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.

A challenge that pharmaceutical companies continue to have in adherence programs that they bring to the market is driving initial participation and ongoing engagement in their programs without “inducing” the patient. Traditionally, adherence programs have been run through a combination of interventions that include the use of alternative coupons and vouchers, samples, patient starter kits, and loyalty programs. These programs have not been extremely successful as adherence continues to be a challenge. Part of the reason, I believe is that not enough patients are motivated by a co-pay deduction or a seven-day free trial of a drug to actually take action. In addition, adherence programs are front-loaded with communication when a patient initially opts-in, but then the communication all but disappears (I know this because I am enrolled in several adherence programs).

Similar to today’s wellness programs, pharma companies have to begin understanding the catalysts that will truly motivate patients to participate and engage in adhering to their medication. They need to find methods that tap into the intrinsic motivators that engage patients.

Companies should consider a more integrated adherence program that incorporates more of a loyalty premise that enable patients by offering a choice of rewards for staying adherent – ideas such as offering patients points for persistency. While there may be some discussion around getting close to the line of an inducement, the idea is that providing patients with points that they can then redeem for health related rewards offers what we call at Maritz “purposeful choice.” It essentially allows the patient to choose from rewards that are personally meaningful and may further engage them in maintaining adherence to their medication regime. Rewards could include items such as debit cards to be used on prescription refills or may include merchandise that helps them better manage their life around the disease they have.

Or better yet, why don’t health plans, who are actively initiating wellness programs, consider working with pharma or adopting these programs under their larger wellness strategy?

The discussion on wellness has reached a crescendo pitch. From bulletin boards, to hospital outreach, to employer and health plan sponsored programs, wellness initiatives represent a strategy for recalibrating how consumers think, act and decide about their healthcare activities. For some, it is a term that conjures up images of slow deep breaths, brilliant skin and tight abs. For others, it is just another thing to be added to the already long list of things to get done. So what exactly is wellness?

Physician Halbert L. Dunn first coined the phrase in 1961 in the publishing of a small book entitled “High Level Wellness.” Dr. Dunn saw wellness as a life-style approach to achieving an optimal state of physical and mental well-being. The philosophy he embraced was based on principles of personal responsibility and environmental awareness.

Beyond what I believe are the no-brainer activities around wellness: maintain a healthy weight, don’t smoke, exercise regularly, reduce stress and eat right, there are other behaviors that are not so obvious. Some of these are: taking vitamin supplements, regular check-ups, get plenty of sleep, mental health, and while it may sound strange, taking your medication as prescribed.

But wait a minute! Doesn’t it mean if I am on medication I am not well? If I was well, I wouldn’t be on medication. Makes sense, right? Not necessarily.

Medications are prescribed for a multitude of chronic medical conditions. The most prevalent are hypertension, high cholesterol and diabetes. Patients are told that they should take their medication as directed and for as long as medically necessary. Who could possibly want a stroke, heart attack or blindness? No one comes to mind, yet millions of people are acting in ways that could trigger one of these devastating medical events because they self-medicate or in situations where they have an asymptomatic disease, they may stop taking medication all together.

There have been many industry studies completed that have gained insight on why patients discontinue their medication for chronic medical conditions. Financial hardship, no prescription plan, negative side-effects, laziness, patients reported feeling better and even denial that it is needed. Without the medications, these patients are no longer healthy. Decreased medication adherence increases hospitalizations and total costs of care. They have not achieved an optimal state of physical or mental health as called for by Dr. Dunn.

Not taking medication correctly or self-medicating actually impacts the full benefits that patients derive when taking their medication correctly and it can’t be underscored the importance that medicines play in helping to control and maintain health. In order to understand how they relate to an individual’s personal responsibility in their overall wellness, one must look at the definitions. Compliance and adherence is defined as the extent to which a patient’s behavior coincides with medical advice. This behavior includes modifying habits, taking medications, attending clinics or health fairs, changing eating habits and nutrition. Persistence is the continuation over time of the medication therapy. In other words, is the patient taking the medication for as long as medically necessary?

From these definitions, one can see the role personal responsibility has in medication therapy and its overall contribution to a person’s state of wellness. Regardless of whether the medication is needed due to poor habits or is hereditary in nature, taking it as prescribed, and for as long as necessary, will play a large role in whether a patient is on the path to wellness.

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.

In previous posts, I’ve mentioned briefly about Maritz’ “whole-brained” approach to implementing successful wellness programs. Just to reiterate, what I mean by “whole-brained” is essentially rewiring the brain to activate new behaviors and sustain them long term. At Maritz, we apply the focus, repetition and positive reinforcement model to ensure the wellness program’s success. More specifically:

Focus: the act of paying attention, which creates chemical and physical changes in the brain.

Repetition: repeated, purposeful and focused attention, which leads to long-lasting personal evolution or change.

Positive reinforcement: people receive positive feedback; it creates a synapse in the brain, encouraging the behavior to continue.

When companies take a whole-brained approach to health and wellness incentives and answer the five integral questions – what do you want me to do, why is it important, how do I do it, what’s in it for me, and how am I doing – successful health and productivity programs becomes a continuous cycle resulting in optimum member participation and, more importantly, healthier members.

With flu season right around the corner, doesn’t that seem like a good opportunity for health plans and employers to encourage consumers to proactively get a shot? It seems to me like it would be an obvious and low-cost method to communicate a message of caring. What is your organization doing to support these types of health services?

It’s official: under the Workplace Wellness Resolution, the first week of April will now be known as National Workplace Wellness Week. Introduced by Reps. Herseth-Sandlin and Boustany, it is a good first step in officially trying to increase the awareness levels and importance of workplace wellness.

Still outstanding though is the challenging task of providing employers with an incentive for leading the initiative on workplace wellness. The Harkin Bill was introduced in 2007 as a means of offering organizations tax credits for adopting and promoting wellness programs in the workplace. It was later defeated.

According to a PricewaterhouseCoopers survey we will continue to see an increase in the number of wellness programs that offer rewards and incentives to participants for either participating in the wellness program or in some cases, based on actual health outcomes. An area of workplace wellness programs that continues to be a sensitive issue is in the handling of the tax implications for participants who receive wellness rewards.

Many health plans and employers are struggling with the treatment of taxable rewards. The general sentiment seems to be that it leads to an awkward situation with employees and members and offsets some of the productive goodwill that the employer gains by offering incentives in the first place.

Are your organizations facing a similar challenge? If so, how are you dealing with it?

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.

I recently read an interesting post on Fierce Healthcare regarding why people hate pharmaceutical companies so much. The gist of the article is that consumers hate pharma companies because their mishandling of current safety issues around Vioxx, Vytorin and Avandia – to name a few – has shattered public trust. The post also references an Adweek article that says consumers love to hate pharma because they don’t want to be sick enough to need drugs. In addition, negative attention aimed at pharma’s marketing practices has further eroded trust in the industry.

Despite all the criticism, I continue to believe that pharma plays a vital role in our health system and as a former pharma employee, I see the good things that pharma companies do everyday to extend and enhance the health and wellness of our society.

Undeniably, as industry continues to mishandle situations, public distrust and negative perception of the pharma industry will thrive. That said, I am amazed at the fierce level of anger and disgust that seems to exist about pharma companies. You know it’s bad when companies that were long held as gold standards in ethics and integrity are now being equated to used car salesmen, as evidenced in this Pharma Marketing Blog post

While the industry needs to do a better job of improving public trust and reassuring the public when news begins to leak around safety and efficacy issue, I believe that an argument can be made that the benefits derived from the products and services that pharma companies bring to the public far outweigh the periodic issues that occur when a drug is found to have risks that were not previously identified.

Where would we be without companies that have invested hundreds of millions of dollars in developing drugs that continue to extend and enhance human life, continue to help mitigate the risks of chronic diseases and in some instances find cures for diseases once thought incurable? Think about this … a child suffering from Hodgkin’s disease 20 years ago may not have lived, but with pharma’s continuing efforts to bring new products to market, that child today has an opportunity to live a long and healthy life. Also, pharma provides many subsidies to the uninsured population through patient assistance programs and samples of drugs that many physicians give to their patients who can’t afford medicine.

Furthermore, our healthcare system is reaching a crisis mode with escalating healthcare costs and an ever increasing unhealthy population. With the growing focus on preventative medicine and proactive wellness initiatives in reducing healthcare costs, pharma will continue to play an important role in preventing illness from occurring, managing those already sick and curing diseases that we could never fathom curable a decade ago.

There is some disconcerting news out today that indicates the U.S. is facing not only a shortage of nurse professionals but also primary care physicians. According to an Associated Press article only 2% of graduating medical school students are planning to enter into primary care internal medicine, down 7% from last year.
This troubles me for several reasons:
1) The push towards preventative care (wellness) is going to require a good deal of coaching and guidance to move patients along the continuum of change. Primary care physicians are seen as the most likely candidate to assume the role in quarterbacking and coordinating those wellness efforts. However, coaching, educating and following up with patients in an effort to drive more proactive and preventative behavior takes quite some time. With an aging population (the largest consumers of a PCP’s time) and an expectation that PCPs will quarterback wellness initiatives, the news about a shortage of PCPs is problematic to say the least.
2) The concept of the Medical Home Model that has repeatedly been discussed as the optimal model for coordinated care that can lead to better, healthier outcomes once again rests on the premise that a primary care physician should act as the quarterback for coordinating these care efforts. Without adequate capacity, and a reimbursement model that doesn’t reward PCPs for assuming these additional responsibilities this model will fail before it even begins.
3) The reimbursement model that healthplans have constructed creates a large disparity between primary care physicians and specialists which must be addressed if the U.S. is going to continue to entice med school students into primary care.