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.

Got Engagement…?

Originally posted on by Frank Hone

Here’s the problem in a nutshell – Health and Well-Being Improvement Programs are:
a) Free
b) Good for you
c) Relatively easy to access

And, yet participant engagement rates remain far below expectations.

Here’s a thought: Why don’t we “market” these programs with the same sort of strategic approach used for consumer brands?

Most marketers are successful when they can effectively define their brand’s positioning, market strategy, target audience, key messages, creative approach, media plan, roll-out schedule and measurement criteria, and do so with discipline and focus. These elements are all critical to brand sales.

There’s an awful lot of effort they do in the planning process (including consumer research) that enables them to be fairly confident in the results they can achieve. And they know how to motivate behavior change.

Got Milk?

gotmilkThe nation’s dairy farmers took a page from the marketing textbook when they created their “Got Milk” advertising campaign nearly 20 years ago.

They started out with three specific and clear objectives:
1) to change the public’s behavior regarding milk
2) to create the idea of ”milk occasions” by associating the product with certain foods
3) to curb the decline in sales by convincing people to buy milk more often and in larger quantities.

The basis of the campaign was formed by conducting a fair amount of market research on consumption patterns, consumer attitudes and strategic gaps.

Though the campaign has changed and evolved over time, the basic message remains consistent. The advertising has been tremendously successful for the dairy farmers and serves as a great example of leveraging consumer insight to build a compelling brand story – even though the “brand” is generic.

Employee Well-Being

A parallel here is to think of Well-Being as a brand.

Unfortunately, most corporate well-being efforts aren’t afforded enough time or budget to conduct full-scale market research or strategic planning.

But there are many ways to implement a number of the same sort of ideas and approaches that can get and keep the attention of your population. We believe that for many programs, a solid dose of marketing may be that missing element in the engagement strategy is the missing element.

Begin by being very clear on the specific objectives you aim to achieve, and then design and deliver a cohesive and relevant story to your audience. Give them a “reason to believe” (a core tenet of all good advertising), and move them through their decision pathway and along the continuum of health and well-being improvement.

So, the next time you sit down to review the effectiveness of your company’s programs, think about whether you’ve “Got Engagement?” and consider what effective marketing could do to strengthen program impact.

Healthcentric Partners Opens as Engagement Strategy and Marketing Consultancy


Former Healthways Executive to Lead Firm Focused on Sustainable
Engagement for Employee Health and Well-Being Improvement

NAPLES FL, May 2, 2012 – Healthcentric Partners, Inc. starts business today as an engagement strategy and marketing consultancy focused on Frank-Hone-chief-engagement-officeremployee health and well-being improvement initiatives. Frank Hone, former Director of Sustainable Engagement at Healthways, will serve as Managing Director.

The firm’s specialty is helping employers, both directly and through their vendor and health plan partners, to overcome the growing challenge of poor employee health engagement. Healthcentric Partners supports customers with strategy development and communication planning using consumer insight and principles of healthcare advertising proven effective in motivating behavior change.

“Our view is that the same sort of marketing power that builds consumer brands has the potential to ignite and energize health and well-being improvement and overcome the rational and emotional barriers to health behavior change. We also need to instill more of a business emphasis to well-being programs – there needs to be strategic focus, realistic expectations, effective delivery and meaningful metrics”, Mr. Hone stated.

In their 2011 survey of US employers, Towers Watson reports that 66% of employers claim that “employees’ poor health habits” are the top challenge to maintaining affordable health coverage, and 74% state they would like their health plan to do more to help change member behavior relative to making healthy lifestyle decisions.

These data represent the clear frustration of employers about the lack of progress in achieving effective engagement for available programs. Most companies – customers and vendors alike – are simply stymied about how to address the lack of participation and follow-through.

Mr. Hone notes, “There is no question that the industry has a big challenge with the “Engagement Gap,” even though most programs are offered at no charge, and many include participation incentives. This general disinterest in self-improvement comes when some 70-75% of health conditions are thought to be lifestyle and behavior related, and more than half the population has some sort of chronic condition. Most employers truly desire a healthier and more productive workforce, but achieving this requires smart and relevant engagement strategy and marketing matched with the right program offerings.”

Frank Hone brings many years of consumer advertising and healthcare marketing expertise to the consultancy. His recent engagement strategy experience with Healthways adds to his thought leadership in the areas of healthcare consumerism and direct-to-consumer (DTC) advertising.

His past career includes many years with Ogilvy Healthworld, Medicus Consumer/DMB&B and other New York-based consumer healthcare advertising agencies. He also studied with W. Edwards Deming during graduate work at Columbia Business School and applies his principles of quality and process improvement to the firm’s engagement strategy projects.

His 2008 book, Why Healthcare Matters: How Business Leaders Can Drive Transformational Change is an Employer’s Guide to Healthcare Consumerism. It looks at the business and cultural dynamics that contribute to today’s healthcare crisis, while providing market-based ideas and solutions for employers. It offers strategic and practical guidance for America’s business leaders to be more proactive and engaged in addressing health improvement and behavior change in their own companies.

About Healthcentric Partners, Inc.
Healthcentric Partners delivers consumer engagement strategy consulting and solutions for health and well-being improvement service providers, health plans and employers. The primary focus is on program branding, communication planning, impact assessments, consumer insights and strategic process.

The Engagement Gap


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

It’s probably largely due to the fact that the concept of engagement is generally amorphous – hard to define, harder to measure. We just know we need more of it, and that without it, our efforts will fall short.

A more tangible way to think about engagement might be to consider what it takes to achieve it. 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”.

Engagement GapSome practitioners advocate “paying for participation” by offering incentives to gain interest and drive action, but the impact is often short-lived.

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.

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 engagement, but we first have to agree that it is a problem that needs more effective solutions.