Originally posted March 04, 2014 by Kathleen Koster on https://ebn.benefitnews.com

Employers and wellness vendors can elevate worker engagement to new heights by reinforcing healthy behaviors through the seamless application of emerging technologies. From using big data to identify and manage at-risk employees to combining biometrics with the social health version of Facebook, EBN looks at three areas of new technology that can help spur wired employees toward well-being.

Virtual trainers and clinics

According to the National Institutes of Health, users who have a weight-loss coach are 214% more likely to lose weight than those without. However, for most employees hiring a personal trainer is not financially feasible. Yet the interest is there: 74% of American adults want, but cannot afford or accommodate, a “traditional” personal trainer, says David Joseph Aguayo, regional vice president of sales at Anthem National Accounts.

As an alternative, Anthem provides a trainer-centric approach to wellness that doesn’t break the bank. The health insurer partnered with online trainer FitOrbit to provide virtual fitness and real-time, Internet-based coaching. Members begin by answering short questionnaires covering their dietary needs, exercise habits and preferred coaching styles. Based on their individual responses, they are matched with a list of nationally certified personal trainers. After selecting a trainer, the employee electronically receives a customized fitness and nutrition plan and ongoing coaching – the latter via the modern miracle of unlimited texting, plus a weekly personal exercise plan – to support their goals.

In an independent 20-week study, active FitOrbit users consistently lost an average of 1.3 pounds per week. Over three years, the tech platform’s own data shows 0.83 pounds per week of weight loss across all users.

Anthem also delivers the robust benefits of onsite clinics to employers who could otherwise not afford them, using similar technology.

“For employers that want to provide easier access to care or have onsite clinics, but don’t have the financial resources to invest in a brick and mortar facility, online care is way to explore that,” says Aguayo.

Using a new Anthem app, employees can seek medical advice through a live video chat feature that was launched late in the fourth quarter of 2013. Thereby, the employer can drive primary care access for employees without the major cost burden. The white-glove concierge service for health, as Aguayo describes it, gives members access to qualified and very experienced care professionals who can help assuage health issues and prescribe medicine for primary care needs, such as headaches or fever. The best part is the app engages employees where and how they want to be engaged, using text, instant messaging or phone.

The app also helps to keep employees going over the long run, in programs and resources they would ordinarily not participate in. For example, if a member calls in with a question about their health, the customer service advocate uses that opportunity to connect them with a coach or nurse.

“We’re leveraging our technology and investing in our people and trying to engage and create a whole new health experience that’s just in time [for the consumer],” says Aguayo.

Instead of “dialing for dollars” outreach, which most vendors employ to reach as many people as possible, Anthem advocates let members know what’s available at the point in which they’re actually asking for it, when they call in for help on their own.

Aguayo points out that 27% of people Anthem is trying to outreach to and engage with will call customer service in next three to six months to ask a question. That’s a great opportunity to tell them about the resources, capabilities and incentives available.

“We look at every possible pathway to engage people,” says Aguayo, emphasizing the role that technology and, in particular, mobile outreach has in today’s workplace.

Target outreach with big data

Another wellness vendor, Healthstat, implements patient engagement and behavior modification outreach via its electronic health records system, Pro-change Behavior Systems. The behavior change technology and coaches can identify employees’ level of readiness to change their behavior as well as how to best engage them.

“It’s not enough to know their risk profile, you need to know where they’re at, mentally and emotionally, and their readiness to change,” says John Kaegi, chief corporate strategist of Healthstat, Inc.

The system derives information from e-clinical employee health records to channel employees toward healthy living by combining behavioral science and employees’ risk assessments.

On the provider side, the technology prompts the coaches or trained clinicians to ask their patient the right questions, based on the patient’s risk analysis and their readiness to change. They can also proactively reach out to clients before they visit the clinic.

“It’s a lot easier when you have all the information at hand…to change behaviors,” says Kaegi.

The health risk assessment survey includes questions on readiness to change along with their risk profile. Straightforward questions (and some indirect ones) help triangulate their information to gauge a patient’s consistency. The program also culls data from the employee’s biometric screening results so the coach knows their data, even if they fail to mention that they smoke or have a certain health issue.

For example, the survey may ask how many times they tried to diet in the last 12 months. If the individual is not mentally ready to change, they may not have dieted before or have just tried brief stints at losing weight.

The Pro-change Behavior System uses a trans-theoretical model on how people change health behaviors and what spurs them to change. Based on decades of research, this model asserts that people fall into five stages of behavior change: pre-contemplative, contemplative, preparation, action and maintenance.

Kaegi says that 80% of Americans are stuck between pre-contemplation mode, meaning they don’t think they need to change, and contemplation, which means they wish they could change, but don’t know how.

Based on this model, the Healthstat program uses a different approach than what doctors may use. If a morbidly obese person sees a doctor, that professional likely advises them to diet or they will suffer greater health risks and eventually die prematurely.

“Sharing information and warnings just doesn’t work with people who are in [high risk] categories. What does work is an understanding, listening and caring coach who can walk them through the change at their own pace,” says Kaegi. Doctors don’t have time for this type of approach, he adds.

If a pre-contemplative obese person is targeted by Healthstat’s process, their coaches suggest the individual schedule an appointment at the clinic by a certain date. If they don’t make an appointment, then the coach is prompted by the electronic health record. A trained coach calls the individual and convinces them, kindly and patiently, to go to an appointment the coach will schedule. Once at the clinic, their staff can treat patients for health complaints like a sore throat or ear infection and then spend the remainder of the 25 minute appointment helping them begin a journey of personal health.

For this program, the employer would need access to an onsite clinic or they could combine with other smaller employers who can’t afford an on-site clinic to participate in a near-site location.

Sharing biometrics online for social support           

In their new platform, online wellness facilitator Keas combines a social media front end with biometric integration to offer employees a fun, social and supportive environment to improve their health while building camaraderie in the workplace. Companies such as The Cheesecake Factory, Pfizer and Salesforce.com are customers of the platform, which offers employees customized content specific to their individual health needs. Safeway and Target have recently signed on as well.

When not working or watching TV, adults spend a great deal of time on Facebook and other social media platforms. Keas has created a “Facebook for your health,” says CEO Josh Steven, where employees can share healthy meal ideas and exercise routines in an online community where their peers can like their posts and exchange comments. Comments bring people back into the platform, increasing engagement and making health a two-way street.

Participants can also join groups for challenges and goals as well as enter company-wide challenges to take more steps or eat more greens. Since the platform is fully integrated with quantifiable data from their personal measurement and accountability devices, such as FitBit bracelet trackers, employees can upload their results and receive actionable advice or feedback on how to achieve their daily fitness goals.

A longitudinal health profile that gives employees a basic overview of their individual well-being and health risks provides them with a visual representation of how they are improving their health over time. In addition, quizzes, challenges, weekly goal setting and healthy breaks will be tailored to address high risk issues such BMI, blood pressure, cholesterol, and pre-diabetes. The platform sets small goals to teach users how to accomplish weekly objectives no matter where they are in their personal health journey.

“Give them information that they can use, that’s actionable and not too medical,” says Steven.

The program requires employees use their names because they behave better, says Steven, though he says those taking part have few qualms because “the tone and quality of participation is positive and encouraging.”

While employees can share their biometric information (after agreeing to a pop-up that ensures they are fully aware of the risks sharing their private information), most people instead share examples of how they’re improving their health. For example, individuals will post, “how I reached over 12,000 steps a day” or “how I managed my stress.’”

“Users’ stories are not medical in nature, but they relate to medical conditions that carry high risk factors and drive up health care costs. We approach it from the ‘how to’ or a ‘what you can do’ approach, rather than from hard data,” explains Steven.

All too often, a person with high risk factors will stop attending coaching sessions because they fail to do their homework. They feel guilty so they stop participating. This program, which can integrate coaching, suggests manageable and fun goals from which the participant chooses three each week.

“Tech has to be presented in a way that it’s not technical. Employees don’t want to know about what tech is used; they want it to be easy, fun and social. We look at technology as an enabler and a tool that makes health fun and social and allows integrated data,” says Steven.

Steven believes that the more people are social about their health, the more they can be proactive and make changes like improving their diet and exercising.

“When communicating with peers about losing weight, improving your diet or reversing metabolic screening rates, as long as you’re not alone and have colleagues to share with, collaborate and encourage you, that really drives behavior change,” he says.