A Winning Loss
Employee wellness programs are on the rise, with more than two-thirds of employers planning to expand their offerings in the next three to five years. But for those dollars to deliver results, employers must also rethink how they approach prevention, especially as it relates to weight management programs and their impact on reducing risk of chronic diseases, says Rally Health Senior Vice President Steve Olin.
In 1985, every single state could boast that less than 15 percent of its population was obese. By 2016, the inverse was true: No state can claim an obesity rate below 20 percent.
Medical costs have risen right alongside our national waistlines, and employers are also paying a greater price: Studies show that obese employees can drive medical claims as much as seven times higher than their fit co-workers.
Yet the alarming trend doesn’t have to continue, says Steve Olin, senior vice president at Rally Health, who leads the digital health company’s health solutions focused on wellness, coaching and digital therapeutics.
The key is to view wellness programs through a preventive lens and signal to employees and employers that maintaining a healthy weight is just as medically necessary as getting a cancer screening or flu immunization. That fresh approach can drive better health for employees — and ultimately cost savings for employers.
Corporate Wellness Magazine: In the United States, 69 percent of adults are overweight and nearly 40 percent are obese. How do you think the current approach to weight loss is falling short?
We are struggling to get people to engage. Many of the engagement efforts are following the classic arc of clinical treatment: The conventional wisdom is that we look at the data and try to find all the people with the condition and treat them or, in the case of obesity, try to find the people who clinically match that definition and provide an intervention.
But that isn’t working. The truth is that when you try to engage people around a clinical prevention program by alerting them to staggering statistics around heart disease, diabetes, and high blood pressure, enrollment rates tend to suffer.
What if, instead, we took a marketer’s versus a clinical approach in how we present the program? We are taking the 20 plus years of science and research that supports diabetes prevention and the importance of healthy diet and exercise and presenting it in a consumer friendly, aspirational wrapper around weight loss, and are seeing greatly increased levels of consumer engagement.
In doing so, we are getting more of the at-risk members in a population — those who have a clinical need for preventive care due to a high probability of developing a chronic disease — to participate in the program and begin to make important lifestyle changes.
CWM: But it makes sense that employers would want to especially encourage their highest-risk populations to participate, doesn’t it?
Yes, and we’re suggesting they broaden their focus. For instance, in the past, the industry has been focused on making sure that the diabetes prevention program is given only to people who are known to be at risk for prediabetes.
That means they target people who have elevated blood sugars or have failed the risk quiz, putting them at high risk. But that’s a tough marketing message: “I’ve got a program you might be eligible for, it’s to help you with a condition that you may never have heard of called prediabetes, and to find out if you have it I need to prick your finger, run a lab test, and if you qualify, then I’ll let you into the program.”
As a result, we put too many barriers in front of the consumer, and they don’t enroll. As such, the capture rate of prediabetes in these very important and impactful programs tends to be very, very low.
Three years ago, the United States Preventive Services Task Force augmented the call to action around prediabetes to focus on all obesity-related illnesses, which allowed us to move from a clinical-risk message to a broader call to action that was relevant to some 70 percent of Americans: Weight loss via diet and exercise.
CWM: Sounds easy enough. But the trick is still getting people to participate, right?
Absolutely. When you think of preventive care, you think of things like colonoscopies, mammograms, immunizations — things that are easy to check off a list. It’s harder to get people to engage in programs to prevent obesity or encourage weight loss, because people struggle a bit when prevention is based on lifestyle habits.
Yet those are exactly the things — stress, sleep, nutrition, exercise, smoking, alcohol consumption — that contribute to the onset of chronic conditions. We need to deliver programs that allow consumers to break these big lifestyle changes into small steps and then surround them with the information, tools, and social support to be successful.
On the employer side of the equation we also need to be more creative in how we sell and price these science-backed preventive services to make them more affordable and deliver more value for the dollar.
CWM: And how do you do that?
We are providing a preventive service that employers can run through medical claims and that is structured as pay for performance. There are no set-up or implementation fees, and we charge only when participants are attending the weekly classes and are on track for weight loss.
Since it’s a preventive service, under most plan designs there is no copay or deductible. The employee gets access to a best-in-class weight-loss program at no cost, and the employer has a business partner whose financial success is tied directly to achieving the same goals.
CWM: Can you talk about how approaching weight loss as a preventive health measure affects the cost side for employers?
Eighty percent of all Real Appeal participants lose weight, with an average weight loss of 10 pounds. Forty-two percent of participants have lost at least 5 percent of their body weight, which is an important number relative to reducing the risk of diabetes.
Our most recent study shows that this level of engagement and weight loss has resulted in a 16 percent in-year medical savings for participants versus non-participants, which is enough to offset program costs and deliver a 1:1 ROI in year one.
CWM: What are the potential costs to employers when people elect not to participate in some kind of prevention program?
Prevention can be hard to quantify, so we thought the best and most accurate way to quantify is not to project what might happen but to use data to see what actually did happen. To do this we worked with our partners at UnitedHealthcare and looked at data across a number of industry types.
We found that for an average employer with 50,000 lives, roughly 10 percent of the population sees a decline — gets sicker, if you will — each year. The incremental medical costs related to that risk progression range between $25 million and $30 million a year — each and every year — much of which can be slowed or avoided if we can get people to engage in the basic, fundamental lifestyle changes I previously mentioned.
To take $25 million to $30 million out of medical costs in other ways, employers would need to reduce benefits, change cost sharing, etc., all of which have an impact on employees’ ability to access the care they need.
Increasing the conversation around prevention and the role that clinically backed programs serve in advancing population health is critical to the long-term sustainability of health care.
CWM: The wellness program space has certainly grown more crowded. For time-strapped benefits leaders, how can they differentiate offerings, and what’s really going to help their employees?
Roughly 60 percent of employers either offer or are considering offering a weight-loss program. There are many different forms, from app-based programs, online coaching models, and commercial brands. But real change happens when you approach weight loss as a prevention tool and treat it as a medical expense.
Do people recognize this as a medical issue? Are they willing to invest in a clinical program that supports people who have clinical needs? Will they spend some time activating employees so there’s real engagement driving real results? That’s when you move the needle.
CWM: Speaking of engagement, any tips for getting the word out to employees, once a program is in place?
The first step, honestly, is having higher expectations than 1 percent engagement. There wouldn’t be an HR professional in the world who would be happy if only 1 percent of the women in their workplace got their mammograms or cervical cancer screenings, or if only 1 percent of the kids in their population had their immunizations.
But there is message fatigue. So, for example, we partner with employers to help them promote our program in a way that’s a good cultural fit with their organization; the greatest response rates we’ve seen are for something as simple as the CEO sending an email blast to employees.
Together with better consumer positioning, a great set of promotional materials for use by employers, and the dedicated efforts of our amazing clients, we have enrolled nearly 500,000 people to date.
CWM: And I imagine making it more about weight loss and lifestyle probably lifts some of the stigma around obesity and its associated diseases, especially in a corporate environment where maintaining employee privacy is essential.
It’s easier to appeal to people when you are providing them with something they want now — to look better or have more energy, for instance — than it is to approach them about longer-term clinical risk reduction.
Throwing any old tool at the problem isn’t going to work. Participants need science-backed solutions, and employers need to know they’re going to get the ROI they need to support those programs.
About the Author
Steve Olin — Steve is senior vice president in charge of health solutions at Rally Health, a leading digital health company focused on driving employee health engagement. Previously, he was CEO of Real Appeal, which merged with Rally in November 2017. Real Appeal is a science-backed digital weight-loss program built from the ground up to help people lose weight and avoid weight related illness.