For years, most corporate wellness programs have done little more than "look good" as an added benefit on paper. Health culture within companies has gone neglected, with associated programs given little attention and their initial goals often left incomplete. Unfortunately, while wellness programs are now prevalent, the results they yield are not as far-reaching.
The root of this inefficiency is twofold: the misuse of incentives and the overburden placed on the HR department. As obesity and diabetes rates continue to climb, today the issue of health is more important than ever and many companies are seeking a change. This change means breaking out of stagnant corporate wellness programs to move towards ones that are more innovative, fun, and actually produce results.
It is not just about creating a culture of health, but making it a culture that generates actual health improvement & ROI. The solution is also two-fold and addresses the pair of issues mentioned above. It begins with the reconceptualization of incentives. To drive maximum and long-term engagement, incentives must join forces with behavioral economics for strategic and outcome-producing distribution.
Secondly, shift the weight away from the lone HR professional, overwhelmed with tasks for which the vendor should take responsibility so that the wellness program gets the undivided attention it deserves and needs.
Before diving into the details about how to execute these resolutions, let's first review with a background of some of the pervasive standard wellness program blueprints currently employed, yet with little to no results to show.
We'll take a quick walk through each of them, beginning with one where incentives are actually at its base, yet are unable to drive any sort of community or effective culture of health.
Know (and Forget) Your Numbers
For the past several weeks, Sally has been bombarded at work with emails about participation in a company-wide health-screening event. "Get to know your numbers." "Effortless and quick." "Money in your hands for a simple blood pressure reading."
The claims are alluring and drive Sally to receive a screening and complete a Health Risk Assessment (HRA). She shows up, steps on the scale, participates in a series of other painless measurement procedures and walks away with a paper documenting it all. The process is, indeed, easy and the cash that comes with it feels great.
Her company is pleased to have her records and directs Sally to a health coach who can help explain her numbers mean. However, fast-forward two months later. Sally's original screening paper is long gone. Its numbers are far from her memory, and any small association of Sally's workplace caring about her health derived from the process is a fading memory.
In fact, those thoughts vanished within weeks after Sally's one-time health coach meeting was no longer in mind. After the screening, no established community of health remained at her office. If Sally were to make improving her health a priority, it would be because of her own initiative.
With a screening showing moderately high blood pressure, her health coach informed her it would benefit her to do so. Unfortunately, Sally is not naturally inclined to exercise, and could use a little outside motivation to get moving. Yet, there are fewer than three more emails about "knowing her numbers" and no encouragement to boost her stats.
There are no workout tips or advice to eat more greens. There is no accountability placed on Sally to continue on a path to improvement. Sally received her incentive money, and was left on her own. Feeling too busy at work to research the topic further, Sally doesn't change her behaviors to improve her health.
She has taken and spent the upfront incentive, with the lone remnant of the health program - her screening takeaway sheet - sitting as sedentary as Sally in the garbage bin.
Identifying the issue - It's a common story, and so are ineffectual programs like these. Initially, the incentive acts as an incredible tool to drive awareness around health. It encourages people to get a screening, view their stats and identify areas that need attention.
However, with no additional incentives and little support to follow, the needed social culture of health, and the accountability it draws, remains absent. Hence, health improvement and ROI results remain absent, too.
Let's take a look at two other common wellness platforms that stratify incentives a bit further. The following even include some extra social support, but in the end, also prove to fall short.
Outcome-based, A Poor Outcome for Those Who Need It Most
Like Sally, Joe and Gary have both been receiving numerous emails from their workplace, informing them that they should come out for a workplace event to complete a biometric screening and HRA. They're told they'll each be rewarded with $50 upfront, which is enough to drive both of them to attend. After walking through the screening, both Joe and Gary discover their BMI measurements lay within the upper limits of the classified overweight range.
They are informed that if they bring it down to the normal range, 24.9 or below, they'll receive an extra $100 at the end of the year. Each leaves the screening event feeling excited and ready to take on the challenge to slim down before the year's end.
Over the next two months, Joe and Gary receive three health-related emails at their work containing encouraging tips for health improvement. Joe scans through them, and strives to do his best to lose weight. After dropping five pounds he's feeling extra inspired to keep moving.
Gary, on the other-hand, is feeling bogged down at work, and sends those emails straight to the trash. Without any personal encouragement or attached interim incentives, he quickly loses the motivation and momentum he built in his first two weeks following his screening.
He hasn't stepped back on the scale, nor is he focusing on his BMI, nor is anyone guiding him to do so. At the end of the year, Joe and Gary receive an email once again to take another biometrics screening. Excited by all of his hard work, Joe diligently attends.
Gary opts to skip it, assuming he hasn't improved his health and feeling as though he doesn't want to take the time out of his day to attend. On screening day, Joe finds out he has significantly improved his BMI, but is one point shy of the "Normal" category. Unfortunately, despite his hard work, that makes Joe ineligible to receive the $100.
Joe feels demotivated by the experience. Combined with the conclusion of the program and no sort of incentive ahead, Joe quickly finds himself filling up his originally designated exercise time with other activities, and losing his interest in improving his health.
Identifying the issue - Both stories of Joe and Gary identify the holes within this type of wellness program. Joe shows that even with significant health improvements sometimes a penalty will result. For Joe, this simply meant not earning the financial incentive he anticipated, but in some cases, this can result in employees having to pay a premium surcharge for their health insurance.
To an extent, this discourages health improvement for individuals who feel like the pre-set goals for the program are not attainable - in other words, sometimes achieving certain numbers feels out of reach, and with no middle point incentive, they take no action at all.
Instead, it favors individuals who are already healthy and require less effort to meet these goals. Those who actually benefit most from improving their health have an unfair advantage that can feel discouraging and ultimately become disabling. In Gary's case, the lack of ongoing engagement is a lack of accountability that's needed in order for individuals to think about their health and improve upon it.
A one-time payment at the beginning, with a far-away payment at the end, is often not enough to drive improvement. Individuals not naturally motivated to improve necessitate continuous reminders and support. With no designated person hired to direct such a program, the little communications effort put in place often proves ineffective.
The last program that we'll review, the "Activity-based Program," includes ongoing incentives that act as health reminders. Yet, it too shows some of the inefficiencies outlined above.
Incentives for Action, But Not Necessarily Improvement
Unlike the first two platforms, the traditional "Activity-based Program" often utilizes incentivizes on an ongoing basis throughout the year to encourage healthy behaviors. With this program, individuals are encouraged to complete activities related to certain health factors, and are rewarded for doing so.
For instance, an individual might receive $20 for getting a flu shot, $50 for participating in a walking program, and $100 for attending a smoking cessation program. This type of program provides the support and guidance that the above two programs are missing with an incentive attached to each. So what's the problem?
Identifying the issue - While paying for actual activity is a step in the right direction, unfortunately this doesn't always translate to improvement. For instance, let's say Mary's enrolled in an Activity-based Program. She is a smoker, so she is encouraged to join a smoking cessation program.
Mary enrolls and receives $100 for doing so. Although Mary attended all of the classes, she doesn't care about actually quitting smoking. She was more interested in earning the money. Again, one-time payment leaves a lack of accountability for Mary to actually create habits that will improve her health.
The Shake-it-Up, Habit-forming Solution
"Most wellness programs just train people to jump through hoops to get their money," explains Amanda Goltz, a Health Management Solutions Leader at company Aetna. "I learn if I get a health assessment, fill out my office HRA and participate in one challenge, I can get my $75 and a $20 gift card, and then I'm done. I'm just checking off the boxes, but I haven't really changed anything about my lifestyle."
There belies the major problem of why most programs fall short on yielding results - actual behavioral changes are never generated. However, the common wellness programs do begin to drive awareness towards health in the workplace. Take the elements from these various programs to create a program that will make an impact.
For starters, encouraging individuals to become aware of their health stats is a great launching point for awareness and behavior change. However, social support and continuous incentives need to follow in order for this type of awareness campaign to become effective in establishing the habits that will drive long-term change.
It is clear that incentives can be powerful motivators for action. However, research shows that varying the increments of payouts and establishing a continuous delivery of them throughout the program will yield the best results. "The typical incentives are extrinsic motivators, not intrinsic. They've gotten me to do things, but they haven't made me want to live a healthier life on a day-to-day basis," says Goltz.
She further explains that annual incentives are not enough and instead smaller, weekly incentives are a better driver for change. "You compel people to make these weekly changes, and tell them you'll reward them regularly for doing so, and that's when health becomes a habit," she explains. Pair regular incentives with continuous communications, reminders and support, and only then will ROI become more than just an unmet goal.
At play here are a whole handful of factors that must come together to achieve success. This is what then necessitates that the wellness vendor begins to play a larger role to take some of the heavy weight off the HR professional. "Often, the wellness director signs on to a program and they have to do so much of the work themselves to implement it," says Goltz, who voices that far too many wellness companies take a one-size-fits-all approach.
"You need a totally different strategy for each demographic to drive actual engagement, and so the programs fall short. It falls on the health and wellness manager to adapt the program to their population and do all of the needed work to promote it to their audience in order to draw engagement. That's really hard for someone internal to do."
Instead, the engagement should be part of the strategy for the vendor itself. The vendor needs to take on the communications, build a workplace excitement for its services and do so in a way that's segmented for different populations. Then, the HR person can utilize his/her time to find ways to work on improving the wellness program, rather than just operating it.
Once the vendor acts to facilitate regular incentives and health-based communications on an ongoing basis, the external motivators make the shift to intrinsic drivers of the healthy habits that'll draw actual life changes. It is then that the workplace can actually help people like Sally to lower their blood pressure, and those like Joe and Gary to lose weight, and individuals like Mary to quit smoking for good.
Incentives pave the path for individuals to want to get healthy, but they need to be ongoing at the start to drive a continuous awareness around health. Once that feeling of health kicks in, individuals are more likely to keep it running with their own two feet.
About the Author
Grace Dickinson is the Communications Manager at LifeVest Health, and a freelance journalist with a background in health/nutrition. She is also a photo enthusiast and recipe creator and brings these passions together on her blog, FoodFitnessFreshAir.com.
When not creating health tips for LifeVesters or art projects on her cutting board, you can catch Grace teaching yoga or cruising on her bike with a camera strapped to her back. (You'll find her frequently encouraging fellow colleagues and clients to pedal-power their way to work, too.)LifeVest is a digital health platform that enables users to track their health metrics.
Users receive real-time feedback and get paid instantly for doing so, driving them to stare their stats in the face and use them as encouragement to get moving. Rooted in behavior economics, LifeVest's model for health is scientifically proven to drive higher engagement.
As users make improvements to their health, their earning potential goes up. There are extra monetary and prize-based lotteries, social health challenges, and individualized communications, too, to keep the program engaging and fun.