The Kaiser Foundation recently published a survey that indicates that wellness programs aren’t showing a return on investment.

What wasn’t included in the study were reasons why wellness programs aren’t showing a return. After having many discussions with clients on their frustration with low participation and on-going engagement rates, here are my thoughts on why wellness programs aren’t showing a return.
• There has been a prevailing philosophy that offering wellness services should be enough to motivate individuals to want to participate in them. While many people start off with good intentions of wanting to participate, often times a little thing called life gets in the way and the demands of work and family begin to take precedence over working out, eating right, taking time to relax etc…
• Too many programs are focused on front-end participation and there is not enough emphasis placed on continuous dialog, intermittent communications.
• Too many organizations have subscribed to a one-size fits all model for rewards instead of applying behavioral science tenets to better align wellness incentives and rewards to actual program design and specific segmentation strategies.

For wellness programs to really work and really change behavior the program has to be meaningful and motivating and stay top of mind. Where wellness programs further tend to fail is in not answering five key questions for participants:

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 IS IN IT FOR THEM?
5) HOW ARE THEY DOING?

The last two questions are emphasized because they are the most common points of failure in wellness programs. Unfortunately, we live in a “what’s in it for me society” and the best way to motivate individuals to do something is to offer them incentives and rewards. Through the use of strategic incentives and intermittent communications that are segmented and personalized, behaviors begin to slowly change and new habits begin to be adopted.

First it was Disease Management, then it was Case and Utilization Management. Give health insurers credit for initiating various support services to try to help patients manage their health and gain access to the appropriate health services. The problem has been that very few of these methods have actually resulted in better health outcomes and lower costs, primarily because these programs are restricted to relatively small population sizes and because these programs often identify a participant after a catastrophic event has occurred.

Fast forward a decade and you see health insurers and employers alike focusing their efforts on wellness programs. According to a Maritz survey, the number of formal wellness programs have increased from 35 to 42% from 2006 to 2008. Health insurers and employers are hoping that by offering wellness programs, employees will improve their health and become more productive, decrease absenteeism, presenteeism and lower healthcare costs.

The question remains …will wellness be the answer to reducing healthcare costs and improving the overall health and productivity of individuals?

There has been quite a bit of debate about the subject of consumerism in healthcare and what it means in the healthcare market. By all indications, it appears as though certain characteristics of consumerism are taking hold in the healthcare market. Countless surveys, including Deloitte & Touche’s Consumerism Survey indicate that consumers want and are ready to take on more decision-making responsibility for their healthcare decisions and how they buy services. So what does that mean to the healthcare market? How prepared are healthcare providers to deal with consumerism? Do healthcare providers understand what consumerism and the characteristics of a consumer-centric marketplace mean for their business?

I recently attended an interesting webinar hosted by Deloitte & Touche Consulting regarding consumerism in our health system. While many believe that consumerism is slowly making its way into the health system, D&T concludes that traditional characteristics of consumerism already exist in our healthcare market.

The healthcare market is unique in that not all of the knowledge or decision making actually resides with the consumer. Employers usually choose a health insurer for employees, health insurers determine what physicians and drugs will be covered and physicians determine the best treatment strategy for a patient. Very little data exists that provides information around cost, quality and value – attributes that consumers typically use when purchasing goods and services. Yet there is a movement occurring as employers continue to encourage employees into Consumer Directed Health Plans (CDHPs). The thinking is that if consumers share more of the out of pocket costs while also having more control of healthcare dollar spend that they will become more responsible consumers of health services. And while that may be logical, the question remains as to whether consumers have access to enough data, information and health/disease knowledge to make good decisions on how they consume health services. The question remains…will consumers make appropriate decisions about how they consume health services or will there be a risk that additional out-of-pocket costs will create a disincentive for consumers, who may then “hold” off on seeing a doctor until it is absolutely necessary, potentially leading to catastrophic events? This in effect may undermine the entire objective of making individuals better consumers of health services.

What do you think? Is true consumerism really present in the healthcare system?

Do you find it as perplexing as I do that although healthcare is a national topic this election season, the focus of the candidates continues to be on only half of the equation – access and affordability? While both issues are important given the number of uninsured and underinsured, there seems to be very little discussion regarding the plan to keep our nation healthy through more proactive and preventative care. Because a significant percentage of chronic diseases are driven by lifestyle choices and behaviors and chronic diseases are the primary contributor to continuing escalation of healthcare costs it should have more of a focus within the candidates’ healthcare agendas. The lack of focus on wellness and establishing a “healthy” nation is a glaring omission in the health reform agendas of our politicians and yet it is a hot topic of discussion for employers and health plans alike.

Employers have long footed the majority of the cost of healthcare consumption for their employees. As costs have continued to increase, the aggregate effect has eroded corporate profits and impacted employers’ abilities to remain competitive. Logically it makes sense….healthier people cost our health system less money and increase productivity. As a result health plans are being tasked with identifying methods for reigning in healthcare costs. The market has determined that an emphasis on coordinated, preventative care is the best solution to driving down healthcare costs. If that is the case, why doesn’t wellness have a more prolific position in the health reform conversations during this election season?