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:

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

Social Media Meets Wellness

Want to get employees up and moving? The Hotseat Pilot opportunity offers an opportunity for companies that understand that employees who sit all day are less productive, less collaborative and less healthy.

View the Infographic below or here to see why sitting all day is a health hazard.

Making Activity Easy

Hotseat is a health app offered by Context Communication Consulting that unseats employees through nudges, social competitions and game mechanics. Employers can give employees two minutes a few times per day.  They can use their phones to help “unclog your mind and uncramp your body.”

The solution is advertised as a good fit for companies that:

  • Understand that pedometers only work if you get up and small fitness breaks lead to major health benefits.
  • Have desk workers, on-the-road sales folks, delivery and truck drivers, tellers—people who sit too much.
  • Figure employees’ attachment to their smartphones can work in their favor.
  • Want to offer hotseat to 5,000 or more employees.
  • Are interested in innovation and collaboration.

What the Pilot Offers

Pilot companies receive:

  • Ongoing access to the hotseat app for pilot employees
  • Ongoing access to an employer dashboard that shows who’s using hotseat and how (excluding hosting costs)
  • A ready-to-roll launch communication packet to drive participation
  • Project management and customer support
  • Post-pilot year participant survey

The brilliant call to action: “If this is you, don’t just sit there. get in touch.

Sitting is Killing You
Via: Medical Billing And Coding

America Is Officially the Fattest Developed Country in the World.

Health care costs linked to obesity and resulting conditions such as diabetes are greater than those that are related to smoking and problem drinking. A Rand Corp. study published by the Wall Street Journal found that compared to people in a normal weight range:

  • Costs for obese people on hospital and outpatient care is 36% higher.
  • Costs for medication is 77% higher .

Jennifer Benz of Benz Communications  recently highlighted the HBO four-part documentary series, The Weight of the Nation, which discussed  how obesity rates are continuing to increase to the point there are unprecedented health problems in children. Some statistics highlighted:

  • 68.8% of Americans are overweight or obese.
  • 9 of the 10 states with the highest obesity rates rank among the nation’s poorest.
  • The CDC listed obesity as one of its seven public health priorities

Employers Pay the Price

A study in the Journal of Occupational and Environmental Medicine, highlighted in Time, shows that obesity costs U.S. employers $73.1 billion a year.

“Presenteeism” — a lack of productivity while at work — accounted for 68% of the cost for obese men and 56% for obese women.

Rising Childhood Obesity Costs Employers Too

Over 20% of 2 to 5-year-olds are either overweight or obese. This affects employers’ health care budgets, particularly now that children can stay on their parents’ employer-provided health care plan up to age 26.  The National Business Group on Health finds that children and adolescents are responsible for 14.7% of an employer’s health care costs, and that obese children have much higher health care utilization.  Since obese children miss more days of school and have greater emotional challenges, this can take parents away from work, or distract them while they’re there. Helping them do something about it also positively affects parents’ health behavior and their sense of loyalty to their company.

A “Winnable Battle”

Benefits communications and wellness programs can help.  This is a “winnable battle” that can start at the office with programs you may already have:

Effective Benefits Communications Can Be Vital

Some of Jennifer’s suggestions include:

  • Engage your employees. Studies show that they if they are not actively engaged and interested, they do not participate, and the program fails.  Employees respond to what’s important to them, and the most successful programs speak to all of the interests and concerns of employees, are clearly and obviously aligned with corporate goals (encouraging health to reduce benefits, administration and employee turnover costs), and are linked to incentives that are personally or financially meaningful to employees (including healthcare premium savings, days off and other rewards.)
  • Harness the power of community. The power of  peer groups is widely documented in research such as Connected.  Although our actions and beliefs are influenced by those around us, few companies encourage a peer-to-peer employee conversations about health or have adopted social media to support their education efforts and allow employees and families to learn from each others’ choices.
  • Employ tools to help parents support their obese children, which can influence the health of your employees as well. Tools employers can use include:
    • Review their benefits plans’ services and eligibility to make sure kids can access available counseling and programs.
    • Expand wellness programs’ eligibility and incentive structure to include kids.
    • Design specific interventions and challenges to focus on kids’ interests and rewards.
    • Create family-based events and educational experiences to collaborate with parents.
    • Join local and state conversations about food lunch programs, food access, neighborhood walkability, etc.
    • Give to organizations that increase access to food, improve school lunches or in other ways support this mission.
  • Use biometric screenings to start helping people make real changes. To make it successful you need to:
    • Effectively use communication and branding to drive participation and understanding.
    • Provide guidance on how to prepare for a screening that will ensure the best possible results.
    • Provide an opportunity to learn key health numbers and  empower people in a way that blood tests as experienced in a hospital or doctor’s office often are not.
    • Follow up with advocacy and support – be able to discuss next steps, direct employees to additional resources, accurately outline the appeals process, and explain the design of the incentive system to make it physically, emotionally, and financially relevant for employees.
    • Ensure data accuracy and integration – data collection and integration technology that integrates the various vendors that provide health care-related services can improve  ease of implementation, oversight, speed, and accuracy.

Promote Nutrition, Physical Activity and Obesity Support

  • Promote your health risk questionnaire, which often gives an employee a snapshot of their overall health. Medical carriers can provide coaching on nutrition/
  • Educate your employees about the preventive care that’s available to them. This could include a biometric screening, which checks your Body Mass Index, cholesterol, blood pressure and other indicators of  overall health.
  • Start a weight management program or encourage participation. Organizations like Weight Watchers can provide corporate discounts.
  • Providehealthy cafeteria options including nuts and fruit.
  • Support a healthy recipe exchange program between coworkers.
  • Challenge employees to take 10,000 steps a day, and provide them with a pedomoter .
  • Negotiate gym discounts.
  • Encourage participation in charity walks.

More resources

Snap! principle of the cost of obesity to employers:

Employers can stem both the medical and productivity costs of obesity through investments in weight management or other wellness programs.