I recently read a whitepaper by Hummingbird Health entitled Why Wellness Programs Fail and it got me to thinking about some additional observations I would make on why programs are not optimized as they should be. The whitepaper highlights some key failure points that are consistent with what I see when helping clients assess why their program isn’t delivering the results expected.

- The wellness movement has to start at the top. Executive management needs to embrace wellness as a business imperative not a “nice to have” and they need to live to that mission.
- Know the demographics of the workforce. Demographics are one key data point that help in disseminating the appropriate communications and rewards but I would suggest going a step further in taking the pulse of your population and their readiness for change. Understand what they expect, prefer and what types of tools, communications and rewards may actually engage them in the collective process of adopting healthier behaviors.
- Serving all employees. Understand the health of your workplace. Sounds easy enough but I am continually amazed at how difficult that is for organizations.
- Lack of communication. This is probably the single biggest reason that I would say wellness programs fail. There is not enough budget or emphasis given to the importance of communication either in content or frequency. Effective communication continues to reinforce attention on the wellness movement and it answers five key questions that employees continue to have: 1) what do you want them to do 2) why do you want them to do it 3) how do you want them to do it 4) what’s in it for them and 5) how are they doing.
- Scrimping on costs – spend money to save money on healthcare costs. I couldn’t agree more on this finding. Too often an organization tries to cast too broad a net and spreads investment dollars too thin with the result being a rather disjointed and haphazard program with very little strength to drive change. Make the most of those investment dollars and focus them on a couple of objectives with the idea that you can always phase in more services and interventions after the wellness movement picks up momentum.
- Goals – make them measurable. Begin with the end state in mind. What will be your measure of success in your wellness movement?
- Know the bottom line. Understand the impact of your workforce’s health on corporate productivity, value and profitability. At Maritz we call it the lifetime value of an employee.

Creating a wellness movement in an organization takes time, resources and investment. The last thing that you want is for it to fail. Taking some of these observations to heart may help in mitigating the risk of failure.

Last week my company presented a webinar on Health and Productivity Strategy with an emphasis on the “motivation” factor or what it takes to truly rewire the brain to change behavior. Since then, I have had numerous conversations with audience members on our Whole Brain Philosophy and the need to strategically integrate wellness rewards with strong communications, social networks and gaming in order to truly engage individuals in the behavioral change progression. The discussions have centered around Maritz framework of focus, repetition and reinforcement in order to rewire the brain.

Some very enlightening observations have come out of those conversations such as:
- There are opportunities to better integrate health management services with stronger motivation strategies to fully derive the benefits of your health and productivity investment.
- A critical component seems to be lacking in most health and productivity programs - communication.
- Health incentives are being used but not as strategically as they could in order to reinforce new behavior adoption
- Understanding your population in terms of ensuring appropriate rewards options, health support services and communication support is just not happening

The result of this is disjointed health and wellness programs that are not really promoting behavior change. The one issue that continues to stand out to me as a challenge for organizations is in communications. I continue to see programs that front load the communications about health and wellness benefits during open enrollment but there are little to no communications pulsed throughout the year to keep the health and wellness program top of mind. The focus on the program is non-existent. The other ramification of not communicating throughout the year is that employers are missing an opportunity to recognize how their employees are doing with their wellness goals. The repetition and reinforcement are virtually non-existent.

In thinking about your wellness program, it is very easy to focus on the health services piece and then the incentive strategy but the importance of a robust communication strategy can’t be overlooked as a critical success factor.

Note to health plans: if you are offering health and productivity incentives for members to use health tools and services … make sure to pay them out or it could really impact your members’ feelings of goodwill and loyalty.

My health plan recently launched a health and wellness program with a great amount of enthusiasm and fanfare. To go along with what looks like some wonderful health services, the plan was also offering some intriguing and exciting wellness incentives and rewards for participating, staying engaged throughout the year and providing feedback on their program.

Sounds great doesn’t it? The first order of business was to take a Health Risk Assessment and earn a $100 gift card. Given that I am very focused on proactive healthcare and preventative maintenance (because of what I do for a living), I immediately called the 800 number and energetically informed them that I wanted to enroll in the new Health & Productivity program. This is what I heard, “I am sorry, but you are not eligible for this program. In fact you aren’t in our database as even being a member of our plan.”

I ask, “How could that be? I have my member card with my member ID and I just received a packet with all of the wellness program information.” I was then told that they would have to escalate this for further investigation … that investigation took 14 days. Ten calls later and many chats with “managers” of my health plan it was indeed confirmed that I was a member and eligible for the health and wellness program, however, there was one day left for me to take the Health Risk Assessment and receive my $100 gift card promotion.

I immediately took the Health Risk Assessment and awaited my gift card in the mail, dreaming of the things that I could do with that gift card – a nice 90 minute stress relieving massage … aahh. I waited and waited for weeks and then months. Finally, I called my health plan again and inquired about the status of my gift card only to be told that even though I had completed the HRA, the information was not received until the morning after the promotion ended and therefore I didn’t qualify for the gift card.

The long and short outcome of this story: I will never participate in my health plan’s wellness program again Instead I will stay healthy my own way, and if I have a choice to change health plans, you can bet that I am going to do it in a heartbeat.

Hewitt Associates recently published a survey on what to expect in healthcare in 2009 and the news is not pretty. With average raises hovering somewhere between 0-2%, the average healthcare premium is expected to increase 8.9% - well above inflation and salary increases. Yet, employees will continue to see more of the cost burden shifted to them in their benefits this year. I am no mathematician but it doesn’t take much to clearly see that this isn’t sustainable for employers and employees alike.

Health plans and employers must find ways to reduce these costs and employees have to become an active part of the solution. In a recent post, (link to the Employers Role in Health) I discussed the fact that only 12% of employees felt that employers had a role in educating and encouraging them to be healthy. That number must increase if we are to collectively stem the skyrocketing costs of care. Obviously the entire system contributes to these cost escalations, but employers and health plans can act as the catalyst for reshaping their organizations by making the right investments in wellness programs that become part of the organizational culture.

Once again, the key challenge for organizations is driving participation and engagement in these programs in order to encourage healthier habits and decision making. Health Risk Assessments are no longer good enough. While incentive and reward programs are focused right now in trying to drive initial participation and engagement, I wonder if organizations should start getting bolder with their incentive and reward strategy by offering meaningful rewards for health outcomes as opposed to participation. Have we reached a point where organizations need to push the envelope in thinking more about what is driving these costs up – inappropriate utilization and poor health outcomes and engage individuals in proving that they can indeed be healthy and recognize them for such an accomplishment?

An interesting survey by Hewitt Associates came out regarding the role that employers feel they must play in keeping the workforce healthy versus the role that employees see their employer playing. Below are some interesting sections from the report:
• The number of employers who say they will get more directly involved in managing the individual health of their employees jumped 25 percent from last year, reflecting a nationwide trend to find more ways to save money in a tightening economy.
• For the first time, keeping employees healthy was named as one of U.S. companies’ top business and workforce issues this year.
• But while companies believe they need to get more involved in keeping their workforce healthy, employees are less convinced.
• 75% of employees think that employers are responsible for helping them understand how to use their health plan, just 12% believe that companies have a role in helping them understand how to stay healthy.
• 88% of employees claim they engage in healthy behaviors, but when asked about specific steps they take toward living healthy, less that half actually take appropriate actions to reinforce the claim.

Wow. The statistic that stands out to me is that only 12% of employees believe that companies have a role in helping them understand how to stay healthy. That is a huge hurdle that employers need to tackle before they can expect wellness programs to work. I believe that Tim Stebtiford, principal of Hewitt Associates Communications practice, summed it up best when he said, “Companies need to stop communicating and start motivating. People don’t like to be told what to do and with a mind numbing array of Web sites and brochures from their employer, they often just tune out.”

There lies the opportunity. If employers are going to address the skepticism that employees have about their role in encouraging healthy behavior, why not use a strategic incentive and communication solution to begin to engage their employees in their wellness programs. It is apparent from this study that simply building and offering wellness services are not enough to entice employees’ participation. Employers must establish a trust factor and find methods to energize and motivate employees to use these services. Wellness incentives could and should be the next investment employers make to mobilize their employees to utilize the wellness services.

What are your thoughts on these findings and how employers can reposition their role in helping employees understand how to stay healthy?

A study released by Blue Cross and Blue Shield of North Carolina indicates that companies offering comprehensive wellness programs can realize an approximate cost savings of 25% in medical and absenteeism in about 3.6 years after implementation.

I find this study interesting because it speaks to some of my earlier posts that discuss the whole-brained approach that Maritz employs in the health and productivity solutions we deliver to clients. The bottom line is that human beings are complex individuals and that asking individuals to adopt and consistently act on new health behaviors is a very personal journey that requires time and continuous reinforcement.

Blue Cross and Blue Shield of North Carolina further discusses the mindset change employers are embracing – less cost shifting to drive behavior and more health services and wellness offerings to drive healthier outcomes.

The key to seeing this type of cost savings resides in a highly integrated approach to supporting the participant. Obviously, the wellness offering needs to include a wide variety of offerings and campaigns that keep it fresh and top of mind with participants. As I mentioned in a previous post, communication around five questions that participants want to know is critical:

1) What do you want me to do?
2) Why do you want me to do it?
3) How do you want me to do it?
4) What’s in it for me?
5) How am I doing?

Organizations tend to either neglect or take a prescriptive approach to questions four and five. The result: poor participation and engagement rates. Organizations that want to see 25% cost savings need to consider incentives and communications to be equally important investments in their comprehensive wellness programs.

The following are critical elements to ensure a successful wellness program:

Assess – understanding your participants, what motivates them – both from a rewards and recognition perspective – and how they want to be communicated with, as well as the current realities of your health & productivity program.

Design – the program must be both fair and fun, taking into consideration your unique member population, what is realistically achievable and the ability to measure results along the way.
Educate – timely communications that don’t just take place at the launch of the program, but throughout its lifecycle so that health insurers can help members understand the importance of achieving goals and keep participants engaged.

Communications – ongoing reminders, feedback and recognition, using multiple media, taking into account member preferences, also are key to member engagement.

Measurement – helping members understand how they are doing individually as well as understanding the success the overall program will help both members and program managers make the necessary tweaks to stay on track.

Management – ensuring one person and/or partner is managing all aspects of the program is vital to its success.

Rewards – providing personally meaningful, memorable and motivating rewards are the crux of all successful motivation programs, especially wellness programs because the required behaviors are new, challenging and difficult to sustain.

I came across an interesting article in the Kansas City Star regarding corporate wellness programs impacting the bottom line. According to Hewitt Associates, 88%of companies it surveyed this year “plan to make investments in longer-term solutions aimed at improving the health and productivity of their work force over the next three to five years, up from 63% last year.”

Even more interesting to me is the fact that Health2Resources (http://www.health2resources.com/) this year calculated that 80% of survey respondents more than broke even with their investment in wellness programs. Yet, what my organization is seeing in the marketplace and where we see clients struggling the most with these programs is how to gain the awareness, participation and ongoing engagement in wellness programs. It truly seems as though organizations that have been able to break even or calculate an ROI of $3 to $1 have been few and far between.

Why is that? Perhaps it is due to what many of my clients are struggling with – I call it the “wellness cliff.” People start off the program with good intentions and a commitment to participate, but then two things happen:
1) Employers and health plans that have invested a lot of time and money communicating an awareness about the program stop communicating (usually due to budget constraints).
2) Employees have a little thing called life that tends to interrupt their good intentions and without continuous communications wellness activities begin to slide down on their priority scale.

If the trend continues as the Hewitt Associates survey indicates, health plans and employers are going to need to develop strategic methods for continuing to engage people in their programs. While it may sound altruistic, shouldn’t living a long and healthy life be enough to engage people in using services that will help them? The reality is that while it seems like an obvious benefit, we live in a more instantaneous gratification world where “what’s in it for me?” really does motivate people to take action.

If employers and health plans are going to reap the $3 to $1 ROI benefit on these programs, using interventions such as personalized one-to-one communications and memorable, meaningful rewards that touch an individual’s intrinsic motivators will be critical to success. The use of a blended rewards strategy to truly engage participants in the program and actually continue to take them down the path of committing to healthier decisions and behaviors will continue to be a necessary component of a health and wellness program. Why you might ask? Because the natural human instinct to adopt very personal lifestyle changes is starts with most people asking what’s in it for me? The natural human instinct is that accomplishments are met with recognition and recognition continues to feed motivation.

In 2007, 75 percent of employers surveyed said they offered a corporate-sponsored wellness program. Many of these programs are in their infancy and involve employees or members filling out HRAs in return for cash or a gift card. This simple “do this, get that,” approach works well for a basic type of wellness program. However, as the pressure to greatly reduce healthcare and lack-of-productivity costs increases, health insurance companies are launching the next generation of wellness programs. These programs include personalized health coaching, disease management, preventive care education and outcomes-based tracking. The programs are ongoing, require continuous engagement on the part of members and, when successful, have a significant impact on both healthcare costs and outcomes.

As they roll out next-generation health & productivity programs, health insurance companies are discovering two important hindrances to the success of these more complex and sophisticated programs: 1) members aren’t motivated by the promise of longer, higher-quality lives and 2) prescriptive one-size fits all incentive rewards alone do not engage members long-term.
But, why aren’t people simply motivated by the knowledge that they will lead healthier more productive lives? And, why don’t incentives sweeten the deal? The answer is simple: because our brains don’t work that way.

Change is hard and doesn’t happen overnight. According to the authors of “The Neuroscience of Leadership,” changing one’s behavior is actually painful, causing physiological discomfort. The authors describe how hard the brain must work to remember a new behavior and must rewire itself to make a behavior become a habit. The most important and relevant of the authors’ findings is this: One-time incentives or punishment, or single instance communications and training are not enough to establish brain wiring for a behavioral habit.

The “build it and they will come” mentality has been the cornerstone of disease management programs and health and wellness programs for quite some time. The belief was if health insurance providers and employers offered these health services members would naturally see the long-term benefits that could be derived from adopting healthy behaviors and would naturally utilize the health services and programs offered. The reality is that health and productivity programs and services are not living up to their potential, with the majority of programs experiencing less than 25 percent participation rates. The culprit? Low awareness rates, a prescriptive one-size fits all approach, poor communication and very little on-going engagement strategy.

A recent study from Maritz Research found frequency of participation virtually unchanged from 2006 to 2008, despite a seven percent increase (moving from 35 percent to 42 percent) in the prevalence of formal corporate programs. While wellness programs engender goodwill among employers and members, their true purpose – improving people’s health and productivity – is lost when people fail to participate.

Maritz Research 2008 Employee Engagement Study

Note:  All percentage differences are within the expected range of sampling error

As a result of low participation rates, both health insurance companies and employers have begun implementing incentive and communication strategies to encourage participation and engagement in health service offerings.

However, while incentives may motivate some initial participation, simply offering a prescriptive one-size fits all incentive offering will not be enough to create a sustained commitment to healthier behavioral change. If a health insurer is to truly reduce healthcare costs and employers are truly committed to strengthening their best asset, their people, the mindset around wellness programs has to evolve. Health insurers and employers alike must recognize that truly changing behavior will require a long-term commitment on their part and a strategically designed wellness support structure coupled with a strong incentive and communication strategy that touches the intrinsic motivators that all individuals have and continuously answers the most pertinent question participants want to know – “what is in it for me?” and “how am I doing?”