what the best do better ebook-2016
Post on 06-Apr-2017
38 Views
Preview:
TRANSCRIPT
REDBRICK HEALTH
What the Best Do BetterLearn the best practices that drive meaningful health engagement and get better results
2 © 2016 RedBrick Health Corporation
Let’s face it: getting people to engage in their health can be challenging.
It’s also essential for organizations seeking to improve program performance
and achieve stronger program outcomes. With so many things competing
for people’s attention, the optimal path to cut through the clutter is unclear.
The answer? While there is no magic bullet, there is a
path for achieving success. This eBook summarizes
practical, evidence-based advice that is the product of
sophisticated research—conducted over the past year
by the RedBrick Insights research team on the broad
and diverse populations we serve. It includes some
recommendations that seem intuitive, and others that
may surprise you. It offers a window into a broad,
data-based consulting approach, which begins with
the identification of the factors that are within each
organization’s control and tunes the organization’s
strategy based on the RedBrick best-practice model.
Our goal in preparing this eBook is to help you develop
a more tailored and successful approach in your
program, based on our emerging understanding of
what the best do better.
INTRODUCTION
3© 2016 RedBrick Health Corporation
Let’s start with an important question: Is all
engagement meaningful engagement?
Leaders of health and well-being programs—and the
providers that serve them—tend to judge success by
what’s easy to measure. Some look at things like portal
registration rates, others at portal login events, or
mobile app downloads. We call this the “clicks and calls”
method. But are these metrics predictive of driving
objective health improvement outcomes?
While there are many ways consumers engage in
improving their health, we at RedBrick Health are most
interested in meaningful engagement. As it turns out,
there are significant performance-related differences
between traditional wellness program models (that focus
on “once and done” reward-driven actions), and those
that focus on creating habitual health engagement.
Simply put, meaningful engagement drives better
outcomes. And the simplest metric for characterizing
meaningful engagement is the level of sustained
engagement over time. We found that some
organizations that have high overall engagement (for
example, in one-time activities) fell down when it came
to getting meaningful engagement.
So how do you get your population to be meaningfully
engaged? The Insights research team used advanced
statistical methods and set out to answer that question
scientifically. We started by identifying the engagement
patterns that are most predictive of positive program
outcomes, such as clinically meaningful improvement in
objective biometrics as well as self-reported improvement
in essential lifestyle habits.
Next, we characterized the amount of engagement
achieved across a broad and diverse set of organizations
into three groups: low-performers, middle-performers,
and top-performers. We then analyzed the contribution
of a wide range of controllable and non-controllable
factors to the level of engagement achieved.
Finally, we found consistent patterns across a group of
factors directly linked to meaningful engagement.
Based on these findings, we identified a set of program
design best practices. We call these best practices
What the Best Do Better.
What are top-performing organizations doing di erently?
Which individual and organizational attributes drive meaningful engagement?
What are the best moves I can make—considering the attributes that are in and out of my control—to increase my program performance and avoid budget-sapping mistakes?
?This eBook shares highlights of this year-long
research project, so that you can get answers to the
questions you might be asking yourself right now:
4 © 2016 RedBrick Health Corporation
1LET PEOPLE CHOOSE
“I like RedBrick Journeys® … I am working on
three right now. They give you different activities
you can do, and there are recipes I’ve tried.
I learned if I choose little steps at a time, each
time I do a step, I can move forward and it’s
going to benefit me.”
DARLENE T.COMPUTER OPERATOR
5© 2016 RedBrick Health Corporation
Health improvement is personal. Choice architecture
is the art and science of providing relevant choices
(not too many, or too few) that nudge individuals in a
desired direction.
Using data to offer relevant choice presents a powerful
way to put the person back into the personalization.
Use data to present relevant options, but ultimately
allow people to select the focus of their intervention as
well as the modality for its delivery. Modalities can
include digital coaching, using a wearable device or
popular app, working with a personal coach by phone,
taking advantage of opportunities in your own
community, or using on-site resources. As it turns out,
choice matters. It intensifies commitment and
engagement. And it works.
Many conventional programs use risk identification
and stratification to stream people into intervention
modalities. Applying choice architecture provides
consumers with a set of suggested options, and the
power to choose how and when they want to engage.
Our findings suggest that allowing individuals to choose
the mode of intervention and focus area can result in
stronger engagement and clinically meaningful outcomes.
In a recent large-scale analysis, the Insights research
team found equivalent positive results across intervention
modalities. We even found crossover effects: Participants
at elevated health risk improved biometrics—even when
the selected topic wasn’t the top health risk factor. The
positive impact of engagement in one area spilled over
into the higher risk areas—the data showed the impact.
In other words, the RedBrick mantra is: Do anything. The
more engagement and the more specificity the better,
but even a small change in another area makes a positive
difference in health. Even a small change in health habits
in an adjacent area can catalyze health improvement
related to the target risk factor. Success breeds success.
Choice also increases engagement among those with
chronic conditions. The net result was far more
condition-relevant coaching, given the traditional low
rates of enrollment in disease management interventions.
Choice-Based Model Health Improvement
≥ 10% Reduction innon-HDL cholesterol
41% 41%
Categorical reductionin blood pressure
34% 31%
≥ 5% Weight loss
20% 20% 40%33%18%RedBrick Phone Coaching (started any)
Activity tracking (after 30 days tracked)
RedBrick Journeys (started any)
In a choice model, di�erent intervention modalities are similarly e�ective at producing clinically meaningful change.
80%Nearly 3xmorecondition-relevant coachingengagement
More than 4xincreasein total coachingengagement
of coaching participants choose to start by managing lifestyle
LEADING TO
6 © 2016 RedBrick Health Corporation2 “I didn’t realize by just talking to somebody on
the telephone you could really get motivated and
encouraged to do better for yourself.”
DIANA M.CLIENT MANAGER
MAKE IT SOCIAL,
AND OFFER SUPPORT
7© 2016 RedBrick Health Corporation2Though many companies are turning to a broader
focus on employee well-being, national surveys
regularly confirm that their primary reason for investing
in employee health is to manage healthcare costs.
Ironically, most programs focus on the individual
employee, overlooking spouses and significant others,
who often have higher healthcare costs and nearly
always have a strong influence on the health behaviors
of the employee.
We recommend including spouses and significant others,
and including a focus on the family as a unit for behavior
change. Social support is not only a predictor of
meaningful engagement, but also, a catalyst for more
meaningful engagement.
Support can come in many forms. Sometimes it comes
from family and friends, and sometimes we need help
from experts. A quick call with a warm and caring
expert can be just the right thing to get started on the
right path. A long-term coaching relationship can be
profoundly helpful. However, our research found that
even a “concierge-style” single session can drive
significant and sustained engagement. We call that type
of encounter a Next-Steps Consult™.
Designed to educate, motivate and engage, the
Next-Steps Consult provides a human connection for
those participants who are unsure what they should
do next. Our research found that organizations that
offered a Next-Steps Consult to participants increased
and achieved meaningful engagement—even without
increasing the rewards for engaging in activities. In fact,
in a multi-employer comparison study we found that
a single consult out-performed sizeable incentives and
that the result persisted after the consult.
O�er programs to spouses, significant othersand dependentsas well as employees
Spouses nearly always have a stronger influence on health behaviors than employer-sponsored programs
Spouse population often has higher healthcare costs
Meaningful Engagement Increases with Next-Steps Consult
Online programs
14% 28%
Phone coaching
3% 16%At 30 days At 30 days
Activity tracking
35% 51%At 30 days
Without Next-Steps Consult call
With Next-Steps Consult call
8 © 2016 RedBrick Health Corporation
3COMMUNICATE STRATEGICALLY
“I like getting the email notifications to remind
me, ‘You have a Journey to complete’ or ‘You
have an activity you need to update.’ I do enjoy
those. I get them throughout the day.”
DANIELLE Y.PROJECT MANAGEMENT OPERATIONS SPECIALIST
9© 2016 RedBrick Health Corporation
5-10%
30-35%
20-25%
20-25%
10-15%
Use a Mix of Messages
HEALTH TOPICSLower open/click,
but bolsters awareness, culture of health
CHALLENGESSupports culture
of health, diversity of ways to engage
REMINDERSHigh response rate; date-driven, involves dollars/deadlines, helps maintain momentum
EVENTSHighest response rate; drive specific action, typically involve reward
AWARENESSIntroductory; typically provides date-driven call to action with rewards
We know it’s important to cut through the clutter. Our
research focused on pinpointing those communication
practices most likely to produce success, which in this
case means higher rates of meaningful engagement.
It’s important to keep in mind how your messages are
communicated, what they are saying and how often they
are being delivered. Our research team found three
factors mattered most:
1. Is your population reachable by email?
It’s perhaps obvious, but the data make it clear: The
stronger your email coverage, the higher your chances
are of driving meaningful engagement. We found
digital communication essential, especially for digitally
delivered engagement modalities. Operating without
a strong, clean email list means facing an uphill battle
in achieving initial and ongoing engagement. Those
reachable by email have 92% more engagement. Our
best practice organizations had at least 75% email
coverage for their target population.
2. How often do you communicate?
Frequency matters, and the math is simple: The more
you expose consumers to insightful communications,
the better response you’ll get. Top-performing
organizations have a consistent communications plan in
place, which effectively builds awareness and triggers
actions. Our top performers follow the RedBrick best
practice of communicating at least monthly. The lower
performers in our analysis communicated less than half
as frequently.
3. Are you delivering the appropriate mix of messages?
Our research found that top-performing organizations
use a broad mix of messages, such as: personalized
reminders, health topic-specific content, invitations to
participate in challenges, awareness-related content and
promotion of relevant activities. Not all messages will
connect with all audiences, so mix it up. Include specific
event and deadline-driven messages, and don’t forget
general interest messages tied to national health events.
10 © 2016 RedBrick Health Corporation4USE INCENTIVES...WISELY
“To earn 60 points per quarter, that’s about a
dollar per point. I say to myself, ‘I’m going to earn
another dollar now’ and it gets me out of bed.
It’s like the little angel on your shoulder—your
conscience—to get you to go do it. Without that,
I wouldn’t have a goal.”
BILL H. SUPPLY CHAIN SPECIALIST
11© 2016 RedBrick Health Corporation
When designed effectively, rewards can play an
essential role in your program design. However, poorly
designed rewards can have unintended consequences,
waste precious budget dollars, or even backfire relative
to their intended effects.
When it comes to effective reward design, more isn’t
always better. But more frequent generally is. And
rewarding outcomes may, ironically, not be the most
effective way to ensure population outcomes. Our
research revealed the following best practices in reward
design. Follow these recommendations when designing
a cost-effective rewards strategy and avoid making
budget-sapping mistakes.
1. Incent ongoing engagement—Not just initial clicks.
By rewarding consumers for consistent, ongoing
participation over time (rather than just focusing on
one-time events like health assessments), you can
achieve higher meaningful health engagement.
2. Reward early and often—and avoid designs that
postpone payout.
Organizations that rewarded their consumers on a
regular basis, rather than just one time at the end of the
year, yielded higher engagement rates and ultimately
better population outcomes. Quarterly rewards models
out-perform annual reward models at producing
meaningful engagement.
3. Balance reward allocations between up-front and
ongoing reward opportunities.
Many organizations spend the bulk of their incentive
budget rewarding participation in up-front activities
(like health assessments). Our research team found that,
paradoxically, organizations with the largest budgets
for health assessments, achieved poorer results in terms
of meaningful engagement. The research found that
the optimal incentive range for health assessments
is $50–$100, with diminishing returns for each $1 spent
above $50. In fact, a health assessment completion
incentive of $50 produced similar rates of sustained
engagement as a completion incentive of $250 among
our study organizations.
For best results, offer at least $200 per participant
for ongoing healthy activities, allocating the bulk of your
incentive budget for participation subsequent to the
health assessment.
4. If you’re interested in outcomes, reward participation.
Many organizations have begun rewarding for biometric
outcomes, along with reasonable alternative standards,
as required by law. It certainly seems logical to do so—
after all, you’re paying for the result you want. However,
our research found that participation-based rewards
worked equally well in producing biometric outcomes,
and we found evidence that outcome-based reward
designs depressed participation, especially among those
at elevated risk.
Health assessment reward of
50-100dollars Health screening rewardof at least
50dollars
Healthy activity reward of at least
200dollars
12 © 2016 RedBrick Health Corporation
5RECOGNIZE AND LEVERAGE
THE ROLE OF CULTURE
“We had a company-wide challenge over the
holidays. We had six members per team and
there were about 10 teams. Everybody signs up
and we all do a weigh-in on the first and last
day. The highest average percentage of weight
loss determines the winning team.”
WILLETTE B. PAYROLL ACCOUNTING ASSISTANT
13© 2016 RedBrick Health Corporation
BOTTOM-U
P C
HA
NG
E
ENVIRONMENT
TO
P-D
OW
N C
HANGE
HEALTH-FRIENDLY CULTURE5If we were to survey your population today, would your
respondents agree that the organization promotes a
culture of health? Do leaders walk the talk? Are healthy
habits contagious? Can you see visual signs of your
organization’s commitment to health and well-being as
you walk the halls on campus?
Our research found that organizations whose employees
report that the organization actively supports their
health improvement efforts are rewarded with the highest
rates of meaningful engagement.
In top-performing organizations, approximately two
out of three employees reported that they were
actively supported by their organization in their health
improvement efforts.
Building a culture of health doesn’t happen overnight,
but it also doesn’t need to be hard or complex. Start
by testing employee perceptions, and looking at
workplace environment and patterns against criteria you
would expect to see at a company focused on creating a
health-friendly culture.
Here is our advice for enhancing a health-friendly culture:
> Make top-down support visible
> Empower local wellness champions
> Include spouses and families
> Publish success stories regularly
> Change the physical environment
> Offer healthy food choices
> Sponsor healthy competitions
> Create well-being “winners”
14 © 2016 RedBrick Health Corporation
Successful engagement is not just about personalization,
or mobile access, or social connections, or rewards,
or reminders, or culture. It’s about all of these things.
Each organization’s unique success formula can be
different. If your company doesn’t enjoy strong culture
of health ratings, all is not lost. Our research found
you can still achieve top-performer status simply by
emphasizing the other best practices outlined above:
offering choice, making it social, communicating smartly
and rewarding wisely. On the flip side, a strong health-
friendly culture is wind in your sails—you can be less
aggressive with your rewards and communications and
achieve a similar result.
And these factors aren’t independent of each other.
Communications influence culture and vice versa.
Likewise, the social dimension serves as a form of cultural
and communication support. Understanding underlying
population demographics as well as each individual’s
intrinsic motivation can help you tailor the best approach
at both the population and individual level.
Start with the assets you have, size up your current
practices relative to the best practice recommendations
in this eBook, and determine which best practice you
can dial up most quickly and easily in your environment.
Remember that success breeds success.
Most importantly, focus your tactics on sustained
engagement over time—that’s the key to achieving
meaningful program results.
CONCLUSION
15© 2016 RedBrick Health Corporation
APPENDIX
16 © 2016 RedBrick Health Corporation
A summary of our methodology, from the RedBrick Insights™ research team
RedBrick Health’s purpose is to help people be healthy. To that end, the
RedBrick Insights research team studied and identified program design
elements that are directly linked to high rates of health engagement.
There were three steps to this analysis:
STEP 1 Investigate engagement patterns associated with increased
health improvement and identify the best predictors of health
improvement.
STEP 2 Estimate the effects of program design elements on
engagement patterns associated with health improvement.
STEP 3 Determine best practice recommendations for program
design elements based on organizations that achieve the best
patterns of health engagement.
17© 2016 RedBrick Health Corporation
STEP 1
The first step consisted of identifying what type of
engagement was most associated with health
improvement. We looked at 71,592 individuals who had
health screening measures in both 2013 and 2014, and
160,777 individuals who completed health assessments
in both 2013 and 2014. We observed successful health
improvement over a variety of health indicators:
> Weight loss ≥5%
> Non-HDL cholesterol reduction ≥ 10%
> Blood pressure reduction to less than 140/90 mmHg
> Physical activity increased by at least
60 minutes/week
> Increased fruit and vegetable consumption of at
least one serving/day
> Improvement of at least 1 point on a stress
coping scale
We matched health improvement observations with
detailed program engagement data between the
measure dates for each participant, and used logistic
regression models to test the association between
each health improvement measure and several
engagement descriptors.
Our team found that the characteristic of engagement
that most consistently predicted health improvement
was the number of actively engaged months between
measurements. Individuals were considered actively
engaged in a month if they had any interaction in the
calendar month. These interactions included completion
of the RedBrick Compass® health assessment,
completion of a biometric health screening, completion
of a Next-Steps Consult call, completion of phone
coaching calls, completion of steps in a RedBrick
Journey (digital coaching), recording activity in a
physical activity tracking tool via a wearable device or
through an app or web page, or completing another
client-specific healthy activity. The number of actively
engaged months became our key dependent variable
in Step 2 of the analysis.
STEP 2
In order to understand which program design elements
were associated with sustained engagement (and
therefore with more health improvement), we examined
engagement data for over one million individuals from
more than 50 organizations. We included both employees
and dependents that were eligible to participate for the
entirety of 2014 and used a multi-level regression model
to isolate the effects of particular program design elements
while controlling for other differences. A zero inflated
negative binomial model best fit the observed data.
We examined the effect of many factors on active
participation months, such as age, gender, relation type,
email availability, median income decile in ZIP code of
residence, population density in ZIP code of residence,
and the number of various types of messages received
at the individual level. We included incentive amounts
associated with various health improvement activities
as well as incentive design characteristics. At the
organization level, we included industry groups, a culture
index, geographic dispersion categories, and the average
number of communications sent per participant.
The regression model identified program design
elements associated with either increased or decreased
engagement.
18 © 2016 RedBrick Health Corporation
STEP 3
The purpose of Step 3 was to understand what the
top performing organizations were doing with respect
to each program design element identified in the
regression analysis. In the absence of a clear definition
of the “best,” we ranked all organizations in our book
of business according to the average months of active
engagement that they had achieved in 2014, and divided
them into thirds. The top third of organizations were
defined as “the best.” We compared program design
choices among the top third of organizations with
program design choices among the middle and bottom
third of organizations. For continuous variables such
as incentive amounts and communication frequency,
we examined differences in the means between groups.
For categorical variables such as whether a range of
program offerings is in place, we examined differences
in proportions between groups. Recommended ranges
for each program design element were based on
what we observed the top third of organizations doing
with respect to each program design element.
SUMMARY
Through this multi-step methodology, we identified
a measure of engagement predictive of health
improvement. We then isolated program design elements
that were associated with better engagement, while
controlling for differences in population demographics,
industry and other program design choices. Finally,
we developed a set of best practice recommendations
based on what the most successful organizations did
with respect to each of these program design elements.
19© 2016 RedBrick Health Corporation
Do you want to learn more about driving meaningful engagement within your population? Are you interested in a detailed benchmark-based recommendation on ways to improve? We can help.
Contact us for a free best practices review today at:
www.redbrickhealth.com/bestdobetter
BestDoBetter@redbrickhealth.com
855-776-5515
RBH-136 4/16
© 2016 RedBrick Health Corporation
RedBrick Health Corporation 510 Marquette Avenue, Suite 500 Minneapolis, MN 55402
RedBrickHealth.com
linkedin.com/company/redbrick-health
twitter.com/RedBrickHealth
facebook.com/RedBrickHealth
top related