Business of Well-being

How a Simple "Nudge" Could Increase Employee Wellness Engagement and Reduce Wellness Program Costs

In the drive to increase employee participation in health improvement programs, businesses have rapidly adopted financial incentives as a key strategy for jump-starting employee engagement. Using gift cards, cash, tokens, prizes, premium reductions and other creative tools, employers entice, cajole, seduce and persuade employees to make healthier life choices or participate in wellness initiatives.

The good news is that incentives appear to produce improved engagement in some wellness programs.  The bad news is that employers are spending more and more to get those results. According to a recent survey of nearly 150 mid- to large-size companies, the cost of incentives provided by employers increased a whopping 65 percent between 2009 and 2010, rising from $260 per employee to $430 per employee, on average.  

The cost of incentives for dependents rose also, to an average of $420 per person. That all adds up to a good chunk of change for employers.  In today's economic climate of shrinking margins and budget limitations, some groups are asking themselves whether they can afford to continue doling out dollars to entice employees to get healthier.

Alternatives to Costly Wellness Incentives

New research on employee health engagement may help employers reduce their dependence on costly incentive programs.  According to a study published in the Proceedings of the National Academy of Sciences (June 13, 2011), a simple "nudge" may prove to be as effective as financial incentives at increasing employee participation in health and wellness activities.

The study - conducted by researchers at The University of Pennsylvania, Stanford University, Yale University and Harvard University - in conjunction with Evive Health, proved that simple messages prompting employees to "make a plan" to complete a health activity can significantly increase the likelihood of follow-through or compliance.

In the controlled study of more than 3,200 employees at a large Midwestern utility firm,  researchers found that prompting people to simply write down the specific date and time that they would engage in a health activity - such as getting a flu shot - was a highly effective and low-cost method for improving engagement.  

Of those who received a specific prompt to write down the date and time when they planned to get a vaccination, 37.1 percent obtained the vaccination, an increase of 4.2 percentage points over those who received an identical reminder that contained no prompt to make a plan.  

The planning prompt was most effective among employees for whom on-site flu shots were offered on a single day only.  Prompting these employees to write down the date and time when they intended to receive a shot increased compliance by 7.9 percentage points.

Researchers believe that similar prompts could be used to increase engagement in many other healthy behaviors that employees may be overlooking due to competing demands on their time. This is significant news for any business concerned with motivating employee or consumer health behaviors.  

The research proves that there are low-cost strategies that can replace or work in tandem with financial rewards to further increase health engagement.

Why Simple Messaging Works

Consumer marketers have known for decades that behavioral science can offer deep insights into consumer likes, dislikes and behaviors.  In fact, they've made an art of using behavioral science applications to motivate people to buy certain products and services.  

Through consumer research, they understand why people prefer certain brands of cereal over others or certain product packaging - such as certain bottle shapes or colors - over others.

Using these same techniques, innovative wellness companies have been exploring the kinds of mailings, messages and prompts that motivate member engagement in wellness programs.  

They can address, for the first time, what kinds of promotions elicit better responses than others, as well as what kinds of barriers - from financial to family or other socio-economic factors - inhibit health participation.  

By understanding these issues, companies are developing more targeted and personalized messaging that can help individuals better participate in health and wellness programs. New, behavioral science-based engagement solutions work by gathering and merging an individual's historical and real-time health analytics with their socio-economic characteristics to develop a multi-dimensional profile.  

Such "data profiles" can not only help to reveal current and potential health risks, but can help to predict future health behaviors and barriers to health engagement.  Using clues from such profiles, plan sponsors can create the kind of targeted, "intelligent messaging" that can educate, motivate and assist individuals in taking positive health actions and making positive health choices.

This new approach is already achieving dramatic results in the workplace, demonstrating, on average, 19 percent increases in employee engagement in the first year alone. Personal health messaging and reminders can be delivered via direct mail to the home, or by email, telephone or text messaging and can be used for early interventions, health improvement or disease management, delivering the right "nudge" at the right time to produce the desired result.

Four Simple "Nudges" That Increase Engagement

The best engagement messaging focuses on four key tools to engage and "nudge" employees into action.

1.    Personalized Messaging

Through the years, wellness providers have learned that generic calls to action elicit low levels of participation.  New engagement technologies create highly personalized communications to each individual member and include information specific to the member's health status, providers, coverage, age and even ethnicity.  

Each section of every message - from the introductory greeting to the body copy to the call to action, and even the graphic design - is fashioned to be relevant to the individual, and thus produce the desired response.

2.    Educational Messaging

Fully 88 percent of workers surveyed say they "lack an understanding of the value of preventive services," according to a 2010 study by the Midwest Business Group, a coalition of large employers.  In other words, the employees weren't sure why they should bother to get a regular physical, colonoscopy, mammogram or other preventive measure.  

Education can be a powerful tool for improving wellness compliance.  Wellness messaging tools can clearly communicate the health risks and potential adverse outcomes that are specific to each member.  

By educating the employee on the simple preventative steps that can help to avoid adverse health situations, higher rates of compliance can be achieved for preventive checkups and screenings.

3.    Easy-to-Follow Directives

Studies show that the more specific the call to action, the greater the chance the recipient will understand and be motivated to respond positively.  Intelligent messaging provides highly specific information the member needs to make important health choices.  This information covers:

  • what (action they need to take)
  • when (a specific appointment date)
  • where (the address of their provider)
  • who (the name of the provider) and
  • why (how the procedure or screening benefits them).

Members who receive easy-to-follow directives can better understand what is expected of them.

4.    Interactive Tools

The most successful direct mail and email campaigns of our time have used surveys, check boxes, fill-out cards, peel-off stickers and other interactive tools to engage recipients.  Taking a cue from these success stories, today's wellness technologies use interactive decision support tools, such as chronic care stickers that can be affixed to appointment calendars and pill planners.  

Such devices engage people in their health in a tactile and memorable way. New engagement technologies make it simple for employers to "nudge" workers toward their health improvement goals.  They integrate easily with existing wellness and disease management plans, providing a turnkey technology solution that requires no service interruptions, no additional staffing, no new investments in IT and no new costs for marketing.  The best programs also will offer:

  • Ongoing Response Tracking, Problem Solving and Message Refinement

Some wellness programs can now dynamically track member responses to communications and automatically refine and execute new messaging and campaign elements based on prior member responses.  

For example, members who don't respond to a colonoscopy mailing could receive new reminders utilizing different communications tactics that may better engage and nudge that particular member to the desired outcome.In addition, intelligent messaging technologies allow wellness plans to predict potential logistical, financial, educational or other barriers and provide messaging or solutions that can help members navigate around their personal challenges.  

For example, a member who has no car may need a list of bus routes to a health facility.  This type of dynamic problem solving enhances engagement and outcomes over time.

  • Outcomes Measurement

Understanding outcomes is crucial to achieving success in wellness engagement.  New technologies provide timely reporting that helps companies adjust their programs, coverage and messaging to achieve better returns on investment.

  • Proven Results

Results from the best new health engagement platforms demonstrate increased employee adherence of 19 percent on average in the first year alone.  Such programs can engage 100 percent of employees, and have an opt-out rate of less than of 1 percent.  Employees are more highly satisfied with their experience because the program helps them navigate the health system, overcome personal barriers to care, improve their health and lower their premium costs.

  • Cost Savings

Interventions that create positive and sustainable health behaviors in member populations can be immensely cost efficient.  Assuming increased utilization costs for tests and screenings and increased avoidance of costly medical procedures and hospitalizations, businesses with these programs report an ROI ranging from 1.22:1 to 4.3:1.

New wellness technologies incorporating intelligent messaging get the right message to the right workers at the right time, providing just the right "nudge" to make engagement in wellness easy and manageable for most everyone.

About the Author

Prashant Srivastava cofounded Evive Health, LLC in 2007 to encourage employees to seek appropriate healthcare and live healthier, more productive lives. Prior to founding Evive Health, Prashant directed clinical operations for Focused Health Solutions.  Dr.  Srivastava earned an MBA from the University of Chicago (GSB'05) and a Ph.D.  in Chemical Engineering from Michigan State University.  Contact Prashant at or visit

Learn about how you can become a Certified Corporate Wellness Specialist→