Business of Well-being

Peer Support and Gaming Encourages Healthy Behavior and Creates a Culture of Health

Unhealthy behaviors cost companies billions of dollars. In a study recently published in Health Affairs coauthored by Ron Goetzel, 22.4 percent of the $366 million spent annually by seven employers and their employees was attributed to 10 modifiable risk factors. At a population level, the study identified that the following five risk factors were associated with the highest per capita costs: obesity ($347), physical inactivity ($179), depression ($128), tobacco use ($106), and high blood glucose ($104).

The additional annual medical cost for an employee with depression was a significant 48 percent more than for a worker without depression. Chronic health conditions, including diabetes, heart disease, and asthma, account for more than 75 percent of healthcare spending in the U.S., which can add an estimated $3,600 a year per person to employer healthcare costs.

With U.S. workers spending more than a third of their daily lives at work, companies have invested in a number of work-based wellness initiatives over the years, such as health screenings and weight management programs, to incentivize healthy behaviors. Despite the rapid growth and adoption of wellness programs, companies are struggling to realize anticipated health outcomes and return on investment.

An increasing number of companies are seeking new solutions that leverage social media and technology to better engage employees and promote social-based health improvement.In addition to the cost benefits, employers who invest in employee wellness programs that influence positive behavior change can lower absenteeism and develop a better sense of well-being for their workers, improving productivity, job satisfaction and the bottom line.

But getting employees to sustain positive behavior change and stick to a plan requires ongoing encouragement and accountability. This is where programs based on peer support and gamification strategies come into play.

Supporting Each Other

Peer support brings the unique perspective of another person's experience and understanding into the health decision making process, offering credible examples through the sharing of a personal story. Growing evidence shows that participation in peer support networks encourages new perspectives and behaviors.

Employers are beginning to leverage the power of peer support and social networking by investing in new types of health management and behavior change programs that combine clinical principles, game mechanics, and peer-supported health communities to engage and empower members, track and record health progress, improve modifiable and chronic health risks, and reduce treatment costs.

A survey by the National Business Group on Health and Towers Watson found that 19 percent of companies planned to incorporate social media tools into their wellness initiatives in 2012, and another 17 percent indicated they are slated to add social media tools in 2013. At the core of successful peer support programs is a safe networking environment that allows employees to exchange information and concerns in a private, non-judgmental setting.

Online peer networking programs with condition-specific communities are an important and growing employer-based health management tool. These programs utilize the collective influence of family, friends, and peers with similar conditions to empower employees to achieve specific health goals and sustain behavior change. Available 24/7 via web and mobile devices to employees from participating companies, programs can offer immediate support and be customized to meet individual needs by providing a variety of ways to share information with peers such as forums, group chats, online meetings, and storytelling.

Employees can access a global network and interact with hundreds of people with their same medical condition. Environments where individuals can choose to participate anonymously or openly in both giving and seeking advice and support achieve higher levels of engagement. Studies indicate that focused social networking groups with common goals tend to be more successful because of the ongoing community support received from similarly motivated users sharing the same experience.

This shared experience and positive decision making promotes growth and wellness, and teaches employees how to modify their behavior. Behavior change platforms which link to providers are important for employers because they look at accountable care strategies and benefit designs that leverage key risk bearing provider groups.

Provider linkage is important for the employee because programs with provider endorsement demonstrate higher engagement and a "whole person" approach. Behavior change and chronic condition support work best in the context of the care plan and how it clarifies and supports adherence to the care plan.

Game Mechanics Engage and Motivate

Behavioral economics and motivation theory can be used effectively to encourage employees to make lifestyle changes that improve health. One increasingly popular way to do this is by using game mechanics and incentives to increase participation in the organization's health promotion programs. Game mechanics, also called "gamification" or "gaming," is becoming a key component of many corporate wellness strategies to help increase and reward employee engagement by using feedback mechanisms traditionally found in games.

To help engage employees and motivate healthy choices, many health promotion programs use game mechanics such as badges, challenges, points, and levels to provide motivators related to achievement and reward. Participants are incentivized to earn points and badges that drive positive next steps, motivate healthy decisions, and encourage the desired behavior.

Gaming elements provide positive feedback to help employees gain self-confidence, map progress against established goals, and compare their results to other employees or groups of employees. Game mechanics also help employees identify top achievers and trustworthy participants in the program.

Early studies suggest that gaming concepts are particularly beneficial in improving modifiable health risks that support improved health and wellness outcomes, such as weight loss and smoking cessation.

Improved Outcomes

A leading social networking and behavioral change management program is currently being used by several large employers, national health plans and treatment centers in the U.S. The program provides a secure, supportive environment for participants to network and access condition-specific communities to make more informed and sustainable healthcare decisions. The majority of people with chronic conditions or a recent acute event invited to participate in the program by their health plan, employer or provider enroll in the program.

Of those people who join the program, over half return to the website multiple times, demonstrating persistent user engagement. Communities specific to chronic conditions allow members to be stakeholders and take group responsibility for creating programs they find most relevant and effective for themselves as individuals with the condition. On average, individuals participating in the program join over three condition communities, mirroring the growth of the percentage of the U.S. population with multiple chronic conditions, and underscoring the need for an integrated condition care plan.

One of the key drivers of the program is emotional health and the perspective of the individual while participating in the program. Using tools to identify the emotional state of the person allows for the application of game mechanics to identify, stratify and add relevance to the program experience. In addition, the capture of emotional state at a specific point in time allows the peer community to react and support the individual's specific need at that moment, leading to better results.

Behavioral change programs based on peer support and gaming are also showing promising results for reducing readmissions and total healthcare costs relative to traditional care management approaches. Such programs can significantly extend the reach and efficacy of care, condition and disease management programs.

Social networking programs are showing great potential to engage employees and increase their self-confidence and ability to manage high cost modifiable and chronic health conditions. They also hold the promise of making healthcare interaction more inspiring.

People do not always make the best decisions regarding their health. However, by offering employees a behavior change platform combining peer support, gaming and clinical principles, organizations can encourage employees to make better decisions that will drive healthier outcomes.

About the Author

Dr. Laura Clapper is Chief Medical Officer at OneHealth Solutions, Inc. For over 20 years, Dr. Clapper has dedicated her passion and efforts to enabling healthcare organizations to achieve results through leveraging technology to enhance condition and population management including behavioral management strategies and practices. She can be reached at

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