Deming on Engagement Strategy


While W. Edwards Deming is best known for helping Japan emerge from the post-World War II defeat by introducing quality concepts and process flow methods to their manufacturing companies, his methods can also have relevance in driving engagement strategy for health and well-being improvement.

W_Edwards_Deming.gifDeming was a statistician by training who believed that quality was the result of having appropriate inputs to a defined process and the having effective implementation of that process on a correct and repeatable basis.

He told the Japanese to treat manufacturing as a system rather than “bits and pieces.” He advised them to include the supplier and the customer in the system and to use feedback from the customer to continually improve products, services and processes.

His teachings led to the Japan’s economic resurgence in the ’50s as their leading export companies adopted his methods.

Consider the way that many health and well-being improvement programs are put together – often with multiple vendors, an array of communications from different sources, and many “teachable moment” opportunities. There are actually several processes that comprise effective engagement. If we were to “map out” all that goes into the engagement process, we’d see an array of flows, including these:

The participant screening and assessment that leads to various intervention options or other types of support, some of which have multiple stages:

– The marketing process that guides individuals to the interventions
– The incentive design and delivery process
– The method for collecting metrics to determine program impact

All these elements combined represent a giant puzzle of moving parts that need to be coordinated and optimized in spirit of continuous improvement. Think of the various inputs and outputs and how they could be enhanced with a true commitment to quality in the process flow, rather than simple “silo hand-offs.” There is much to be done to better integrate vendor partners in areas other than technology platforms and data sharing.

We need to both listen to and understand the customer (employee) and integrate their feedback. Many more lessons from Deming’s work can inform and improve the ability to move employees along the continuum toward improved health and well-being. And when we think of the “quality of life” that can result from such an approach, we can thank Dr. Deming for another contribution.

Purposeful Behavior, Peak Performance and Meaningful Rewards


Across all walks of life, the idea of performance, especially “peak performance” is a marker of success.

There are machines – luxury cars, mountain bikes, high-end computers – “built for performance,” that claim competitive superiority because they let you achieve more, be more – and, as a result, they often sell more.

For lovers of music and team sports, stellar performances are always in demand and appreciated, whether it’s the talent and orchestration of a fine classical concert or the successful game plan execution of a high-profile football game. Sold out venues and loyal fan support are their rewards.

rory-mcilroy-performance-rewardsPerformers can also stand alone, whether soloists in music, or those with singular efforts in golf, tennis, or track. Each player does what they do best to achieve their own clear and defined purpose, and each has their own rewards.

For success in business, high performance is also essential, both on a team basis and for individuals. For the total organization, earnings that exceed expectations are rewarded with increased valuation. For employees, achieving goals that contribute to team or division successes can be incentivized in various ways.

In each of these scenarios, positive behavior leads to peak performance and results in meaningful rewards.

Another key is that the entity that “performs” must be free of hindrances or barriers to achievement. Said another way, participants need to be healthy, and oriented to good well-being practices so they can put forth top efforts and deliver optimal results.

So, here’s a potential conflict with today’s employee health promotion model.

For years now, employers have been concerned about their health and medical expenses, and have instituted health improvement programs to help lower costs (increasingly with incentives), with varying degrees of success. Some have had good outcomes, and data are beginning to show productivity gains as well (performance, per se, is rarely studied).

But, consider those top performers that may come to mind as you think of professionals at the top of their game. Do they need “health promotion” plans in place in order to take better care of themselves?

They know that the only way to achieve peak performance is to ensure that their body, mind and spirit are in tip-top shape. For them, purpose is the underlying driver, superior health is mandatory, and the rewards they accrue are generally commensurate with their efforts.

For employees struggling to reduce medical costs and improve health, one may wonder how the situation might be difference if their emphasis was on purposeful behavior rather than cost avoidance.

When leaders provide their enterprise with a strong sense of purpose and make certain that all participants know their role and understand how and why their contribution is integral to the achievement of results, employees are then more likely to match their health and lifestyle behavior with those of top performers – i.e. they don’t need a health risk assessment and telephonic coaching to do what’s right.

By providing individuals the necessary resources and support, and by more creatively designing rewards (and penalties) that are proportionate to their achievements, they might just work harder and smarter at taking better care of themselves.

Imagine if all those new innovations in health promotion such as team competitions, gaming concepts, reward points, and others were channeled toward improved organizational performance…

The employer market is not yet ready to embrace this philosophy, but as health promotion continues to evolve and encompass total populations, more enlightened organizations will begin to rethink the emphasis on cost avoidance, and increase their strategic focus on promoting and rewarding peak performance.

Why Aren’t We Doing More to Address the “Engagement Gap?”


In one sense, the Engagement Gap is one of the more glaring and worrisome problems in employee health and well-being improvement today, but in another, it’s one of those factors that just never seems to get the right amount of attention, energy or investment.

The annual Towers Watson/NBGH survey has consistently found that employers identify low employee engagement as the biggest obstacle to changing health behavior.

So why isn’t more being done?

Engagement GapOne reason is that the concept of engagement is generally amorphous – hard to define, harder to measure. We know we need more of it, and that without it, our efforts will fall short.

We see engagement as having dimensions of depth, duration and quality in the information, interactions and interventions an individual may experience, and that success is achieved through personal accountability for choices and actions. Engagement is a process, not an event.

Another view is to think about what it takes to achieve sustainable engagement. It’s really about the ability to encourage or influence individuals to take notice of a health or well-being factor that needs attention and do something positive about it to “make it better” on an on-going basis.

Promotion + Process

To us, this means that two of the “4P’s” need to be in place and working hard: a strong promotional program that leverages consumer marketing and advertising concepts to effectively “sell” health and well-being improvement; and a fully integrated, well-delivered process that moves participants seamlessly through the linear steps toward delivering meaningful results.

Individuals need context in their lives to make meaningful change. They need some amount of rational understanding as to why they need to undertake something new or stop a current behavior. “Because we said so” is not enough, nor is the simple idea that “it’s good for you.” There’s usually more, in fact a lot more, involved in such initiation.

Decision Pathways

People have decision pathways for much of what we do, and often face barriers that keep us from completing our intentions. These are sometimes rational, sometimes emotional. With health behavior, inertia comes into play, as well. Why change at all?

Understanding the dynamics of health behavior change can help improve the odds for designing for better engagement, but knowing how to break through to reach into their hearts and minds will win the day. Storytelling, peer influence, transparency and persistent, creative messaging can all contribute to positive outcomes.

There are many ways to address the Engagement Gap, but first one has to have a strategic imperative to do so. If you do, we can help.

Employee Performance: The New Well-Being Metric…?


Employee health management programs have traditionally been put in place to reduce healthcare costs. For years, that was the sole desired outcome for most employers. The primary target was the 3-5% of the population that cost the most and the main aim was to “bend the cost curve” through disease management outreach.

Broader industry thinking has evolved the field toward identifying improvements in other areas such as health status, well-being and productivity. The core concept is that by screening the total population, stratifying by risk or other factors, and intervening with individuals, then the additional business metrics can be achieved.

This linear approach generally dominates the thinking around today’s model – get enough people through the behavior change sequence via health and well-being interventions, and then business-related outcomes will occur. There is plenty of good research to support the notion that healthier people are more productive.But productivity has traditionally been difficult to measure. It also tends to have greater relevance to the manufacturing sector. So we’re seeing more of an emphasis evolving toward performance as the more relevant metric for the Information Age. We’ve recently seen proof of the linkage between well-being and performance as reported by Healthways.

We expect that performance will become the focal point of many health and well-being improvement strategies going forward.

Which Comes First?

There is some question, however, about which comes first – well-being improvement or performance? Some contrarian thought leaders are beginning to turn the tables on traditional thinking that says improving health (and well-being) is the way to achieve greater productivity (or performance).

Wendy Lynch, PhD, has long advocated human capital focus and rewards as the leading idea as the point of emphasis for corporations. She believes that by providing individuals with the tools and resources to perform their best, and reward them for doing so, they will more naturally take better care of themselves.

At last week’s HERO Forum12, she and Bruce Sherman, MD took on this topic in a “Chicken and Egg” debate that challenged conventional wisdom about employee health management approaches. Each provided smart and supportable viewpoints, and the well-entertained audience was left to ponder the competing perspectives.

It is likely a debate without resolution, as the real determinants of success are the employer culture, strategic imperatives, and philosophy about performance and well-being. But it does prove that the industry is moving along a path toward greater sophistication and ultimately, better outcomes. Stay tuned…

Healthcare Consumerism at the Heart of Humana + Walmart Loyalty Program


The announcement of last week’s deal between Walmart and HumanaVitality to provide consumer incentives on selected healthy food products represents a solid milestone in the evolution of Healthcare Consumerism.

great for you logoThe Vitality HealthyFood program is available to Humana members that participate in their healthy rewards program, and complete a HumanaVitality health risk assessment. This entitles them to a Vitality HealthyFood card that rebates 5% of the price of selected produce and other food items with a “Great for You” label at Walmart stores.

The connection to Healthcare Consumerism is that it promotes accountability for better health and wellness through an incentive approach that rewards positive behaviors to participants. It also indirectly impacts other audiences through the anticipated promotion to multiple stakeholder groups from both companies.

On paper, it is a very smart arrangement and allows Humana and Walmart to trade on one another’s strengths and gain equity in the wellness space:

– Humana is able to promote their healthy rewards program and the offer to their base of members, and also tout their consumer strategy to healthcare professionals and insurance brokers as a means of elevating the Humana brand
– Walmart has the opportunity to advance their own burgeoning wellness strategy by highlighting the items carrying the label to their shoppers, suppliers, and communities

As a national health plan, Humana has been at the forefront of consumer-centric innovations. Success of this initiative will come in time, but for now it has the markings of a well-conceived foray into the nation’s largest retail marketplace.

That itself is a bold move worth watching.

Using Demand Side Strategies to Drive Better Engagement


Those who provide health and well-being improvement services are always looking at new and different ways to increase participation. Too often though, they focus on program innovation or refinement, rather than on ways to better pitch their offer to the intended audience.

This “supply side” emphasis is actually endemic throughout healthcare, and too often leaves the consumer out of the equation.

When we consider that individual lifestyle and health behavior choices contribute to about 75% of our nation’s healthcare bill, and that the programs being offered are intended to change that, the consumer – or the “demand side” – needs to play a very direct role.

We believe that most in the industry would agree that the interventions and interactions generated by vendors and health plans are generally quite good, and that the missing piece is participant engagement.

Our view is that consumer marketing is needed to stimulate the demand side, and “convince the buyer” that we have something of interest that has value to them. Of course, we’re not asking them to pay, and in fact frequently offer them cash or rewards if they do take part. We see the following five areas as essential to “making the sale:”

1. Identify the clear benefits. We all know the reasons why it is good to take part in health and well-being improvement programs, but don’t do a good job at framing the relevant consumer benefits.

2. Serve up the story. This requires more than a series of e-mails or flyers. A more complete communications campaign is needed to deliver key messages designed to get attention and build interest.

3. Make the sale. Awareness must translate to action. Incentives help, but there also needs to be intrinsic receptivity to the offer.

4. Reinforce the buying decision. Avoid the “trier-rejecter” pattern. Find ways to strengthen conviction through direct messages, portal postings, internal advocate support and pats on the back from coaches or clinicians

5. Reward them over the long term. Health behavior change is difficult and part of a lifelong journey. Consider ways to build financial or benefit-oriented advantages for individuals that have made the right choices and done the hard work to overcome challenges to create new and improved healthy lifestyles.

It sometimes takes a different mindset to rethink conventional approaches to wellness promotion, but by looking at the overall program from the consumer perspective, you may be surprised at how much opportunity for improvement there can be.

So, be a marketer, and convince the buyer…!

The Wellness Imperative: How Health Plans Can Better Serve Employers

Wellness has moved past the tipping point, from a nice-to-have extra, to a strategic lever that helps employers address health risks, lower costs and improve productivity. Met Life claims that 73% of companies with 500 or more employees now offer a wellness program.

And PwC reports that nearly 80% of large employers rated wellness services nearly as high in importance as the basic functions of accurate claims processing and provider discounts.

These data give health plans a wide berth from which to operate to partner with their customers and provide meaningful value-added services to deepen their relationships and help bend the cost curve.

Unfortunately though, according to Towers Watson, employers are generally disappointed in what their health plan partners can deliver– 67% rate their plans’ effectiveness as unfavorable relative to improving member health behavior and lifestyle. Only 7% gave their health plan a favorable rating.

With so much market demand, health plans are working hard to crack the code on developing wellness approaches that sell well to customers and effectively engage member populations.

We see a few key principles that can help guide the way:

1. Programs that fit populations

Too many “plug and play” platforms from vendors are rigid and unable to meet the needs of diverse populations. Each employer group is different and there needs to be flexibility and a degree of customization to be effective across demographics.

Some components can be static, but others need to fit the culture and style of the organization and its strategic aims.

2. Resources and budget to deliver results

Employers need to be realistic about what they ask health plans to provide. Some want “turn-key” packages that don’t require any of their own involvement. That approach is unfair and destined to fail.

Employers need to partner with their health plan. Each needs to be clear about their roles and responsibilities, and share the workload.

3. Strong execution and effective communications

Here’s a case where the devil really is in the details. The overarching aim for programs is to change human behavior, disrupt bad habits, and alter unhealthy perceptions. With 75% of health costs being attributed to lifestyle-related risks, the opportunity is big, but so is the challenge.

Being appropriately aggressive and paying attention to minutiae – as well as the big picture – will help tremendously.

4. Accountability across the board

We’re hearing a lot about ROI now. Only about 19% of companies measure it today, but this is bound to increase. There needs to be greater emphasis on ensuring that all players involved in delivering the program are accountable – as well as the employees to whom the initiatives are targeted.

Make sure actions are trackable and reportable, and that will go a long way to ensuring program longevity.

5. Reporting that tells the story

Unfortunately, reporting in this entire area is generally deplorable. It usually comes too late to act upon and is often inaccurate. There are plenty of ways to improve on this, and it will become increasingly important to do so.

Bigger budgets will be needed to accomplish the promise of wellness, and those that hold the purse strings will need to have proof of impact.

Wellness is a here and now opportunity. Employers are looking for solutions. Use these concepts to refine your approach and build a long-term strategy and plan.

We hope these views are beneficial to your efforts in the wellness arena. The bottom line key is to be able to achieve effective participant engagement. There’s much to be done to get better at this.

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…!