This infographic tells the story of how much obesity costs employers. We in the U.S. are, as a nation, obese. It’s a serious problem, and it’s taking a heavy physical, psychological and economic toll on us. Matthew Pelletier, C&S Safety Training Videos Director of Public Relations, has offered to share this great infographic:

According to the HHS (U.S. Department of Health and Human Services), and HHS Secretary Kathleen Sebelius, as a result of the Affordable Care Act, 5.6 million seniors and people with disabilities have saved $4.8 billion on prescription drugs since the law was enacted. The two main reasons are:

  • The ACA closes the Medicare “doughnut hole” under which seniors must pay for drugs entirely out of pocket.
  • Drug makers have also agreed to offer deep discounts to Medicare recipients.

The results:

  • Seniors have saved $4.8 billion on their prescriptions.
  • 5.6 million seniors have received a drug discount or rebate, including 2.3 million this year.
  • Seniors who hit the doughnut hole have saved an average of $657 this year.
  • Over 20.7 million with Medicare also received free preventive services in the first nine months of 2012
  • The health care law will save the typical person with original Medicare $5,000 from 2010 to 2022.

Significant Savings

Among the provisions in the health care law  to make Medicare prescription drug coverage more affordable are these:

  • In 2010, anyone with Medicare who hit the prescription drug donut hole received a $250 rebate.
  • In 2011, people with Medicare who hit the donut hole began receiving discounts on covered brand-name drugs and savings for generic drugs.
  • For 2013, people with Medicare in the donut hole will receive about 53% on the cost of brand name drugs and a 21% savings for the cost of generic drugs. These savings and Medicare coverage will gradually increase until 2020, when the donut hole will be closed.

Preventative Health Services

The health care law also makes it easier for people with Medicare to stay healthy through preventative health services. Before 2011, Medicare recipients had to pay part of the cost for many preventive health services, making it difficult for many of them to get the health care they needed. For example, recipients had to pay as much as $160 in cost-sharing for a colorectal cancer screening.
Since the health care law means that many preventive services are now offered free with no deductible or co-pay, the cost is no longer a barrier for seniors who want to stay healthy and treat problems early.
  • In 2011, 32.5 million people with original Medicare or Medicare Advantage received one or more preventive benefits free of charge.
  • In 2012, over 20.7 million people with original Medicare have received at least one preventive service at no cost.
  • 2.13 million of them have taken advantage of the Annual wellness Visit, an increase of 650,000 over 2011.


  • State-by-state information on savings in the donut hole is available here.
  • State-by-state info on utilization of free preventive services is available here.

A Brave New World Of Health Insurance Choices

Christopher Goldsmith of Sibson Consulting’s provocative article written for the Society for Human Resource Management (SHRM) explores how behavioral economics can help guide decision making with the complex choices consumers face in selecting better health plan options. This article summarizes that information.

The Problem: Choice and Complexity

Health care reform means more choices for consumers and a more complex decision process than before. Senior citizens will now need to make choices each and every year regarding their Medicare coverages: whether to enroll in traditional Medicare, supplement it with a Medicare supplement policy and a Part D prescription drug plan, or enroll in a comprehensive Medicare Advantage plan instead.

Health insurance marketers face the challenge of guiding consumers through a fundamentally more complex decision process in a way that helps them make more informed and better choices. The most important questions marketers face are:

  1. How to help simplify a complex decision process for the consumer.
  2. How to empower the consumer to make the best choices.
  3. How to differentiate your company in a field of similar products.

Behavioral economics—the study of how people make choices, drawing on insights from psychology and economics—can be useful in designing and communicating employee health plans.

Rational vs Emotional Decision Factors

Decisions regarding health often involve irrational, or emotional elements, where behavioral biases cloud rational judgment. For example:

• Unhealthy Habits: Despite numerous public health messages, many young adults nonetheless choose to become substance abusers or overweight.

• Not Taking Advantage of Preventative Services: Even if they understand the value of preventive health care and preventive care services offered under their plans without deductibles, co-payments or co-insurance, many still fail to take advantage of free health screenings or physical exams available to them.

• Lack of Interest in Health Care Research: When making decisions about hospitals and surgeons, few consumers research data about hospital costs, mortality, readmission and hospital-acquired infection rates.

• Failure to Plan: When enrolling in Medicare, many consumers fail to research the options available to them that would assist them in making an informed decision.

Behavioral Economics and Open Enrollment

Understanding these behavioral tendencies enables organizations to create more effective communications and incentives to make better decisions that produce better outcomes. This is particularly important during the open enrollment process, to steer employees toward cost-effective health plan options. Organizations increasingly want employees to migrate from more expensive PPOs to consumer-directed health plans (CDHP), which have lower costs in exchange for greater employee cost sharing. However, Goldsmith points to three behavioral biases that impede this goal:

• Loss-aversion bias. People tend to overvalue the prospect of losing something of value and to undervalue the prospect of gaining something of value.

• Value system bias. Deeply rooted value systems and selective filters necessitate substantial evidence to the contrary or significant influence to effect behavior changes will change.

• Status quo bias. Inertia, or the tendency not to change, is especially significant when choices are complex.

Optimizing Choice Architecture

Reframing Experiment

Health plan participants considering  the 3 choices below are likely to resist moving from a PPO to a Healthy Living Plan or CDHP because of the potential loss of their current doctor-patient relationship while undervaluing the financial gains or the prospect of improved quality of care available through a rigorous provider selection process.

Original Enrollment Presentation

Choice Architecture

There are also behavioral biases that the organization could leverage in its open enrollment materials to better position the new product offerings that could result in better results. Designing communications in ways that appeal to these biases can put a new perspective on the choice that makes it easier for consumers to consider and evaluate their options.

“Choice architecture” describes how the various options are framed, ordered and explained.  Figure 2 below illustrates how the default option, order of the options, plan names, presentation of decision-making factors, and use of color elements can be used to influence choice:

Reframed Enrollment Presentation:


Preliminary testing with various focus groups show many people who chose the PPO Plan in Figure 1 subsequently chose the Healthy Living Plan or Thrifty Consumer Plan when presented with the design used in Figure 2. The expected result of this presentation of the data is better outcomes for the employees and the organization.

Incentivizing Lifestyle Changes

Sibson Consulting’s Healthy Enterprise Survey

Encouraging Wellness Program Participation: One increasingly popular way to promote more healthful lifestyle changes is by using incentives to increase participation in the organization’s wellness programs, as shown in the chart above from Sibson Consulting’s Healthy Enterprise Survey.  Studies have shown that, compared to a control group:

  • Sustained tobacco use quit rates are 3X as high among participants receiving incentives.
  • Obese participants tend to regain their weight when they stop receiving incentive payments.

Designing Effective Incentives: Sibson’s research finds that participation in an organization’s health risk assessment activities increases as the as the incentive value increases, but incentives must be well designed to achieve desired outcomes:

• Too low incentives fail to motivate behavior change.

• Too high incentives can create a “choking” effect that impedes performance.

• Too distant incentives lead people to devalue the reward.

 Too long a qualifying period encourages procrastination, and, as the deadline nears, the perceived cost of change magnifies resulting in lower participation.

 Misguided incentives cause the reward potential to crowd out the intrinsic motivation to focus on health.

• Too many incentive elements makes the complexity is overwhelming.

Using Behavioral Economics to Effect Change

In the preceding experiment, we examined how reframing the enrollment choices aided consumers in evaluating their plan choices.  In that example, two behavioral biases were considered in designing the enrollment material:

• Clue-seeking bias. When faced with complex decisions, people look for clues, which they hope will be relevant to rational decision-making.

The revised enrollment chart provided relevant clues like “thrifty” and “elite standards” to show how the plans would actually work for the customer: Providing discrete columns for the major benefits of each plan (ie. “Your annual payroll deduction,” “Company Deposit into your Account, ” etc.) allows the consumer to quickly pick up cues about the benefits offered.

• Framing bias. Because people make decisions within a larger context, they look to their experiences and the environment to establish a frame of reference.  Therefore, how choices are presented has a substantial influence on the decisions people make.

The original chart, by placing the PPO option at the top, appears to suggest that it is a default option, or a standard-bearer. The revised chart, by placing it at the bottom as a “Legacy Plan” counters some of the intrinsic biases that impede change mentioned above (loss-aversion bias,  value system bias, and status quo bias.)

Countering Behavioral Biases

According to Sibson Consulting:

Some behavioral biases can serve as bridges to better outcomes.

Sibson offers some examples of “countering” behavioral biases that can be used to help employees make more informed and considered decisions:

Marketing Applications

Marketers need to bear in mind that the enrollment materials they design have real consequences in terms of workforce behavioral bias, choice making and engagement. Marketers can use principles from behavioral economics to help customers make more rational decisions regarding their health and their health care benefits. This begins with taking a systematic look at those outcomes you’d like to effect, and the consumer choices that would enable them. The ordering of options, highlighting of decision factors, naming of programs, structuring of incentives and selection of defaults can impact the outcome of the enrollment choices that consumers make.


Visit the Marketing Humor and Wisdom Page 

Employers Incorporate Brain Games into Wellness Programs

(My thanks to Michael Conforme, Talent Performance Expert at GCT Partners for directing this to my attention.)

Katherine Reynolds Lewis writes that some employers are expanding their wellness programs to include brain function exercises to help employees manage stress amid the increasing demands on their time and attention.

She reports that Nationwide Insurance employee Jeanne Siersdorfer  is logging hours of computer time online at work balancing a virtual basketball while other objects fly across the computer screen. But Nationwide actually encourages her to play the game as a part of its wellness plan.

Surely You Kid?

Don’t call me Shirley. These games are produced by a company called Brain Resource as part of a wellness solutions package called MyBrainSolutions that are intended to teach concentration and stress management techniques to boost executive function and memory, increase positive thinking, and achieve other brain-enhancing goals.  The solution is recommended for jobs that rely on knowledge work, creativity, and communication skills, which require that workers be mentally sharp, emotionally present, and free from distraction. Gregory Bayer, chief executive of Brain Resource says:

The brain, we’re finding out, is much like muscles in the body. If you exercise it, it gets better. You actually grow neurons. If you can teach people how to manage those multitasking and stressful environments optimally, you’re going to preserve their health.

Beyond the immediate benefit of improving brain function, the suite of games can work in tandem with other wellness programs to help individuals achieve other health goals, such as weight loss, exercise, or quitting smoking. Employees can set goals within the MyBrainSolutions software and track their progress, in addition to working on cognitive areas that will help them stick to the plan.

What’s the Methodology?

MyBrainSolutions users begin with an assessment of their brain to provide a baseline along four axes:

  • Emotion
  • Thinking
  • Self-regulation
  • Feeling.

Based on the resulting profile, the software suggests specific games to build up the areas of cognitive function that are weakest. The system then tracks users’ progress, giving points for playing time and badges when users reach milestones.

According to  Jesse Wright, a psychiatry professor at the University of Louisville whose research on computer-assisted cognitive therapy was cited by Brain Resource in a white paper on the scientific basis for the program, this is a form of cognitive behavioral therapy (CBT):

Wide spread use of CBT computer programs does have the potential of helping people who do not have psychiatric illness but could benefit from the practical strategies of CBT to enhance problem solving, stress management, etc. A caution is that people with real problems such as depression would likely need genuine, well-constructed help programs to relieve symptoms.

What’s the Need?

David Nill, vice president and chief medical officer at electronic medical records provider Cerner Corporation introduced MyBrainSolutions as a pilot program this summer to offer support to a workforce of about 9,500. The pilot will eventually expand to its global workforce as far as India, where seeking mental health care carries a stigma.

Reduction in Health-Related Costs: It’s a key area of interest at Cerner because behavioral health issues such as depression and anxiety affect 30% of their employees and family members and cost about $2 million in health expenses. The most expensive cases, which represent about 5% of Cerner’s workers, involve stress-related conditions, according to Nill. He says:

Usually, people don’t engage in this type of activity until they’re not functioning well; they’re headed toward a diagnosis. Brain Resource brought on an ability for consumers to engage any time, any place, on their own terms without having to talk to anybody. I’ve been aware of the science for quite a while. It’s very compelling. It’s cognitive behavioral therapy; you’re just doing it without them having to sit in a therapist’s office.

Now if only we can distract those corporate efficiency experts with games, we might be able to save some jobs.

Show Me The Money!

Wellness Results
The fun, game atmosphere of MyBrainSolutions helped Nationwide achieve goals, contributing to greater effectiveness of the broader wellness offerings. For instance, it made the employee assistance program (EAP) more appealing and stigma-free.
Nationwide’s results after introducing MyBrainSolutions in 2009:
  • EAP use at Nationwide Use skyrocketed to 18.4% in 2011 from 7.7% in 2007  (that year’s industry average was 4%.)
  • Nationwide’s percentage of obese and overweight workers declined between 2010 and 2012.
  • In 2012, for the first time more than 70% of the population became low risk.
  • The high-risk population fell to an all time low of 7%.

Cerner’s results:

  • Over 1,000 employees signed up for the program within the first two weeks and currently there are 2,500 users, more than Nill anticipated.

Self Development Results

At Nationwide, a case study found,  based on self-reported responses to Brain Resource questions, that workers who played the games regularly:

  • Increased their positive thinking by 5%
  • Boosted social skills by 8%
  • Heightened their emotional resilience by 9%.

Bottom Line Results

Nationwide’s bottom line improved as well, according to these self-reported results:
  • 8% improvement in productivity
  • 7% decrease in absenteeism

Kathleen Herath, associate vice president for health and productivity at Nationwide states that the best outcomes are when people are doing this along with another program:

If I’m trying to do a weight loss program, learning what motivates my brain and how my brain functions is the key to helping change my behavior.

Wellness Programs Reduce Medical Costs

Savings generated from wellness programs based on a meta-analysis of multiple workplace wellness programs

BY  of BenefitsPro highlights a recent study by Zoe Consulting Inc. on behalf of Interactive Health Solutions Inc., a provider of performance-based health management solutions for employers.  The analysis is based on multiple years of medical claim data from two comparable population groups.

The reason this issue is so significant, according to Joseph O’Brien, president and CEO of Interactive Health Solutions, is that health care spending has grown to over 25% of total labor expense. However, the study finds that employers using wellness programs experience a significant average medical cost trend reduction that includes:

  •  6.1% average annual medical cost trend reduction.
  • 13.5% average annual medical cost trend reduction among members with core conditions, including:
    • asthma, coronary heart disease, chronic obstructive lung disease, diabetes and hypertension.
  • Many health effects from core conditions can be managed through early detection and compliance with prescribed therapies.
  • 7.7% reduction in per member per month for the survey’s final year.
  • 85% of members maintain or lessen their health risk levels.
  • Fewer days off due to workers’ compensation and short-term disability claims.
  • 9 day earlier returns to work under workers’ compensation
  • 17 days earlier returns to work for short-term disability.

A Growing Market

Global revenue for mobile healthcare applications in 2012

According to Ralf-Gordon Jahns and Grace Gair of Research to Guidance, in the Mobile Health Market Report 2011-2016 report, 2011 already showed significant growth for the mHealth app market, and, in 2012 the market size will nearly double, reaching US$ 1.3 billion in 2012 – up from US$ 718 million in 2011. In 2012 the number of mHealth application users – mobile users who downloaded a smartphone mHealth application at least once – will reach 247 million. Compared to the 124 million users who downloaded mHealth smarthphone applications in 2011, this is a near doubling. However, they warn:

Despite this substantial growth, the mHealth market is still in an embryonic state – especially in comparison to the US$ 6 trillion of the overall global healthcare market. Several factors (esp. smartphone penetration), will continue, however, to drive mHealth market growth over the next couple of years.

Mobile healthcare market drivers: The increase of revenue stems from downloads, in-app advertisements, mHealth services, direct transactions and sensor sales.

Dependent on Technical Developments: As a number of big healthcare companies published mHealth apps in 2011 that go far beyond a simple allergy tracker or pill reminder (e.g. Sanofi Aventis’ sensor-based iBGStar Diabetis monitoring app) sensors are a growing part of the landscape. As the technical aspects of the healthcare landscape are changing rapidly, healthcare data, apps and usage are growing. But much of it is dependent on sensors attached to smartphones.

Is It Worth the Investment? Adult Usage Still Low

Pew Internet research suggests that major investment may be premature:

  • 50% of adult cell phone owners have apps on their phones
  • But just 46% of downloaders have paid for an app.
  • Only 68% reported actually using them.
  • 17% of cell phone owners, or 15% of adults, have used their phone to look up health or medical information.

Overall, this means that 35% of U.S. adults had apps on their phone, but only 24% of adults actually used them.

Health Apps At the Bottom of the List

While there are various types type of health apps available, including apps that people use to track their fitness or help diagnose a condition, Pew research indicated that health apps were at the bottom of the list of the type of apps adults download.

According to Richard of DTC Marketing, who has research of his own:

I have led extensive research with adults on health apps (apps that help people manage certain health conditions not diagnostic or fitness apps) and found that in most cases people do not want to be reminded they have health problems and they just don’t have the time to enter data and learn new apps unless the app provides “significant value” to users.

We also found that of the people who did download health apps to help them manage their health that over half deleted the app after 60 days and one quarter never used the app.

What Healthcare Information Do Mobile Phone Users Seek?

The most commonly-researched topics are specific diseases or conditions; treatments or procedures; and doctors or other health professionals. See: summary charts of health topics.

The typical search for health information is on behalf of someone else.

Default Use: “I don’t know, but I can try to find out”

The default setting for people with health questions is to find out things they don’t know:

  • 34% of internet users, or 25% of U.S. adults, have read someone else’s commentary or experience about health or medical issues on an online news group, website, or blog.
  • 24% of internet users, or 18% of adults, have consulted online reviews of particular drugs or medical treatments.
  • 18% of internet users, or 13% of adults, have gone online to find others who might have health concerns similar to theirs. People living with chronic and rare conditions are significantly more likely to do this. See: Peer-to-peer Healthcare.

Leading Edge Use: “I know, and I want to share my knowledge”

The leading edge of health care is active tracking and sharing:

  • 27% of internet users, or 20% of adults, have tracked their weight, diet, exercise routine or some other health indicators or symptoms online.
  • 6% of internet users, or 4% of adults, have posted comments, questions or information about health or medical issues on a website of any kind, such as a health site or news site that allows comments and discussion.
  • 4% of internet users, or 3% of adults, have posted their experiences with a particular drug or medical treatment.


Richard concludes:

It’s still about driving brand objectives and connecting the money invested in developing an app to ROI is hard to do at a time when budets are being cut. Does this mean that pharma marketers should ignore mobile ?  No it just means that if you’re going to do it do it right starting with a strategy that asks “what value can provide our users that balances brand objectives?”

Are mobile health apps really worth the investment? Maybe not yet. That is, unless you can crack the code on value. The company that can deliver and promote real value may have a key differentiator.
Snap! principle of Mobile Health app development:

Ignore the hype from agencies who want to develop health apps unless you can do extensive usability testing and research to find out what users actually value. 

More Mobile Health Reports:

– Mobile Health Applications Landscape: Best Practice Examples (2011 – 2016)

– mHealth App Market Trends and Figures 2011-2016

Employee Engagement Stagnant

An AonHewitt study of more than 3,100 organizations representing 9.7 million employees globally, titled 2012 Trends in Global Employee Engagement shows that 58% of respondents were engaged in 2011, just a slight increase from 56 % in 2010.

Here are some of the other key findings and analysis from the study as highlighted in the Executive Summary:

  • Four employees out of 10 employees are not engaged worldwide. Engagement level by region varies. While almost 58% of employees globally are considered in the engaged status, 42% percent of employees are somewhat or completely disengaged.
  • Employees’ motivation to stay and exert extra effort seems to fall short. While engagement levels are relatively stable, 2012 will be a challenging year for retention as employees seek new opportunities outside their organization as a result of limited career development and advancement opportunities.
  • Some engagement drivers improved, but not the ones that matter most. Across all possible engagement drivers examined, there was noteworthy improvement in Business Unit Leadership, HR Practices and Brand Alignment – but none of these areas showed up consistently as a top driver of engagement.

Communications Drive Employee Engagement

The survey finds one of the top drivers of employee engagement to be communication. Effective and engaging communication impacts employees on rationally, emotionally and behaviorally relevant levels. According to Oehler:

“Corporate communications is the primary connection point between the majority of employees and executive leadership. We saw that employee perceptions of communication declined in 2011.  As companies recovered from the recession, they likely became less focused on clear and consistent communication from leaders.  Messages usually break down at the mid-management or immediate manager level so it is important for the leaders to continue to provide clear messages about business objectives, challenges and what is required of employees.”

Benefits Communications Drive Participation

Benefits communication strategist Jennifer Benz of Benz Communications points out that:

“Reminding employees about benefits once a year is not enough to get them actively engaged in decisions about their health and financial wellbeing. The key to capturing employees’ attention is feeding them bite-sized chunks of information year round. Social media is the perfect tool for simple, ongoing, two-way communication  to get them actively engaged in decisions about their health and financial wellbeing.”

5 Social Media Tools That Drive Benefits Engagement

 of Benefits Pro highlights the five best social media tools that companies can utilize to for their benefits communication. Not only can companies do this on their own, but benefit providers can offer support here as a value-added tactic.

Here are some ideas of how to use Social Media to improve engagement and drive benefit programs.

1. Blogs

Blogs make it easy to create web content and give readers the opportunity to respond quickly and dialog.  Adding a blog to your benefits website or intranet can be useful to post reminders, new features and articles, including tips to help employees get the most from their benefits. Moderating is easy since no comments are posted until reviewed.

2. Microblogs

Twitter and Yammer and others let you post short updates at will—both pre-scheduled and ad hoc—and enable more interactivity than a traditional blog. Your Twitter feed can be imported into your benefits website or intranet to keep them fresh. At Twitter.com/BenefitsTip, Benz Communications provides benefits content that can be re-tweeted, copied or re-purposed.

3. Podcasts/Videos

These can be played on employees’ computers or mobile devices. Suggested uses include:

  • Video of your CEO speaking about a new wellness program or upcoming benefits change.
  • Video podcasts of enrollment meetings and new hire orientations – helpful for remote employees.
  • A series on benefits basics,  paired with an online forum for questions.
  • A contest for the best two-minute employee-created video about health care, wellness, etc., since hearing messages from their colleagues encourages employees to act.
  • Interviews with benefits team members and brief explanations of benefits offerings.

4. Social Networks

Peer influence and support boost engagement and achievement.Facebook, LinkedIn and other social networks that connect individuals around interests and activities can be powerful tools for distributing information and ideas. Suggestions:

  • Build an internal social network to connect employees interested in similar wellness topics.
  • Create a Facebook page for your wellness program, integrated with your blog and/or Twitter feed —especially if you’re offering online classes or events where frequent updates and information can be shared and family members can participate.

5. User Forums

Moderated online discussions focused around a specific topic can encourage employees (and your benefits team) to exchange ideas and answer each other’s questions about how to get the most from your programs. Structuring the forum by benefit plan makes the information easy to navigate. User forums are usually most effective at organizations that use online discussions for other topics. And since they require more monitoring than some other channels.

Snap! principle of Employee Benefits engagement:

Ongoing, systematic communications are the key to increasing engagement

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