Is the definition of health engagement changing?

Karin Bultman

Karin Bultman

By Karin Bultman, Vice President of Market Development, RedBrick Health

In April 2015, we commissioned a survey to explore how buying patterns, program offerings and program design have adapted given the rapidly changing healthcare environment. This survey was a follow-up to a similar survey we sponsored in 2010. Our goal was to better understand benefits strategies around wellness and health management and how they relate to healthcare costs.

One of the things we were curious about was how employers are defining engagement. As wellness programs mature, is the definition of engagement evolving as well? Are employers looking for more than mere participation? And if the definition of engagement is evolving, how will this impact programs for employee health and well-being?
As it turns out, we did see the beginnings of a shift. While employers largely still define engagement in terms of participation, there is an increasing awareness of the importance of an attitudinal awareness of healthy living—and how this impacts employee health.

As part of our survey we asked respondents to characterize their organization’s definition of engagement in an open-ended response. They conveyed definitions of engagement that include employees:

  • Knowing their risk factors and take measures to maintain a healthy lifestyle.
  • Taking interest in learning how to have a better health lifestyle.
  • Paying attention to health messages and participating in healthy activities.
  • Working to improve quality of life through efficient health management.
  • Taking ownership of all aspects of health.


Given what we saw in the survey, and our experience in the day-to-day of employee health and well-being, we think it reasonable that over the next few years, the definition of engagement will continue to shift toward one that encompasses behavior change and improvement in health status. This continuing shift has ramifications for:

  • Which (and how many) programs employers should offer.
  • Reward program design.
  • Communications campaigns that need to reach all demographics and modalities.
  • Making getting healthy easy by leveraging social and community connections, and connected devices.
  • The link with health care delivery and how can wellness be part of the consumer and patient experience.


Yes, the definition of engagement seems to be maturing—and with this maturing will come the need to take a new look at the programs and options available to not only get employees on the path to wellness, but get them to a destination.

How does your organization define engagement? And is that definition changing?

See more survey results in our upcoming white paper, Employee Health Management Comes of Age, on

The seven key principles of health behavior change (and how technology empowers them)

Eric Zimmerman

Eric Zimmerman

By Eric Zimmerman, Chief Marketing Officer, RedBrick Health

This post was adapted from an article originally published by the Institute for HealthCare Consumerism (IHC).

I first cut my teeth as a wellness program coordinator during my internship at the Mattel toy company. It was truly the dark ages of technology. No Web. No smartphones. No social media. We scanned HRA questionnaires through optical readers and gave out printed reports. We delivered classroom educational programs and one-on-one counseling. We staged worksite challenges and tallied team data by hand into leaderboards.

Indeed, we lacked the high-tech tools that make up the modern wellness arsenal.

Fast forward to today. So much has changed. But let’s start with what’s stayed the same. Behaviors—inactivity, poor nutrition, inadequate coping skills, spotty treatment adherence, use of tobacco and other substances. What’s more, there’s greater financial responsibility in the face of an increasingly complex and still weakly coordinated healthcare system, driving the need for greater “healthcare consumerism.”

So is technology transforming the delivery of worksite wellness? Clearly it is. But not just because it lets us reach people faster and cheaper, or create cool stuff. It’s because we can put into practice powerful principles of behavior change in a more scalable and effective way—and make it more fun at the same time.

Here are seven key principles we use to guide the consumer experience, and how technology powers them.

  1. Know who you’re talking to, not just what you’re talking about. It’s not about educating or motivating, it’s about tapping existing motivation. Use technology to capture what moves each individual and use it in creating your experience.
  2. Get small. The classic educational paradigm teaches, encourages goal setting and relies on information to drive action. The new paradigm uses technology to get you to commit to very small steps. Why do small steps work? They help ensure success, which boosts confidence and creates momentum, moving you closer to your goal.
  3. Put the person back into the personalization. Don’t focus so much on tailoring content, but rather on using technology to give you a few relevant choices. Think Amazon, Netflix, Pandora. Get people active in the design of their own health journey.
  4. Give a nudge. This is where mobile technology shines. As people commit to each small step, use data-driven, automated triggers, tuned to individual preferences and schedules, to gently trigger desired behavior.
  5. Measure what works and iterate. Not all small steps are created equal. Use technology-captured performance data to tune experience. Enable the things that work—for individuals or groups of like individuals—to be served up more often.
  6. Make it social. You don’t need to create a new social network for health (though you can). The family dinner table can be a powerful network. Let people engage those who matter most—via Facebook, Twitter or simply email—with each step.
  7. Create fast feedback loops that reinforce. Humans don’t come with dashboards. Fortunately, an explosion of personal technology helps close that gap. Let people link to an array of personal devices—wearables, apps and smartphones—to essentially create a coach-in-your-pocket to reward and reinforce your progress.

Is it technology that’s making the difference? Yes, in that it’s powering smarter design based on a more informed view of how behavior works. Does it work? We’re seeing the rapid growth of a rich data set that suggests it does. And we’re just at the beginning.


Be mindful. It’s practical.

Sanna Yoder

Sanna Yoder

Part 2 of a 2-part series
By Sanna Yoder, Senior Director, Content Strategy and Behavior Design, RedBrick Health

In part 1 of our series, we introduced mindfulness as a practical solution to address the stresses of everyday life and discussed a few mindfulness practices. In this post, we’ll introduce a few additional mindfulness techniques, including one from Amit Sood, chair of Mayo Clinic’s Mind-Body Medicine Initiative.

Sood integrates elements from neurosciences, psychology, philosophy and spirituality to offer a scientific approach for stress management. His “Guide to Stress-Free Living1“ offers countless simple but profound exercises to reframe the stresses of daily life at work. He recommends a simple practice of joyful attention at least four to six times a day.

Here’s how it works: While your computer starts up, close your eyes and send an imaginary thank-you email to someone who’s helped you. While the traffic light is red, note of the shape and color of the cars around you. For just a few seconds, relax all your “frowning” muscles. Refocusing the mind, says Sood, helps cultivate flexibility of attention, allowing you to switch between a narrow focus and broad, relaxed attention at will.

At RedBrick, our coaches and our RedBrick Journeys® digital coaching program promote a practical approach to mindfulness that you and your employees can try right now with ideas like these:

  • Practice gratitude. Set a reminder for the same time each day to focus on three things you are grateful for.
  • Breathe. Take 4 square breaths: Breathe in to a count of four, then hold for a count of four. Breath out on four, then hold again for four. Repeat.
  • Visualize. For five minutes, close your eyes and visualize a vacation.
  • Simply wait. Next time you’re frustrated, pause 30 seconds before responding.
  • Start a meal mindfully. Take 10 deep breaths before lifting your fork.
  • Find a mindful app! Our own chief medical officer, Jeff Dobro, sets one of his smartphone apps to sound a calming chime at random times throughout his day.

Which one appeals to you most? Have you taken a “time out” today? If not, take one of these to your work group right now. Give them the immediate gift of a few moments of mindfulness—and over time, use these techniques to boost their resiliency.



1Sood, Amit, M.D., M.Sc. “The Mayo Clinic Guide to Stress-free Living.” Da Capo Press: Boston, MA. 2013.

Be mindful. It’s practical.

Sanna Yoder

Sanna Yoder

Part 1 of a 2-part series
By Sanna Yoder, Senior Director, Content Strategy and Behavior Design, RedBrick Health

No matter what the make-up of your population, there’s a cost-effective prescription for better health—one that may help lower blood pressure, reduce the effects of depression and anxiety and improve sleep. It may even help control cravings.1

It is called mindfulness, and it’s a practical solution to address the stresses of everyday life.

Mindfulness costs nothing but a few moments of time. It can be practiced anywhere. And while it can help employees feel better in the moment, it may even have a long-term impact, improving job performance, reducing turnover intention2 and increasing the resiliency of your work group.

But how do you “get mindful?” Or promote the practice in your work group? Do you have to carve out 20 minutes to sit and meditate? Do you need special training? Do you have to leave your desk or listen to a soothing voice? Do you have to close your eyes?

These are all valid aspects of being mindful, but sometimes, in the hectic pace of today’s workplace, they’re impossible. That’s why many mindfulness experts promote what author and scholar Karen Kissel Wegela calls informal mindfulness practices,3 or everyday activities that can support an attitude of mindfulness. Here are a few of her suggestions:

  • Simply pay attention to the sights, sounds, colors and movement around you in the moment.
  • Try neither too little nor too much.
  • Pay attention to what’s happening in your body.
  • Let go of distractions.

Rick Hanson, psychologist, best-selling author and senior fellow at UC Berkeley’s Greater Good Science Center, encourages a practice known as Taking in the good. Hanson asserts that the human brain is wired to be like Velcro® for bad experiences and Teflon® for good. It takes at least 20 to 30 seconds for a good experience to register, sink in and rewire the brain into feeling more relaxed, at peace, resilient and ready to take what comes. Focusing for 10, 15, even 20 seconds periodically throughout the day on a positive experience like feeling secure, feeling tenacious or expressing gratitude can reinforce the good.

Here’s a brief exercise from RedBrick Journeys® you can try right now:

Look at your cup of coffee—now imagine all the help that got it to you, from the farmer who grew the coffee beans to the artist who designed your mug.

A few seconds well spent. In part 2 of our series, we’ll take you through a few more mindfulness exercises you can use for an immediate impact on your day—or your work group.


See part part 2 here.



1National Institute of Health. “Meditation: What You Need To Know.” December, 2007. [downloaded from]

2Dane, E., and B. J. Brummel. “Examining Workplace Mindfulness and Its Relations to Job Performance and Turnover Intention.” Human Relations 67.1 (2013): 105-28. Web. 28 June 2015.

3Kissel Wigela, Karin. “Practice Mindfulness Without Meditating.” Psychology Today. Feb 18, 2010. [downloaded from]

Do outcomes-based rewards produce better outcomes?

Eric Zimmerman

Eric Zimmerman

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:

  • Participation-based models that rewarded members with dollars or points for completing a health assessment, screening or other behavior, with no tie to a healthy result.
  • Partial outcomes-based models that rewarded points or credits for biometric measures within a healthy range (subject to the availability of reasonable alternative standards), and also for participation in healthy activities.
  • Outcomes-based models that penalized those whose biometrics were not within a healthy range and required them to “earn money back” through risk-matched reasonable alternative standard activities.
  • Programs where there was no incentive or punitive outcome.


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
2RedBrick Health, Analysis of results by reward design, 2013 to 2014.

What works in wellness? Letting people choose.

Nathan Barleen

Nathan Barleen

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:

  • Over 50
  • Working in a manufacturing or service industry
  • Living in a lower income, rural area
  • Living in a Midwestern state

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.

Read more in part 1 and part 2.

To screen or not to screen?


Dr. Jeff Dobro

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:

  • Identify health conditions early. The obesity epidemic is driving higher rates of hypertension and diabetes and even worse, a significant percentage of people with these conditions don’t even know it. Screenings can catch these health conditions earlier, before complications and high costs occur. For example, we’ve seen very clinically-meaningful improvements in blood pressure in our studies, in large part because individuals with screening measurements outside a normal range are directed to seek medical treatment.
  • Encourage compliance with treatment. Regular screenings remind those with biometric risks about the importance of following recommended therapies.
  • Drive engagement. Screenings raise awareness of health risks, and are often the “call to action” people need to make a change in their health behavior.
  • Save lives. They bring to light biometric measures that are considerably outside a normal range so those individuals can be referred for immediate medical attention. Just measuring blood pressure is likely to save 2-3 lives per 50,000 people screened every year. Our consumer success stories include examples of individuals who were referred for immediate medical intervention as the result of a screening, in some cases with life-saving results.


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.

Top 10 tips for creating engaging consumer health communications

June 24th, 2015

team_Karin-BultmanKarin 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:

  1. Get your evidence together. Give your communications credibility. Accuracy and rigor matter. Agree on what sources are acceptable for your organization. Create your own, catchy “hook” supported by your evidence to attract the reader’s attention.
  1. Conduct A/B tests. Do mini-experiments to learn what works best for your audience. Try issuing the same email to two different groups using a different headline on each one to see what type of message gets you a higher open rate.
  1. Be trustworthy. Consumers need assurance that you know what you’re talking about. Some of the ways to instill trust include referencing relevant accreditations and recognitions, quoting respected experts and using citations.
  1. Provide appropriate context. Explain, in simple language, why the health information is important, especially when you’re requesting information from your consumers. Be aware that your audience might be sensitive to some health topics. Use both visuals and words for clarification.
  1. Test for reading level. Follow plain language guidelines, and evaluate text using built-in tools or other gold-standard tests. Know how to swap out or interpret challenging health terms so they’re more easily understood.
  1. Meet consumers where they are. Health behavior changes must fit into everyday life if participants are going to continue to follow them. Present flexible options with varying levels of difficulty, complexity or duration to encourage ongoing participation.
  1. Invest in localization. The language and culture of the recipient will affect how they interpret your message. Do multiple translation reviews and use idioms wisely to avoid confusion. Make sure to offer culturally appropriate options and suggestions.
  1. Include great visual design. Pictures boost comprehension. Incorporate illustrations and photos into your communication design—and make sure to do this as part of the original design, not as an afterthought.
  1. Listen to your consumers. Ask your consumers what they find engaging and useful. Gather this information using techniques like focus groups, surveys and comments. Make revisions based on what you learn.


And the number 1 tip for communications that engage and inspire consumers…

  1. Design for behavior. Don’t just tell consumers what to do. Give them reasons to act. Apply behavior theory and choice architecture. Tap participants’ intrinsic motivations. Build in social support and feedback. And most of all, don’t sound too serious or earnest. Make it fun—if it feels like a chore, consumers will eventually drift away.


Have your own tip to share? We’d love to hear it.

Traditional triage vs. choice: Put the person back into personalization to get better results in health and wellness

RBH-shoot_day2_EZ_15[1]Eric Zimmerman, chief marketing officer at RedBrick Health, is guest-posting on the Benefitfocus Blog today with additional thoughts on choice architecture:

  • What’s missing from traditional wellness program design.
  • Why you should make consumer choice a core element of your wellness program.
  • How to incorporate choice architecture to get better engagement – and how better  engagement translates to clinically-meaningful outcomes.

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.


What works in wellness? Letting people choose.


Dr. Jeff Dobro

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.

Read more in part 1 and part 3.

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