What Can Employers Do To Encourage Healthy Behavior?

While traditional wellness programs are firmly embedded in corporate culture, a couple articles reminded me there are still a lot of innovative ideas for supercharging health in the workplace:

1) The Wall Street Journal spotlighted the gamefication of wellness program from companies such as UHG, Humana, and Aetna.  As I’ve discussed in the past, the ability to quantify and track progress to a goal, while wrapping in social communities, can make fitness fun. 

However, I’m still not convinced these are good investments.  First, as the article states, the research on these games is thin.  While anecdotes suggest they are successful, we can’t say with certainty if they drive better behavior, especially for people who need it most and may not be participating.

What I find more challenging is the incentive structure.  While a lot of people participate to improve their health, others are drawn in by the giveaways and prizes.  Arguably, the bigger the incentive, the more people who will participate, which is how employers will generate the most savings.  But a bigger prize also means more people may try to game the system (most of these programs are self-reported) or be less than honest about their progress.  The article mentions some programs require special equipment (e.g., a pedometer), but that may dissuade employees, especially those on the fringes, from participating. 

I’d be interested to see a business case comparing the value of the prize to the number of people participating and their average health improvements.  I would be curious to see if there is some prize level that encourages so many people to participate that their benefits, no matter how small, outweigh the costs of others trying to outwit the system.

2) Another article via PSFK highlighted a meeting table withbicycle pedals attached, allowing employees to exercise and generate electricity.  Similar to the hotel concept I previously discussed, I love this idea for a few reasons.

First, it brings fitness into the everyday work environment, but is less awkward than some solutions (e.g., standing treadmill desks), and offers the benefits to a wider range of employees.  Second, it brings a little green energy into the office and encourages environmental conservation.  Finally, from a more practical standpoint, it can cut down on meeting times, which has its own benefits for employees.  In fact, I’ve heard of one other company that has been successful by having only standing tables in meeting rooms. 

Sure, there are some practical concerns to implementing these bikes (e.g., price, worker buy-in, hygiene), but I could see employees of all shapes and sizes using this for the novelty and health benefits.

Can Technology Help Us Shop For Cheaper Healthcare?

Medical cost transparency is the holy grail for keeping our system in balance.  Any high school econ class will teach you that a market functions best with data, so it’s easy to understand why healthcare has continued to be inefficient – it keeps its customers in the dark about prices.  There are products today that force consumers to think more about costs and potentially shop around (i.e., individual health accounts like HRAs and FSAs), but without knowing how much they’re going to spend for treatments, people still can’t make the best decisions.

In light of this, I applaud the Castlight Health and their new app that gives consumers healthcare pricing and quality info on their phone.  By collecting claims data, negotiated rates, and quality metrics, the app and accompanying website show information about doctors in the area and expected costs for services.  The article highlights how the app is especially good for travelers, which help them make on-the-go decisions.

While I love the service, I struggle with the bigger question of how to change mindsets and encourage people to take price into consideration when working with a doctor.  This is especially challenging for patients who have seen the same physician for a long time.  Not only will they be reluctant to talk about prices, but they will also resist building a relationship with a new doctor who, at a lower cost, might be viewed as lower quality (even if data says different).

However, if we’re to rein in costs, patients shouldn’t blindly stick with one physician, or accept their prices, if there are others nearby that provide good quality at a lower cost.  Like any negotiation, the patient needs to be willing to walk away, but this can be a hard mindset to take when this is new territory for patients.

Maybe this will be solved as this generation, which is more comfortable with shopping around for price and understands the healthcare crisis, makes up the bulk of the patients.  I’d also be interested in seeing what Castlight is doing (e.g., member education and communications) to encourage customers to seek lower cost physicians.  Regardless, they have fired the first shot against healthcare price opacity, and I’m excited to see how this plays out.

Can A Fridge Magnet Promote Better Health Behavior?

One challenge healthcare providers face is cutting through the clutter to deliver targeted messages. I’ve talked about dedicated healthcare devices, so I was intrigued by a fridge magnet from a restaurant in Dubai. Red Tomato provides this Bluetooth-enabled device that connects wirelessly with a customer’s smartphone and allows them to easily order a pizza.

Obviously this is great branding, positioning the company as cutting edge and convenient, while building awareness through this unique product. However, I’m more interested in the technology, specifically syncing this device to provide a service. I could see a few applications in healthcare:

- A direct application of this technology would be a device that, at the push of a button, can call a doctor or emergency vehicle – think Life Alert without working through their call center

- This type of device could also collect and display information, connecting with a website or app and transmitting medical information to promote optimal behavior. For example, after entering medication information into your computer, this device could alert you when you need to take your drugs or when to get a refill. Similarly, after entering the dates when you last visited the doctor, the device could alert you when to schedule a new appointment

- Following the fridge magnet approach, this device could be a dedicated food tracking device and barcode scanner. There are lots of smartphone apps that allow you to track calories, but making it convenient by keeping the device close to where you eat and more accurate by scanning barcodes could drive more adoption and interest

There are plenty of challenges. First, this would appeal to tech savvy consumers who aren’t the people who may need this information the most. Second, the device itself would be challenging to create – it would need to be easy to use, have a long battery life, be inexpensive to produce, and address privacy concerns. Finally, there’s the issue of who pays for this – consumers, healthcare providers, or another third-party? If someone is able to solve these issues, I believe this could be a game-changing device that makes healthcare as easy as ordering a pizza.

How Can The Government Improve Smartphone Health Apps?

Every week I see a flood of new smartphone apps hitting the market that help users make better health decisions. And every week there are some great ideas I want to write about, but I’m dissuaded by two things:

1) The apps are usually micro-targeted towards a certain consumer and do very specific things

2) I’m overwhelmed by the number of apps and how many of them feel like clones of each other

This is why I’m intrigued by a new program from the UK’s National Health Service, which is recommending 500 apps and tools for doctors to prescribe to patients. As I mentioned in my last post, we need more health curators to guide us to the best solutions. While you can argue whether or not the government should be recommending services (although, at 500, it’s tough to say there’s any conflict of interest or they’re limiting choices), they have two big advantages that can improve public health:

1) Scope: Unlike other public health organizations, the government can reach all doctors and patients

2) Credibility: The government seal-of-approval gives users confidence that these apps have been vetted by health experts and are provide value

Now, I’m not advocating the government go into the app business - attempts by our government can be mixed at best (see TSA app – functional, but not innovative) and they’re served best by leaving development up to private companies.

But they can play a powerful role by leading people to the most promising solutions. By highlighting the most functional products, these apps may build a user base and encourage their designers to continue innovating. It would also be great to see the government providing small grants or awards to select companies to help fund this expansion.

Ultimately, I think the industry needs to consolidate so smart engineers and health professionals can concentrate efforts on the apps that work. One day, I hope I don’t have as many choices because a smaller number of apps provide the range of services I need and do it best. And I think government can help catalyze this process through similar recommendations.

Can Independent Health Advisors Help Consumers Make Better Decisions?

I attended a presentation this past week discussing health plan reactions to reform. One of my key takeaways was how new consumer attitudes and beliefs were driving change in the industry. A man-on-the-street video highlighted, among other topics, the diverse views around selecting health insurance and the trade-off between quality and price. While there was no consensus around what plans should specifically do, it was clear that consumers yearn for more empowerment as they make decisions about their health.

One of the new solutions described was deploying insurance-backed advisors to help patients choose the right coverage, especially in exchange markets. I think this is a good idea – having a representative walk consumers through the wide range of products can help match a person’s needs to the right product.

However, I’m not sure this model will work for all consumers, especially younger patients. The Internet has created savvy consumers, and any whiff of bias could turn these people off. I like the concept, but I think it could be taken a step further by creating health advisors independent of the industry.

I see this working like financial advisors today (or even rolled into existing financial services). These people would answer basic health questions and help improve health care literacy, whether it’s selecting the right insurance, settling a hospital bill, or understanding preventative medicine. While this could range in engagement (from an annual “checkup” to a 24/7 concierge service), the main focus would be to make healthcare understandable, especially the financial side that is rarely discussed.

The challenge is the business model. A fee-for-service model seems most logical, but could put this out of reach for many Americans. Any sort of rebates or kickback from insurers defeats the purpose and savings calculations, whether it’s vs. their previous plans or vs. expected medical costs, seem complex. Regardless of how this makes money, I think this hands-on service is the right way to customize healthcare to the individual and provide the empowerment consumers are looking for.

What Does The Weather Teach Us About Improving Health?

It was a beautiful day in Chicago and running outside this afternoon reminded me how much weather can impact health. As I observed people walking around, it struck me that this phenomenon is probably motivated by a few things:

- After being cooped up indoors all winter, people are anxious to get outside and change their routine

- Nicer weather leads to shorts and t-shirts, meaning people need to look better as they start to shed the bulky coats

- Sun provides vitamins that folks have been deprived of during the cold winter

Obviously the combination of these factors creates a perfect storm to motivate people to run or bike outside, but there may be lessons health companies can take from this. For example, gyms could have special events that change up routines, encourage people to try a new type of exercise, and even tap into that summer anticipation to reinvigorate folks. Similarly, health insurers could host exercise or social events to get people moving during the winter by encouraging them to prepare for the event by taking steps to look good around others. Finally, providing support for Seasonal Affective Disorder (e.g., having sun light therapy at gyms) could be a differentiator and contribute to improved mental health.

Do Consumers Lose Out If Healthcare Companies Don’t Speak Plain English?

A recent article in BenefitsPro discusses how the current administration may reverse course on a popular provision in the Affordable Care Act. The requirement forces healthplans to simplify plan language and give examples of coverage options by this fall. I imagine this will resemble credit card offers that have a table highlighting key components (e.g., APR) and put everything into plain English.

However, insurance companies are pushing back, saying that this would be expensive – a trade group puts the cost at $382 million over the first two years. The author contends the White House may buckle under this pressure, hoping to appear business friendly heading into the November elections.

Overall, I disagree with the insurance trade group assessment. There will definitely be an upfront cost, but they don’t talk about the potential benefits from this transparency. For example, this education may allow the customer to choose a more efficient plan that puts limits on coverage or helps them understand those limits better, both of which help healthcare dollars be spent more efficiently and lower costs.

While I think transparency benefits the system by helping consumers make better decisions, my faith was shaken by a Freakonomics podcast that discussed financial literacy education. One of the guests argued against this (there’s a great debate in the middle of the podcast), saying that a little education…

1) …can give consumers overconfidence that leads to more reckless behavior – a healthcare analogy is a patient who visits a doctor armed with online research that complicates the diagnosis and treatment options

2) …shows no evidence of positive behavior change. She says that studies show people like learning about finance, but didn’t necessarily change their habits

3) …isn’t sufficient to address the complex financial products available - healthcare insurance definitely has a similar complexity

This isn’t a perfect comparison and educating people on their plan options, not how to use the plan, are two different processes. Nevertheless, while I support greater transparency and providing greater consumer choice, the outcome of this regulation, if it survives, could be a little more uncertain.