Employee Wellness Program Effectiveness 2016
Presented by Extracon Science LLC
Jesse Hercules, President Extracon Science LLC
This webinar is sponsored by Extracon Science. Extracon is
a technology company that offers solutions from turnkey wellness programs for
employers to customized portals and apps for wellness companies.
Jesse: Our customers come in all shapes and sizes.
They’ve included insurance organizations like Highmark Blue Cross. They
include large employers like MARS and UCSF, all the way down to smaller
employers with 250 employees. They include wellness vendors who private-label
our services. And they include quite a few Hospitals and healthcare
organizations.
Ted: So what’s on the agenda?
Jesse: We’re going to talk about our Effectiveness Survey
for 2016. First we’ll talk about who took the survey, and what kinds of wellness
programs they run.
Then we’ll talk about the major finding from the survey.
It’s called the effectiveness gap. Employers know what would make their
wellness program more effective. But they aren’t doing those things. There’s
a big gap between what employer say is effective, and what they’re doing
today.
Then we’ll talk about the barriers to a more effective
program.
And finally, we’ll conclude with a summary that explains how
employers can close the gap and have kinds of effective programs they really
want.
Let’s get started.
In March 2016, we invited more than 8,000 leading employers
and wellness consultants to participate in a survey on wellness program
effectiveness. We got 76 responses, from a representative sample of employers
and wellness practitioners.
37% were fulltime Wellness Coordinators at an employer
20% were HR & Benefits leaders who also oversee a
wellness program. So they are running the wellness program off the side of
their desk.
24% were Wellness Consultants and vendors who oversee
multiple programs.
Responses came from employers with several program types:
41% of programs were run internally by the employer.
15% used a vendor program, or a program from their Health
Plan.
44% had a program that included a combination of the above.
Some parts of the program were run by the employer, others were from a vendor
or the health plan.
Ted: So what did you ask in this survey?
Jesse: The first thing we asked was what effectiveness
means to employers and wellness programs. We have to agree on that first.
The top two answers were not surprising. 79% said an
effective program achieves high participation, and 85% said an effective
program reduces health risks.
But the other top responses were more surprising.
77% said that an effective program means participants work
with their primary care physician. Specifically, that they work with their PCP
for overall prevention – not just when they are sick. You have to get the
doctor involved if you want to be effective.
64% said an effective program means biometrics are followed
up until the problem is resolved, As verified by the participant’s doctor. So
it’s not enough to screen people, you have to actually fix the problems that
are found at the screening. And once again that means working with primary
care physicians.
61% said an effective program includes validated data on
physical activity over 12 months, showing that sedentary people are becoming
physically active. Real data on long term physical activity.
Ted: Are employers really doing those things they say
would be effective?
Jesse: Most of them are not. That’s the
effectiveness gap. Most are not including the physician, most are not
following through on biometrics, and most are not using validated data for
lifestyle.
88% in our survey said their wellness programs could be more
effective.
They agree on what a more effective program would look
like. It would have a better design in 4 key areas: Physical Activity &
BMI, Screenings & Prevention, Screening Followup, and Health Coaching.
And yet they are still running the same programs they know
are less effective. They know they have a problem. They know how to fix it.
But very few are doing it!
Jesse: This is kind of like the definition of insanity.
Insanity is doing the same thing over and over again… and expecting different
results.
Ted: Let’s move on to effectiveness for Physical
Activity and BMI.
Ted: What kinds of lifestyle programs are effective?
Jesse: That’s what we asked employers. Which is more
effective, a program that allows self-report data and uses small incentives or
points? Or a program with significant incentives based on accurately measured
app or device data only.
63% agree that using only accurately measured data
(app/device) and significant incentives would be more effective.
Effectiveness for lifestyle means accurate data only +
significant incentives.
Jesse: But that’s not the kind of programs they are
actually running. 90% of the programs in our survey still allow self report
data.
You can see how that breaks down in the pie chart. 34% only
use self-report data in their lifestyle programs. Another 49% use apps and
devices in their programs, but also allow self-report data.
Only 10% require accurate data in their programs. There
are a lot of wellness programs out there adding apps and devices to their
programs, but they are not changing their programs and incentives based on apps
and devices.
So they aren’t really getting the benefit of this accurate
data- it’s still mixed in with a lot of self report data.
We don’t think it makes sense to mix accurate data from apps
and devices with self-report data. If you mix the two, you still have all
the downsides of the original, self-report program.
First of all, the program length is still limited by self
report. People get tired of logging with self-report, so you have to keep
programs short and you can’t cover the whole year. Second, If you mix self
report data with app/device data, the final data is still questionable. It’s
not good data.
And finally, program incentives are limited by self report.
You have to use small incentives because you don’t trust the data.
Mixing accurate data with self report data doesn’t work
because you still have all the problems and limitations of a self report
program.
If you ever want to reach the sedentary people, and get them
off the couch, you need a long-term program with significant incentives.
You can’t get there if you’re still mixing in self report
data.
Ted: So what’s the conclusion for physical activity and
BMI?
If you remember from a few slides ago, what makes a
lifestyle program effective is accurate data only + significant incentives.
But in our survey, only 2% of the programs have significant
incentives based on accurate data from apps or devices.
Only 2% are doing that. It’s a big gap.
Jesse: So we’re going to talk about what kinds of
screenings and preventive services are effective. There’s some background
information you need before we get into the survey results.
The US Preventive Services Task Force makes the official,
evidence based recommendations to Congress on what screenings and preventive
services are effective. The tests cover heart health, cancer prevention,
mental & social health, Immunization’s, Women’s health and other topics.
The recommendations are tailored based on age, gender and other factors.
So the good news is that there’s a blue-ribbon panel looking
at the best evidence and giving official recommendations on what works. Also,
all the services rated A or B by the USPSTF must be paid for by health plans
under the ACA. And because of that, all the EMR’s now have templates that take
the doctor through the USPSTF criteria. So it’s now a lot easier for doctors
to do the checklist and tailor a visit to exactly what that participant needs.
That’s a contrast with the standard onsite biometric
screening that employers have done for the past 30 years or so. The standard
onsite screening covers the heart health factors pretty well, but leaves out
most of the rest of it. And it’s one size fits all, where everyone gets the
same tests regardless of age, gender and risk level.
So that’s the background on the USPSTF recommendations
versus the typical onsite screening.
Ted: So what kinds of screenings do employers think are
effective?
Jesse: In our survey, we asked, which program would have a
bigger impact on your population health? A program where employees complete an
onsite biometric screening? Or a program where employees complete all of the
USPSTF recommended screenings and preventive services? As verified by their
physician.
75% agreed that completing all of the screenings and
preventive services recommended by the USPSTF would be more effective.
Jesse: But the vast majority of employers are still doing
the onsite screening. The biggest part of their wellness program budget is
going to a screening that doesn’t meet the recommendations.
So we also asked employers, what do you do about all those
things that don’t happen at the screening. How do you make sure people get
their colonoscopy, their mammogram, their tetanus vaccine, and all the rest?
40% don’t track anything for those other prevention
recommendations. So 40% of employers are doing, literally, nothing about most
of the USPSTF recommendations.
Another 42% have some questions on their HRA that are
designed to ask about those other prevention recommendations. So they are
using self-report data.
Only 18% are asking the participant’s physician if they are
up to date on the prevention recommendations.
So here’s the summary. Everyone agrees that sending
participants to their own doctor for a comprehensive wellness visit is
effective. But employers are still doing onsite screenings instead.
Ted: So onsite screenings don’t cover most of the
recommended prevention. Are there any other downsides?
Jesse: Yes. Many employers have low participation rates in
their onsite screenings, and we asked why that might be. The biggest reason
they gave was that many participants have already had the same tests done at
their physician’s office. The second most common reason was that the employee
was uncomfortable with the employer or the employer’s vendor doing the
screening. Most of the downsides of onsite screenings can be solved by sending
people to their own doctor for the screening.
Ted: If you send employees to their doctor every year,
will that cost a lot of money?
Jesse: We asked about that. Employers estimate that about
half of their employees already see a doctor every year for a prescription
renewal, preventive visit or well-woman visit. At some employers, it maybe as
high as 80%.
By the way, the kind of visit is very important. Because of
the way medical billing works, a physician visit is either a visit for illness
or for wellness. It’s coded using either E/M codes for illness or CPT codes
for wellness and prevention. So we’re talking about turning a prescription
renewal visit into an annual wellness visit. Obviously, if they are already
doing a preventive visit, the only difference is sending the data to the
wellness program. If someone is going to the doctor because they are sick, you
can’t turn that into a wellness visit.
So in most cases there’s already a physician visit where the
wellness program can ask the doctor to go through the USPSTF checklist.
Wellness programs can leverage these existing visits for most employees,
instead of needing a whole extra physician visit. It’s about using the
physician visits you’re already paying for, rather than setting up a separate
screening or separate physician visit.
Ted: Let’s move on to Screening Followup
Ted: So after the screening, what kind of followup would
be effective?
Jesse: This is really important. 64% said that effective
followup after the screening means following up until the participant’s doctor
says the issue is resolved. That’s the gold standard. That’s what you really
want to measure. And it makes sense. If you’re spending all this money on
screenings, to find the problems…. Logically you want to know if those problems
get resolved.
But once again there’s a big gap. 58% of programs surveyed
don’t track follow-up after the screening. Isn’t that amazing? Most employers
are doing nothing about followup.
The next biggest slice is the 22% of employers who track
whether participants talk to a health coach. There’s nothing wrong with health
coaching, but talking to a health coach is not the same thing as fixing the
problem with your blood pressure. A small number track whether the participant
promises that they will talk to their doctor – that’s 8%.
Another 8% tracks whether participants improve their
biometrics that year.
Only 3% track whether the issue is resolved according to the
participant’s physician.
So there’s the gap. Employers agree about what to do, but
only 3% are doing it.
Getting physician verification that the problem is resolved
is actually very important. That’s the only way you know that they close all
the gaps.
For example, if they were at onsite screening, do they even
make that first appointment to see their doctor about the problem? 19% don’t
have a primary care doctor.
If they see the doctor and get a prescription, do they fill
it? 31% of prescriptions are never filled, especially ones for long term
medications like blood pressure and cholesterol.
If they fill the prescription, do they get into the habit of
taking their medication every day? In a recent study, 49% of hypertension
patients were non-adherent with daily medications.
And if they do all of that, do they attend the follow-up
appointment where their doctor can re-test and make sure the medication is
working? 37% of followup appointments are cancelled or no-show.
So there are a lot of gaps. And the only way to really make
sure the gaps are closed is to track whether the participant’s doctor says the
problem is resolved, based on that followup visit. That’s what you really want
to track.
Ted: Let’s move ahead to Health Coaching
Ted: So what kind of coaching is most effective?
Jesse: We asked employers which coaching format would be
most effective. Would it be a text-based coaching via email or a website? Or
telephonic coaching? Or face to face coaching?
74% they agree that face to face coaching is more
effective. And this makes sense. 50 years of research in communication
theory says that seeing facial expression, body language, and gestures results
in richer and more effective communication. It enables faster relationship
building.
Ted: Does it make sense to pay people to talk to a
Coach?
Jesse: That was the focus of our next question. We asked
which type of program and incentive would lead to more effective coaching. The
first bar is where coaching is required for high-risk participants to earn an
incentive, based on their HRA or biometrics. Incentives are paid for
participating in coaching, not for any results or changes that happen. So
it’s paying people to talk to a coach.
The other choice was a program that puts incentives on
objective targets – like 5,000 steps a day. Coaching is available for
participants who want help in reaching those targets. In other words, people
talk to a coach if they want to. Not because of an incentive.
71% said it’s more effective to put incentives on objective
targets, NOT to pay people to talk to a coach.
And if you look across all possibilities for participation
incentives, versus incentives for objective targets, employers consistently
favor participation incentives.
The chart shown here is from the RAND study on workplace
health promotion. You’re looking at single digit numbers for any kind of
results-based incentives.
So there is a gap between what employers know is effective,
and what they are doing today. Employers talk about incentives for objective
targets and results, but they are paying for participation and talking to a
coach.
Employers say that face to face coaching is more effective,
but they still using telephonic coaching.
Ted: Next on the agenda, let’s talk about the barriers
to a more effective program.
Ted: So what barriers came up in the survey?
Jesse: Good question. We asked about all the barriers that
we could think of. But none of the barriers got a big response from the
survey participants.
We asked if the incentive amounts needed for an
effective program would be a barrier. Only 33% of employers said yes.
Self-insured employers can adjust premiums to make incentives cost-neutral.
We asked if a more effective program would require asking
employees to make too much of an effort. Only 22% of employers had this
concern.
We asked it a more effective program would require spending
too much on technology – such as fitness devices. Only 38% of employers
said yes.
We asked if it was too difficult to coordinate wellness
with healthcare and primary care physicians. Only 41% said that could be a
problem.
Ted: Isn’t cost the biggest barrier?
Jesse: Based on the answers we got, cost is not a major
barrier. Technology is rapidly driving down the cost of a more effective
program.
Accurate data for steps and weight is now
available at no extra cost. Almost 85% of working US adults now own a
smartphone and carry it daily. There are a variety of apps available to track
steps. You can even use the right App to do a validated weigh-in, by using the
dual cameras on the phone to take a picture of the participant’s weight and
their face. Accurate data is here, at no extra cost.
Face to face coaching is possible at the same cost as
telephonic. Smartphones include forward-facing video cameras, and secure,
HIPAA-compliant video-calling is now available for health coaches and
participants.
And Many if not most already see their doctor every year for
a prescription renewal. 60% of US adults are on one or more prescription
medications. Because of the Affordable Care Act’s mandates, primary care
physicians are now familiar with the USPSTF requirements and have EMR
templates to ensure each patient gets the right preventive services and
screenings. So employers can get more out of the doctors visits they are already
paying for.
If employers can leverage the technology that’s already in
employees’ pockets, and the doctor visits they are already paying for, they can
have a better program for the same cost as today.
Ted: Let’s more on to the final section, Closing the
Effectiveness Gap.
Ted: So what’s the conclusion? Why don’t employers have
an effective programs, and how can they get there?
Jesse: After poring over the survey results, and talking to
a number of employers, here’s the conclusion that we’ve come to. We think
the problem is the “add-on” approach that employers have taken to their
wellness programs. It’s always easy to add one more element or incentive to a
wellness program. But that’s not enough. An effective program has to be
designed from the ground up, and employers will have to stop doing some of the
things they are doing today.
For example. Wellness programs need to consider replacing:
onsite screenings with a physician visit for comprehensive
prevention.
They should consider not using coaches for biometric
followup and instead make sure participants work with their physicians until
the doctor is satisfied with the outcome.
They should look at offering face to face coaching for
participants who want a coach’s help to meet objective lifestyle targets.
And They should consider replacing lifestyle programs and
incentives designed around self-report with new programs designed around Apps.
In other words, programs designed around accurate data and significant
incentives.
Ted: So Extracon is the sponsor of this webinar. Does
Extracon help its clients make the kinds of changes you’re talking about?
Jesse: Yes we do.
Ted: Many of the wellness leaders on this call are
designing their 2017 programs, and thinking about how to be more effective.
What’s your advice for them?
Jesse: Most of the people on this call probably have a
vendor that they’re already working with. My advice is to ask your vendor
about making the changes we’ve talked about in this presentation. Find out
what they can do to help. And if they can’t help, look for another vendor that
can.
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