Engagement Strategy Solutions for Health Plans


It seems that with each successive year, employers look for more and more from their health plans to help stem the rise in premium costs and to maintain competitive coverage. Lately, their interest has broadened to include ways to improve workforce health and well-being.

This is a relatively new area for many health plans, and through vendor partnerships and internal development, many have assembled highly credible offers. The big challenge is getting individuals to take part in the various screening programs and health interventions. Incentives can help, but real change often occurs best with the design and delivery of an effective engagement strategy.

Engagement Strategy

The discipline of engagement strategy for health and well-being improvement is new. This is our specialty and we know of no other consulting practice as fully focused on it and with as unique a skill set and depth of experience as we have.

We know engagement is a top priority issue for the industry now, but most companies don’t address it as well as they could. We see a sizable Engagement Gap sitting between the many well-intended health and well-being improvement programs and the resistant, often indifferent population to whom they are targeted. Good efforts go toward addressing the gap, but they too often fail to produce real change.

Engagement as a Story

The approach to engagement can be expressed in simple terms with the following flow:

– First, what is the story you want to convey? What are the main messages that form the hook that will appeal to your population?
– Then, what is the process by which you will convey the story in a way that resonates with each individual? This includes the media formats and delivery as well as peer influence.
– Next, what is the offer that will get their attention to take action? These are the most compelling benefits that encourage participation.
– Finally, what will enable you maintain the involvement? These are the elements of sustainable engagement.

Strategic Process

Each customer situation has different goals and success factors. We scope out our project plans to meet specific strategic objectives, and set a game plan with a clear and effective process to get us there.

Our recommendations are focused and actionable. They’ll enable you to hit the ground running with new and improved strategies and tactics. The objectives we help achieve include the following areas:

1. Customer Relationships

If your customers are asking for more and better results from your health management and wellness programs, we can help you effectively position, package and promote your offers to the workforce.

And the same techniques we use to help drive consumer participation can also help with customer retention and acquisition, by defining effective competitive differentiation and smart strategic processes. Let us assess your approach and put together some recommendations.

2. Better Engagement

Our Engagement Model helps to frame the linear flow necessary to move individuals along the spectrum toward active participation. The model also provides a high-level strategic view of the tactical elements and shows how the various component parts work together and need to be fully integrated in designing and delivering programs.

3. Effective Communications

Essential to all effective engagement efforts is a solid communications strategy and plan. Our experience in consumer advertising proves that the basic concept of AIDA is a key component of planning out messaging efforts. We look at the full gamut of mass, targeted, tailored and personalized options. And, we aim to support both the broad-based story about employee health goals, and the relevant details on specific program offerings.

4. Branding Support

Employers are increasingly branding their programs which helps provide an easy point of reference for management and the workforce. Effective branding is a tough task. We can help strengthen and enhance efforts.

Our many years of consumer marketing experience have helped us create our 12 Point Branding Blueprint. With a solid branding effort and a clear plan in place, there is less “making it up on the fly” because many potential snags are thought out in advance.

5. Member Experience

To gain a fresh perspective, we look at programs through the lens of the consumer. Historically, there has been way too much emphasis on the “supplier” side of the offer. Part of our unique value is how we assess the demand side of the equation.

We use market research approaches and other techniques to generate consumer insights about how individuals react and respond to the offerings and messages.

6. Well-Being Strategy

Well-being has emerged as an important area of emphasis for companies looking to protect against future health risks, while creating an environment of healthy lifestyles and increased productivity.

As companies continue to broaden their health promotion strategy from targeting high risk individuals to Total Population Health, greater focus is going to defining, developing and promoting well-being improvement. Doing this effectively requires a skill set that can deliver behavior change solutions.

7. Strategic Roadmaps

Our work helps accelerate progress using a strategic roadmap that organizes and aligns efforts. It takes a different set of strategies and tactics to permeate the entire population with messages, interventions and encouragement.

Our consumer advertising concepts and Sustainable Engagement Framework can be instrumental in building an approach that will accelerate positive change.

Introducing the “Four Ps” of Effective Well-Being Strategy


In gearing up for next year’s well-being initiatives, companies can benefit by taking a page from the Marketing 101 textbook that outlines the fundamentals. The basic concept for marketing consumer goods is that the Four Ps – Product, Promotion, Price and Place – are the core components that drive brand sales.

We need a similar set of principles in the area of Total Population Health. In order to engage a broader proportion of the workforce than only those at risk, effective marketing techniques and business discipline are important drivers of health behavior change efforts.

We also see the following Four Ps as necessary to deliver a successful well-being strategy:

1. Purpose

It’s essential to have a clear set of well-defined objectives that incorporate both the high level strategic mission and the specific and detailed well-being program aims. The objectives need to be measurable and realistic, and should ideally expand in scope each year.

Be willing to invest the time, energy and resources to attain the goals. Be prepared to implement alternative plans if the numbers are falling short. Share progress as appropriate and congratulate those who help deliver positive results.

2. Process

Part of the overall thrust of the various activities and programs is to move individuals along a spectrum toward better well-being. This may or may not be a straight line, but it will need to follow a sort of sequential path, that can include “gating” or “qualifying” events and some aspects of triage to get individuals in the right buckets and into experiences and interventions relevant to them.

Deming Flow ModelWe like to apply an approach to well-being strategy similar to how W. Edwards Deming viewed production as a system. With multiple integrated and coordinated touch points and players, each needs to have a specific role within the process and be knowledgeable about their “place” and responsibilities. This sort of thinking has direct relevance to the ways in which well-being models should be designed and deployed.

3. Promotion

The industry has come a long way in improving communications planning around well-being programs, but there’s room for further progress. A complete plan should reflect the entire calendar year; balance the need for building awareness and driving action; utilize the multiple forms of media available in a work environment; and leverage leadership and well-being champions to motivate participation.

A well-coordinated team of dedicated people and relevant outside resources are needed to pull off a smartly constructed, well-delivered promotional strategy. Good results are usually reflective of a strong plan.

4. Performance

Until recently, this area has received far less attention than it warrants. Measurement is crucial for many reasons. We’ll want to know whether and when to amplify promotional levels if participation is below expectations. Keeping a close eye on the data is essential. We’ll also want to track activity against our goals and keep management apprised of progress. Ultimately, we’ll want to provide return-on-investment (ROI) analyses to reinforce the value and support the next year’s budget.

The industry needs to evolve toward performance-oriented well-being strategies. This will accelerate appreciation for the value they provide and deepen long-term commitment, necessary resources and support.

These “Four Ps” can help strengthen strategic focus and deliver positive outcomes.

We hope this provides some food for thought as planning for 2013 gets underway. The more strategy we can feed into health and well-being improvement programs, but better the opportunity for positive and sustainable outcomes.

If this sort of story-flow resonates, and you could use some consultative support, please reach out for a discussion. It could help to strengthen your offer and improve your competitive differentiation.

Engagement Strategy: Planning for 2013

Most corporations have likely nailed down their benefit plan details for next year by now, and are beginning to think about their open enrollment. That cycle of calendar planning has been repeated time and again for many years.

What’s relatively new is the need to consider how to get the workforce informed and activated about the various wellness initiatives that have emerged and grown in scope and importance. Aligned with the availability of these programs are the incentives oriented to drive participation and the measurements intended to support investment.

These areas support total population health initiatives are generally far less developed and far more challenging to effectively design and deliver than the benefit plan itself. And now is the time to develop these and other elements for 2013.

Seven Point Checklist

Too often, key marketing components are considered late in the planning cycle and can lose impact if they are not fully outlined in advance. Here are some specific areas worth thinking through now, so you can hit the ground running early in 2013.

1. Leadership. A core component of change management is getting the top team involved and activated. Think about how best to leverage their influence throughout the year. In addition to executives, recruit middle-management to participate in visible and meaningful ways as well.

2. Branding. Make sure your company’s wellness brand is fresh and ever-present. Let it represent positive change and new outlooks. Consumer brands need to evolve while maintaining their core equity and the same should apply to yours.

3. Champions. Successful companies continue to cite the use of wellness champions as essential resources for program awareness and interest. Individuals enjoy the opportunity to contribute and the role can be rewarding when it is given sufficient importance and support.

4. Communications. This area is increasing complex as it needs to incorporate both the “mass” level of company-wide messaging, and more “personalized” outreach based on the structural makeup of screenings, interventions and other interactions. A solid plan with multiple potential scenarios should be in place and ready for implementation.

5. Environment. Every workplace has its own culture – some subtle, some strong – and much can be done in this area to instill positive influence to individuals. Think creatively about how to use the physical space differently in ways that create new awareness, share information or guide interactions that can contribute to wellness.

6. Events. Company-wide competitions and other activities are now standard fare at many worksites, and successful implementation takes smart planning, good promotion and excellent execution.

7. Recognition. People love being acknowledged for their efforts, whether they are among the first to schedule their screening, or walk the most steps, or be on a winning team for a competition. Find ways to highlight various types of accomplishments – it doesn’t cost anything and should have a positive peer influence impact.

In planning for next year, be sure to look for strategic synergies across tactics, have strong alignment to business objectives, and find ways to measure the impact of anything that may be new or different. Happy planning…!

Social Gaming: The New Engagement Incentive?


As more employers look to expand their enterprise-wide wellness efforts, many continue to be stymied by insufficient participant engagement. In recent years, the “go-to” solution has been monetary incentives – paying people to do what is good for them.

That approach seemed to be effective at driving transactional events, such as biometric screenings or health assessments, but getting individuals to take further positive steps has proven difficult.

A new and intriguing tactic of social gaming is now emerging as an engagement driver with a different angle. This concept has begun to create a degree of excitement among both participants and the companies that have adopted the approach.

A recent Business Week article highlights some of the many players moving into position to capitalize on the inherent attraction (addiction…?) of gaming to help motivate health behavior change.

Most analysts watching this space see the underlying appeal of game as an effective stimulant of desired actions. They regard the hallmarks of gaming: Exploration, Socialization, Competition and Achievement as directly applicable to motivating good health and wellness behaviors.

Who’s in the Game?

Among current players, Keas has an approach that allows individuals to form teams of up to six players that compete with lifestyle-related activities and on-line quizzes; Healthrageous provides support for both wellness and chronic care, including social media applications; MindBloom’s Life Game enable individuals to create their own plan based on what’s important to them; and Daily Challenge from MeYou Health delivers simple activities designed to improve well-being, along with social-sharing platform.

The competitive spirit and team support that a well-structured gaming approach can offer – at a far lower cost – may just be the stimulus to evolve the incentive model away from cash rewards as an engagement solution.

Cultural Fit

Those employers experimenting in this space may find that success comes with some extra amount of personal time being spent on the games, but they should also see a positive morale boost that can enhance their culture, in addition to the motivation toward physical activity, stress reduction, better nutrition, or other targeted behaviors.

The area is new enough that data on sustained behavior change is limited, but as learnings emerge, we expect to see sufficient advantages for this approach to displace standard incentives. Stay tuned….
Some say that the health and well-being improvement area needs some fresh thinking and new approaches. Others claim that there is too much conservatism among buyers. We say, let the market decide and go from there.

Surveys continue to report that low levels of engagement are the biggest challenge for the improving health behaviors. If gaming can engage, then bring it on.

But we would also say, make sure that the elements of the overall program are well-integrated so that strategic efficiencies and good data are part of the outcomes story.

People love a good challenge, and if achieving better levels of well-being or improved health are the result of the competition, then there should be plenty of winners…!

Defining Effective Engagement


There seems to be a consensus among industry leaders and observers that participant engagement is a hot topic right now. Vendors and health plans continue to innovate and evolve their health and well-being improvement offers and yet, most expectations for effective engagement are not being met.

We see two interesting questions here

  • How should expectations be set?
  • How do we define effective engagement?

On the first point, we believe that expectations – or strategic objectives (if you buy into our view of the importance of business discipline) – should be considered and set the same way a company determines sales goals for its products. Use historical data, realistic assumptions and factor in the marketing plan and budget that is designed to achieve the objectives.

Defining effective engagement is more elusive. It is far easier and more practical to describe event-based activities such as participation levels in screenings or assessments and enrollments in web-based programs or coaching. Each of these contributes to the process, but how directly do they lead to effective engagement?

Three Dimensions of Engagement

We see engagement as having three dimensions: duration, depth and quality. Perhaps the marriage analogy applies: a couple becomes engaged at a point in time, and married at a point in time, but their relationship ideally grows along the same three dimensions as they spend their lives together.

For health and well-being improvement, a series of events can help, but there needs to be enough context, interest and motivation to be able to ultimately transfer the relevant program purpose onto the shoulders of the individual and engender personal responsibility that can be taken forward into one’s life experience.

Too many participants in programs today are in it for the incentives, or to “check the box” and be compliant. There is not as much emphasis on the true intention of these initiatives, which should be to bring about health behavior change, by breaking inertia and creating new and better habits.

Effective engagement comes about as the cumulative effect of participation, enrollment and activation combined with an individual’s attitudes and beliefs about what is important in their life and to their future.

Quantitative assessment of these “transactions” can provide good metrics to support program goals, but the more difficult measurement is whether the efforts will lead to positive outcomes and long-term change.

Individuals need to own their lifestyle and health-related choices, and carry them forward beyond the workplace. That is the true measure of effective engagement.

Using Behavioral Science to Drive Engagement Strategy


Last week’s Sunday’s New York Times featured an insightful commentary by Richard Thaler, co-author of Nudge. His piece related largely to government policy but has smart applications to how we can think differently and more creatively about guiding behavioral choice in health and well-being improvement.

Thaler_Behavioral_EconomicsProfessor Thaler, who teaches economics and behavioral science at the University of Chicago, outlined his involvement with Great Britain’s Behavioral Insights Team, established by Prime Minister David Cameron soon after he took office a couple years ago.

First off, it’s rather refreshing for a government entity in any nation to make an investment in behavioral science to help guide policy approaches, and second, it seem there’s a real opportunity to learn from this experience and apply it to health behavior change.

Thaler highlights two key parameters he uses to guide discussions in which he participates:

If you want to encourage some activity, make it easy. You can’t make evidence based policy decisions without evidence.

While these sound like the typical truisms that tend to permeate the field of behavioral economics, his examples go beyond the small-scale experiments noted in the slew of books on the topic that came out a few years back.

In looking at a specific challenge (how to get more Englanders to pay their taxes on time), he adds another ingredient to the mix by citing a key concept from Robert B. Cialdini (author of Influence: The Psychology of Persuasion), which is:

People are more likely to comply with a social norm if they know that most other people comply.

This notion led to the winning formula in the best performing letter sent to those citizens of Great Britain that had not paid their taxes on time (with statements like “9 out of 10 people in Exeter pay their taxes on time”).

With so many of today’s health and well-being improvement programs being initiated via a “welcome letter” or other written correspondence, it’s time our industry take a closer look at how we construct the communications designed to gain interest or drive action.

There’s a lot of talk about behavioral science in our space, and plenty of opportunity to design simple and smart experiments to see what really does stimulate the desired response.

Interestingly, Thaler notes that in the UK, the government has just announced that behavioral science will now be taught to all civil servants. Now, there’s a good idea for all those involved with health behavior change…
Too many health and well-being improvement programs today are on auto-pilot. They tend to use the same letters, scripts and phone messages.

There is a lot of room for improvement, and the ideas that form the basis of behavioral science present a creative toolbox of resources to use.

Find interesting ways to test various messaging platforms, and see what works best. Take a page from the direct marketer’s guidebook and continuously experiment.

There is no one right way to communicate, and trying new and different approaches – with good measurement standards – will yield a boatload of good data and insights.

Healthcare Reform or Not, Consumer Influence Will Rise


With the Supreme Court decision on health reform expected as early as today, many are speculating as to the impact of the various scenarios that could emerge from the ruling. Any scenario will certainly lead to change at some level, though market forces are already paving new paths.

supreme_court_side_view_medium_web_viewMany of these forces will elevate the role and responsibility of the consumer in the healthcare mix. Here are five areas where consumer influence will rise:

1. Health Savings Accounts and Condumer-Directed Health Plans are on the upswing
Since their introduction a decade ago, consumer-directed health plans have generally lagged behind their original promise of making Healthcare Consumerism a driving factor in activating consumer power with more knowledge and control over health spending decisions. Now, according to research by Mercer, CDHP enrollment has tripled in the past five years and in the past year alone, it has increased 18%, going from 28 million to 33 million members. Deeper participant engagement in healthcare decisions will further drive CDHPs growth.

2. Accountable Care Organizations want healthier patients that need fewer services
While ACOs are developing new systems, services and technology to better coordinate and integrate care, a key success factor is incorporating wellness programs into total population health management. This enables data from health risk assessments, health coaching and other interventions to be shared and used by physicians, nurses and other providers for their patients. For success to be achieved, consumers need to be fully activated in ACO activities and outreach.

3. Health Insurance Exchanges can create smarter shoppers
Even as the public health insurance exchanges are a centerpiece of health reform, the private market has been offering these exchanges for the past few years, and with good results. Employers that use them like the flexibility and their employees are happy with the level of choice that they get. Whether public or private, the consumer is likely to win, with more information and better choices.

4. Price transparency will enable comparisons
While the government already publishes information on quality, safety and patient satisfaction indicators about insurance plans and providers, they are not often used. Castlight Healthis raising the bar in this area with algorithms, proprietary technology, and data analytics that allow for drill downs into an array of cost of care information. And, UnitedHealthcare also recently launched My Healthcare Cost Estimator, a new integrated online service that allows consumers to access prices for more than 100 treatments and procedures, and compare, side-by-side, both the quality and cost information for 240,000 different physicians and hospitals. With relevant and comparable information, individuals will be better consumers of healthcare.

5. Websites and Mobile Apps

Each of the above areas will rely on web and mobile access to drive efficiencies and deliver positive consumer experiences. With mobile devices already the go-to source for so many areas, more than 12,000 mobile health apps are now available, and more are coming. Online tools now offer better and more intuitive user interfaces that make understanding health treatment options as easy as comparison-shopping online for other consumer goods. Their usage is starting to reshape the consumer revolution in health and well-being improvement. Consumers will win the day once they click into the many improved resources for health information.

Well-Being Incentive Strategy Tilting toward Health Plan Innovation


Using consumer incentives to help encourage employee participation in HRAs and screenings seems to be the norm these days. And each year, the payout grows.

Data from a survey by Fidelity and NBGH earlier this year cited the average annual incentive amount at $460 per employee in 2011 (up from $260 in ’09) and noted that 73% of surveyed companies had deployed incentives to help engage their workforce in health and well-being improvement programs.

Outcome-Based Incentives

A current debate in this area is whether focus should be more oriented to “outcomes-based incentives” rather than just “paying for participation.” There have been some legal questions and a bit of pushback from a few industry trade groups regarding discrimination, but the consensus is moving toward adoption of this approach.

After all, it does make sense that if the aim is to drive health behavior change, then the incentive should be on achieving change, not on just “getting in the game.”

One group at the forefront of this movement is Bravo Wellness. They have created quite a business using a “self-funding” model to essentially reward those with good outcomes while penalizing those that exhibit a lack of progress against defined wellness goals. They liken their offer to an auto insurance plan that offers a “good driver discount.”

The essence of this move toward rewarding outcomes is to promote more personal responsibility for one’s own health and well-being. That is at the core of Healthcare Consumerism, which was supposed to be the catalyst behind Consumer-Directed Health Plans when they were launched a decade ago.


The early growth of CDHPs was hampered by uncertainty and inadequate employee communication and support. Since that time, the popularity of wellness initiatives has long crossed the tipping point, and now they are also seeing upward trends. According to the American Association of PPOs, CDHPs were the fastest growing plan type in 2010, and 54% of large employers said they’d offer them in 2012.

Couple this with the continuing emergence of Value-Based Insurance Design, which emphasizes the use of “high-value care” and provides an array of incentives and penalties to guide individuals toward cost-effective solutions and healthy behaviors. AonHewitt notes that some 36% of large employers currently offer such plans.

Health Plan Innovation

These insurance trends suggest that health plans could and should be playing a larger role in defining the incentive design and delivery as part of a more fully-integrated offering. This would seem especially important and relevant as plans move toward being far more consumer-centric in their approach.

We expect to see the next round of market-leading ideas and innovation in driving engagement to come from health plans using smart ways to pull the right levers and generate positive consumer actions.

Bridging the Engagement Gap


We see a big opportunity to bridge the “Engagement Gap” for health and well-being improvement by using a three stage solution that employers can implement with the help of their vendor and health plan partners.

In looking across the spectrum of engagement strategy issues and opportunities, we’ve concluded that the three key areas involve:

1) Applying greater business discipline to all health behavior change and well-being initiatives
2) Injecting more consumer marketing principles in employee messaging and outreach efforts
3) Providing deeper health and well-being context for individuals so they better understand the rationale of health improvement program offerings

Business Discipline

Many sectors of healthcare, such as hospital systems, health insurance plans, pharmaceutical companies, and pharmacy chains are run with a fairly high level of business sophistication.

Employers, however, who are taking on an ever greater role in the health of their workforce, haven’t traditionally managed their health and well-being improvement programs with a business mindset.

By establishing clear strategic goals, dedicated resources, and measurable outcomes matched with active leadership endorsement and a supportive environment, there can be a greater likelihood to drive measurable ROI and ensure strategic sustainability.

Consumer Marketing

With the market moving more toward total population health and well-being improvement, consumer marketing concepts can help address the entire workforce with smart messaging and relevant promotion.

Employers have begun to “sell” well-being initiatives under their health improvement brand and should design and implement a balanced mix of advertising approaches (strategically designed campaigns) and promotional techniques (smart use of incentives).

They need to work to find the right balance of story flow and motivation, as well as mass reach versus targeted messages to forge deeper connections with good creativity and content.

Health and Well-Being Context

There can be greater acceptance by employees to the programs being offered by having deeper context and more transparency about the need for health improvement, the cost implications and the benefits of a healthy work environment.

And, with the current trend focusing more on well-being, greater context there is needed, as well. Employees need to understand that well-being is more than just keeping healthy and taking appropriate preventative measures.

It involves balancing all aspects of physical, social and emotional well-being, along with financial and career components. We need to more fully and completely “define” well-being so it can be better appreciated, and serve it up as a “future state” that is truly desirable.

BJ Fogg on Behavior Change


Some of the best new concepts in the area of behavior change have emerged from Stanford University’s Persuasion Technology Lab. BJ Fogg runs the lab and serves as its chief advocate. His casual and conversational style and clear, everyday examples help him successfully convey the notion that changing behavior can be easy.

In a talk he gives about health and well-being improvement (see video), he admonishes us to think less about broad health outcomes (like lose weight or exercise more) and more about the specific behaviors that can ultimately lead to those outcomes. And, the simpler the better. He suggests we focus on strikingly simple behaviors like eating one fresh berry as a step toward a smarter diet, or just put on your walking shoes as an easily achievable task toward getting more movement.

Behavior = Motivation + Ability+ Triggers

One of the core concepts is his formula for behavior. He believes the equation, Behavior = Motivation + Ability + Trigger (ideally all at the same time), will help explain what works and what does not.

Fogg-Behavior-ModelHe notes that we too often try to motivate (e.g. provide incentives) when ability is not there. Or deliver a trigger (go take your HRA) when the motivation is absent. Aligning all three areas, and timing them to match up, will stimulate the behavior.

The graphic is instructive, as a microeconomic model where the demand curve is replaced by the motivation and ability curve.

Those to the upper right of the curve, can be successfully triggered, whereas those along the top of vertical axis (inside the curve) won’t have sufficient ability, no matter how big the motivation, and those to the right side of the horizontal axis won’t have enough motivation, no matter how able they are to change the behavior.

Take a look around the Lab and his related websites. There’s a lot there that can help in how we design and deliver messaging and motivation about behavior change.

Is Behavior Change By Itself Enough?

Unfortunately no. To achieve real success in health and well-being improvement, we need to create new behaviors (and eliminate old ones) that are sustainable, and do so across the population.

This means that, while a “trigger” may succeed in getting an individual to put on his or her walking shoes, successive triggers need to then lead to a habit that continues. Fogg’s Behavior Grid does get at that and can be a helpful model.

To do this across a total population, effective engagement strategy needs to provide the overarching game plan. As noted last week, the combination of business discipline, consumer marketing, and health and well-being context are the three strategic imperatives that unify the efforts and investment toward effective outcomes.