalization.
In Part 2 of this story, we’ll look specifically at those with chronic conditions and the impact of choice within coaching on the level of engagement in condition-relevant coaching.
Helping people be healthy is our motto. Every day we imagine, design and build technology to help our clients provide an engaging environment to foster better health, and we couldn’t do it without the wealth of industry knowledge and experience of our RedBrick Health employees.
One such distinguished personality is Susan Bailey, Director of Client Services. While often seen in our Minneapolis headquarters, Bailey is based in Michigan and provides strategic consultation for both RedBrick Health clients and the non-profit Michigan Wellness Council. In 2015-2016, she will lead the board as Michigan Wellness Council Chair.
The Michigan Wellness Council partners with local employers and the state to bring successful wellness best practices to the workplace, operating as a hub of quality resources and forums. Bailey has been working with the Michigan Wellness Council in a variety of roles for eight years, and is excited to start her first two-year term as Chair.
Congratulations, Susan! We’re excited here at RedBrick Health to see your next steps as a leader in the health and wellness industry.
Learn more about the Michigan Wellness Council here.
On Wednesday, October 8th, RedBrick Health hosted almost 50 health and wellness leaders from Minnesota’s largest employers, consultant groups and other influencing organizations. We invited these movers and shakers to a panel discussion focused on the key drivers of health engagement in a rapidly changing healthcare environment.
We were pleased to present four panelists with distinct industry perspectives about what health engagement means:
· Ken Paulus, CEO at Allina Health, provider lens
· John Naylor, Commercial Market SVP at Medica, payer lens
· Jeni McGill, from the benefits team at Cargill, employer lens
· Sean Wieland, a Piper Jaffrey senior analyst, industry lens
Each panel member introduced their organization and background, provided insight into what health engagement means for them and described the unique and active initiatives they are pursuing to improve health, contain costs and stay relevant. As host and moderator, I had the pleasure of taking the panelists and audience through a series of questions that inspired exchanges around the room. We look forward to providing you key insights, audio and video from the event in the coming weeks.
As a part of the event, we hosted a social hour at RedBrick Health headquarters, where we were able to connect with customers, meet new contacts and tally the number of steps taken with our attendees’ new FitBit® devices. A huge thank you to President and CEO of YMCA of the Twin Cities Glen Gunderson, who was on hand to receive our donation based on the millions of steps attendees took from registration to reception!
Feedback from our attendees has been positive, fueling several requests to host more events going forward. We’re looking at making our Thought Leadership Series a regular event, perhaps coming to a city near you.
A sincere thank you to our distinguished panelists and all of our sharp and focused attendees for making this event such a success.
Kurt Cegielski, Founder and SVP of Employer Solutions at RedBrick Health