Corporate wellness programs are growing steadily, and many companies are betting they will keep their costs under control. But how employers utilize technology to fit their workforces’ needs is a critical success factor. Wellness is rapidly evolving and becoming an integral part of how employers ensure maximum productivity and efficiency of their workforces. The Centers for Disease Control and Prevention (CDC) estimates that U.S. businesses loses $225.8 billion per year to employee illness and injury.

In addition to lost productivity, overall spending on health care rose by nearly $1 trillion between 1996 and 2013. The rise of chronic, lifestyle-related diseases accounts for a significant impact. Tens of millions of workers suffer from chronic conditions such as diabetes. The cost differential per employee with diabetes, for example, amounts to more than $10,000 more per year.

Making Technology Work for You and Your Employees

Given the substantial burden of chronic diseases on the workforce, there has been an increase in technology that employers can embed into their wellness programs to promote productivity and efficiency. Leading companies have recognized the need to get to the root of the problem in order to see real progress. We’ve already begun to see shifts taking place as employers prioritize the health of their workforce.

This shift is not only good for employees, but also for business, as wellness programs can provide a significant return on investment. In a well-known example of successful corporate health promotion, smoking rates among Johnson & Johnson employees dropped by more than 66 percent, and the number of employees with high blood pressure or physical inactivity fell by more than 50 percent. As a result, the company returned $2.71 for every $1 spent on the program.

Knowing Your Workforce

The first key to implementing a successful program is knowing your workforce, including their needs and preferences. For example, wellness programs must take into account potential barriers such as health literacy – the ability to make informed decisions based on one’s understanding of health information. Low health literacy is surprisingly common; the National Assessment of Adult Literacy found that nearly 90 percent of adults lack proficient health literacy.

While it is not anything to be ashamed of, it is certainly something to be aware of, and reviewing tools from the AHRQ can provide a baseline for understanding the abilities of employees to manage their health. Identifying the best wellness program for your organization can be a challenge, but resources are widely available to get started. Of course, it’s vital to keep in mind the relevant laws and regulations shaping the framework for voluntary employee wellness programs, including the Affordable Care Act, Americans with Disabilities Act and the Health Insurance Portability and Accountability Act.

Other resources, such as the Johns Hopkins/Transamerica Center for Health Studies report offer a variety of useful tips on how to proceed with the creation and implementation of a variety of initiatives. With a clear goal and plan in place for your wellness program, integrating technology is the next important step. In our mobile- and data-dominated world, people are constantly on their devices, logging their every move and sharing it with their social networks.

Driving Participation

Wellness innovations are capitalizing on this new status quo to promote health engagement more than ever before. For example, technology can enable lifestyle coaches and dietitians to review employee progress towards their health goals in real time and provide remote feedback and support. This trend towards connectivity and personalization at scale is expected to continue-within the next several years, data-driven incentives for employee participation may be the norm.

Ideally, technology will not only spur active participation in a program but also help employees achieve positive health outcomes. By “gamifying” health improvement with elements like teamwork, competition and instant rewards, a wellness program can be framed for what it is: a fun way to improve your health. Technology can provide the platform for employees to work together, communicate with each other and track their progress managing their health – like measuring minutes of meditation, steps in a day, or days without junk food.

Using Evidence and Data

Following an evidence-based structure for these healthy activities – such as the CDC’s guidelines for lifestyle change – can help ensure the program has a foundation of science to support employees at risk on their way to wellness. With all of the data that technology can yield, making use of it is essential to making your program effective. Dig into your data to understand what the numbers say and why. If the information isn’t painting a cohesive picture of your workforce, or if retention seem to be trending downward, you’ll have visibility into what’s working and decision support tools to adapt your program for improved engagement.

In addition to the quantitative metrics – like healthy activities or number of employees screened to be at risk for illness – take a routine pulse of the more qualitative feedback on your program – like what your employees have to say about their experience participating. Ultimately, it’s how helpful the program is to your employees that will make healthy habits stick. Finally, selecting the right technology for a wellness program must be done within specific parameters for your organization.

Meeting Your Organization’s Needs

With platforms designed for wellness screening, health engagement, biometric tracking and more, it can be difficult to account for all of these components with a single budget. If possible, try to find technology that covers the most meaningful needs for your goals for organizational wellness. Survey your workforce’s preferences: would they be likely to use their smartphones or their wearable devices – or both – to manage their health?

Narrowing down your options can help you find the best fit for your employees and your budget. Workplace wellness programs are nearly inevitable, given the health care trends among workers, rising costs and the potential for both savings and return on investment. However, these initiatives should be carefully chosen, evidence-based, accessible for all employees, and integrated with technology to achieve the goals of a healthier workforce and lower overall health costs.

This article originally appeared in Corporate Wellness Magazine.

Organizations that want to reduce healthcare costs must first identify those drivers that are preventable and then determine the optimal path to avoid them. For lifestyle-related diseases like Type 2 diabetes, health promotion and lifestyle change programs present a real opportunity to lower healthcare costs while improving people’s health outcomes and care experience—all goals of the Institute for Healthcare Improvement’s Triple Aim.

In Iceland’s capital, Reykjavik, a combination of behavioral economics, big data and mobile technology is a promising way forward to identify individuals at increased risk of lifestyle-related diseases and reverse their condition.

What is behavioral economics? It combines lessons from psychology and economics to consider how people behaveas opposed to how they would behave if they were perfectly rational, with unlimited willpower, and solely acting out of self-interest. It considers how people are influenced by their emotions, identity, environment and the framing of information.

Behavioral economics can be applied to the prevention and management of diabetes, a disease that now costs an estimated $825 billion each year globally. A significant part of the economic burden stems from the number of people affected. About 422 million people have the disease, which equates to about 8.5% of the world’s population. In Iceland, where the population tends to be more physically active than the norm, the rate is 6.1%. However, it is experiencing an upward trend.

Because Type 2 diabetes develops slowly over months and years, the good news is the disease can often be delayed, prevented or even reversed. More than 1 in 3 adults are prediabetic—at higher risk for type 2 diabetes and cardiovascular disease—but a structured lifestyle change program focused on diet and physical activity can be an effective formula for achieving and maintaining a healthy weight and normal blood sugar level.

Large clinical trials, including the Centers for Disease Control and Prevention’s National Diabetes Prevention Program, have shown this type of program can cut the risk of progression from prediabetes to type 2 diabetes.

As a physician who has worked with thousands of patients with lifestyle diseases, I recognize that messages of behavior change—eating right, exercising more and managing stress—do not so easily translate to everyday life. People have priorities that demand their time and attention, from managing a career to raising a family, that often relegate lifestyle choices to an afterthought.

In addition, adult health literacy is a challenge, and many people may have a low motivation for lifestyle change until a medical episode brings new perspective to the effects of unhealthy habits. As the industry looks to combat the impact of diabetes and help people engage in their healthcare, two dynamics have emerged to encourage prevention efforts.

First, we are developing a better understanding for how individuals make their lifestyle choices, particularly when a behavioral economics model is applied. Lessons from behavioral economics can support public health because they help us guide people toward better choices. To date, the more traditional, “rational” appeals—such as black-and-white nutrition labels on the back of a food packages—have fallen short in steering people toward healthier habits. Since the more “emotional” part of our brain is responsible for most of our lifestyle choices, targeting decision-making with emotional appeals—such as games, instant gratification and rewards—can more effectively activate the triggers that motivate people.

That dovetails well with the fact that mobile devices are approaching ubiquity, providing a direct channel for preventive care. Not only are smartphones widely distributed, but people carry them at all times, spending several hours per day using apps that often deliver powerful emotional triggers in the brain. Mobile devices can increase provider-patient interaction for lifestyle interventions, as well as offer opportunities for primary prevention.

Combining behavioral economics with technology has applications for both providers and employers. By incorporating a digital layer to traditional lifestyle programs, clinicians and coaches can complement in-person sessions with tools that help people manage their health anywhere and open channels for support along their journey. Employers can integrate similar methods into workplace initiatives to promote employee wellness and reduce the risk lifestyle-related disease among the workforce.

One example of how this approach has been successfully deployed is in Reykjavik. Earlier this year, more than 2,000 municipal employees across the country’s capital participated in the first step of a new workplace wellness program. Using a health engagement platform on their smartphones, employees took part in health challenges in three focus areas.

The first was nutrition, enabling participants to set goals for consuming healthy meals, practicing mindful eating and avoiding sugary foods. The second was exercise, allowing participants to count steps, log workouts and record activities like household chores. The last was stress reduction, such as relaxation, mindfulness and meditation exercises.

Over the course of three weeks, employees who took part in the initiative completed more than 500,000 health-improving activities, including stair-walking the equivalent of 100 trips up Mount Everest.

In addition to the health advantages, the “Reykjavik Health Games” encouraged competition and teamwork across the organization as participants worked to earn the most points for their group or department. Further motivating participants, the points they were earning accumulated towards a charity water donation, which the City of Reykjavik provided to an organization focused on helping children in need. 

Participants were also offered a simple, seven-question prediabetes screening through their phone as part of the initiative. Of the employees who completed the questionnaire, more than 200 were determined to be at increased risk for diabetes and were referred to a 16-week, structured lifestyle change program administered through a digital platform in association with a local healthcare provider.

This approach can support efforts by insurers, providers and employers to reduce health costs. The Agency for Healthcare Research and Quality found diabetes with complications ranked at the top for hospitalizations covered by Medicare and Medicaid and those who were uninsured. Reducing the number of diabetes patients requiring inpatient admissions can help lower this expenditure.

Second, diabetes prevention programs that can effectively motivate their participants to lose weight and adhere to their program can improve the health of their populations and achieve quality metrics for reimbursement.

While cutting healthcare costs is a daunting challenge on its face, lifestyle-related diseases present a clear opportunity for progress. Helping people recognize their potential risk for diabetes, empowering them to make lifestyle change and engaging the triggers that motivate their behaviors and are the keys to keeping them healthy and out of the hospital.

This article originally appeared at FierceHealthcare.

Doctors have all had the lifestyle change talk, probably thousands of times.

We’re treating a patient with a lifestyle disease – obesity, hypertension, prediabetes. We assess the patient, evaluate treatment options and recommend a plan of care. Typically, this guidance amounts to better diet, more physical activity and less stress.

It’s a completely rational course of action. It’s the right approach to living healthier. But it just doesn’t take hold.

We distinctly recall instances of the lifestyle change talk with patients. Once, a middle-aged man recovering from a heart attack came in for an appointment. He seemed to understand the gravity of the situation, received evidence-based guidance delivered in a traditional way, and then was seen outside the clinic lighting a cigarette. On another occasion, a 60-year old woman was admitted to the hospital with high blood pressure. Because the traditional lifestyle change talk wasn’t working for her, the best treatment plan was to prescribe her an antihypertension drug… when she was already taking two.

We were trying to put out fires we would have liked to prevent, and we knew there had to be a better way. After years of research with leading universities and institutions and many real-world examples, we think we’ve found it.

The Dual Rise of Diseases and Devices

Chronic lifestyle-related diseases account for about 70 percent of deaths and up to 80 percent of health care costs worldwide. In 2014, diabetes affected 422 million people, and the trend continues on an upward trajectory. About one in three adults in the U.S. and the UK has prediabetes, increasing risk of heart attack, stroke, and type 2 diabetes. These diseases pose an escalating threat to global health and wellbeing.

At the same time, mobile devices have seen explosive growth and use. Not only are they widely distributed, but people carry them constantly, spending several hours per day using smartphone apps. As such, mobile devices can potentially increase provider-patient interaction during lifestyle interventions, as well as offer an avenue for primary prevention.

At a time where we need to flip the trend of lifestyle diseases, we have a ubiquitous, adaptive vehicle to tailor behavioral interventions to patients. But we still need to make those interventions more effective.

A new approach: Finding the triggers for lifestyle choices

The field of behavioral economics combines lessons from psychology and economics to investigate how individuals actually behave, as opposed to how they would behave if they were perfectly rational, with unlimited willpower, and solely acting out of self-interest. It considers how people are influenced by their emotions, identity, environment and the framing of the information.

Many lessons from behavioral economics apply to public health because they help us understand why people make choices, and in turn, how to guide them towards better ones. In three years of research, we teamed with experts from Harvard, MIT, and more than two dozen professionals on both sides of the Atlantic to determine how these applications could be put into practice.

Effective Engagement to Change Behaviors

We hypothesized that a mobile health-engagement platform could significantly enhance a structured lifestyle change program. We integrated principles of behavioral economics, gaming technology, artificial intelligence, evidence-based guidelines and personal coaching. We combined our clinical expertise with a team of experienced game developers and launched SidekickHealth to prevent and manage lifestyle disease.
Seven concepts from behavioral economics serve as pillars for the platform.

1. “Fast thinking” controls most lifestyle choices    

Behavioral research suggests two separate cognitive systems control our choices. Psychologist Daniel Kahneman describes them as fast thinking – which is intuitive, impulsive and emotionally charged – and slow thinking – which is rational, deliberate and reflective.

By targeting fast thinking, advertisers have been winning our hearts, minds and stomachs for years. The cartoon characters synonymous with breakfast cereals are examples of the food industry’s adept appeal. Public health organizations, on the other hand, typically target slow thinking. Just turn the cereal box over for a black and white label densely packed with nutrition information. There’s a lot of squinting at tiny print required for a rational, healthy choice.

To use fast thinking for good, we designed a gamified platform with colorful graphics, characters, competitions and instant gratification through rewards. The result is a highly engaging experience that enables patients of different health literacy levels, languages and ages to get and stay involved in the management of their health.

2. People use mental shortcuts, which can cause unhealthy behaviors

Studies indicate that lifestyle decisions, like how much to eat, are frequently biased toward an initial “anchor” value. For example, the quantities consumed at a meal are subconsciously cued by the size of plates and glasses. Referred to as “mindless eating,” this anchoring can increase how much people serve and consume.

With our platform, we deliver appetite awareness training to encourage users to eat in response to internal hunger cues – a method that has shownpromise for the treatment of obesity.

3. Stress and cognitive demands may increase the use of fast thinking and adversely affect lifestyle choices

Human cognitive capacity has limits, and slow-thinking processes require significant effort and cognitive demand. To compensate, our brains often outsource lifestyle choices to our more impulsive, fast-thinking brain. The effects on our decision-making can be compounded when multitasking or stress are further straining cognitive resources.

To counter the effects of stress on lifestyle choices, we incorporate relaxation, meditation and mindfulness exercises into our platform as part of an evidence-based curriculum.

4. People tend to discount future costs and benefits, placing a higher value on the present

“Future discounting” works against health behaviors, which usually involve efforts in the present for benefits in an undetermined future (e.g., floss now to avoid a dentist visit later).

SidekickHealth provides opportunities for instant gratification, such as highlighting short-term benefits, promoting self-monitoring (e.g., dietary tracking, step counting, activity logging) and providing immediate feedback to users. We also employ commitment contracts to allow users to pre-commit to lifestyle changes, such as forfeiting soda or sweets, and to have a supporter, such as a coach or friend, for added accountability.

5. Framing health behavior as an enjoyable task, as opposed to an obligation, may positively influence behavior 

The way healthy behaviors are presented to people can fundamentally alter their understanding of the experience. For example, Wansink and colleagues showed that study participants who exercised out of duty rewarded themselves with twice as much candy post-exercise than participants who received a message framing the exercise as an enjoyable nature walk.

In our gamified platform, we integrate messages that emphasize personal achievement, social interaction and fun to promote healthy behaviors. This approach can be especially effective with groups, such as a diabetes prevention program or a workplace wellness initiative.

6. Open channels may encourage some behaviors, while closed channels may inhibit others

“Channel factors” are the many small details that can have surprisingly large effects on people’s behavior. Examples that can lower the threshold for healthy choices include pre-slicing apples at a cafeteria (shown to increase apple sales), and making water more accessible by placing it at eye-level (shown to increase water sales).

We decided to open up channels for health improvement through a veritable “buffet” of options for improving diet, physical activity and stress reduction. Conversely, we avoid blocking channels by adhering to low health literacy guidelines and a visual design.

7. Behavioral economics models assume people are motivated by more than self-interest 

Altruism is an important motivator for health-related behaviors like blood and organ donations, as well as many group- and peer-based interventions. Incentives benefitting our friends can also be several times more effective than standard individual incentives.

For completing health missions on our platform, users accumulate points. Over time, points earn them altruistic rewards in the form of clean water that is sent by charities to help children in need. Users’ earned points and rewards can also benefit their friends in the program.

Making it personal: The role of data

While behavioral economics powers our platform, we use big data and artificial intelligence to drive personalization. Each time a user chooses one of 120 different activities, SidekickHealth’s artificial neural networks learn from these behaviors to make intelligent future suggestions based on user profile and surroundings. Machine learning enables us to predict and present users with the choices that are most likely to activate them – boosting engagement and program retention much like Netflix’s curated suggestions increase viewer engagement.

Data is also important for the invaluable role clinicians and coaches supporting the patient’s path to better health. Through the platform’s care team portal, administrators can efficiently track participants’ activity, remotely send supportive messages and tailor instruction for in-person sessions.

Beyond promise: Results in weight loss, program adherence 

Over the past year, the data-driven, gamified platform has been deployed to improve outcomes for in-person, community-based programs across the U.S., including those serving vulnerable populations at increased risk. Users were up to three times more likely to reach their five percent weight loss goals after 16 weeks, and they were up to 30 percent more likely to remain in the DPP for the full program. Similar results from a clinical trial were presented at the American Diabetes Association’s 77th Scientific Sessions in San Diego this June.

The use of images, games and smartphones overcomes the barriers to change otherwise attributed to social disparities and cultural differences. In a Los Angeles-based Medicare-age DPP where many people had never used an app, participants averaged seven exercises per day, with 84 percent retention at month four. A San Diego-based DPP with a Spanish-speaking cohort averaged six exercises per day, with 83 percent retention.

We have also seen success at scale with large employee wellness initiatives. For example, more than 2,000 municipal employees in Iceland’s capital participated in a three-week engagement program, completing 500,000 health-improving activities. Of the 700 who used SidekickHealth to complete a prediabetes screening, more than 200 were determined to be at risk and were referred to a lifestyle change program.

Conclusion

By understanding why people choose certain behaviors, we can help them choose healthier ones. By combining clinical and gaming expertise to make lifestyle change more engaging, we can help prevent and manage chronic disease. And by using technology, we can bring about the type of change that is needed at scale.

So now, in addition to having the talk with patients, we can empower them to walk the walk.

This article originally appeared in Healthcare Analytics News.

If an ounce of prevention is worth a pound of cure, it is natural to wonder what drives people’s decisions about their health in the first place. Increasingly, the field of behavioral economics is providing insights into the triggers for lifestyle choices that can lead to healthier behaviors.

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Every 23 seconds someone in the U.S is diagnosed with diabetes. According to the Centers for Disease Control and Prevention (CDC), more than 29 million Americans are diabetic, and 86 million more have prediabetes.

Every 23 seconds someone in the U.S is diagnosed with diabetes.

According to the Centers for Disease Control and Prevention (CDC), more than 29 million Americans are diabetic, and 86 million more have prediabetes. Together, these two groups comprise about 45 percent of the U.S. workforce.

The resulting impact on business is significant.

The Health Care Cost Institute found that, for adults covered by employer-sponsored insurance,  the spending difference between people with and without diabetes averages more than $10,000 per capita. In addition to direct medical costs, diabetes causes $69 billion annually in indirect costs due to reduced productivity.

With employers bearing much of the cost for chronic disease, many are implementing workplace programs and policies to reduce health risk factors and lower direct costs, such as insurance premiums and workers’ compensation claims.

The CDC’s Workplace Health Program showed that in 2014, 73 percent of small companies and 98 percent of large companies offered at least one wellness program as part of their health benefits. Approaches range from lifestyle change to weight management and health promotion.

To counter costs from lifestyle diseases like diabetes, employers should aim for a mix of  traditional programs, emerging methods and a supportive organizational environment. The right framework includes five effective, evidence-based ways for employers to promote workforce wellness and address diabetes-related costs:

1. Detect risk factors and disease early on

Type 2 diabetes develops slowly over months and years, so screening initiatives for early detection and treatment are essential.

A seven-item questionnaire from the CDC can be used as an initial screen for prediabetes risk, followed by blood glucose screening for further confirmation.

While the CDC questionnaire is a simple test to offer to all employees, the U.S. Preventive Services Task Force recommends screening for abnormal blood glucose for the 70 percent of adults ages 40 to 70 who are overweight or obese.

Employers should utilize workplace health programs that provide tools to measure workforce health. Having this information – the actual risk factors among their staff – will help determine the overall need and type of programs to implement.

2. Prevent the progression of health risk

A workplace program that emphasizes modest weight loss, improved diet, stress management and physical activity can help employers reduce the incidence and impact of type 2 diabetes among employees.

There is strong evidence that the progression from prediabetes to type 2 diabetes can be prevented or delayed.

Large clinical trials, including the Diabetes Prevention Program (DPP), showed that a structured lifestyle change program can cut the risk of progression to type 2 diabetes by 60 percent among adults who were at very high risk.

The American Diabetes Association and the CDC recommend that people with prediabetes should be counseled on lifestyle changes through programs with goals similar to those of the DPP, and research indicates that these types of initiatives can be highly cost-effective.

3. Help employees take control of their health

Providing employees with evidence-based programs helps them engage more actively in their health, a key step both in preventing type 2 diabetes and in managing the disease.

According to the CDC, “effective behavioral interventions combine counseling on a healthful diet and physical activity and involve multiple contacts over extended periods.” Initiatives that pair guidance with personal goal-setting, weekly action plans and encouragement can support the adoption of healthy behaviors over time.

New digital tools are also emerging to extend the delivery and effectiveness of these programs.

With the proliferation of smartphones, mobile platforms now empower people to manage their diet, physical activity and stress wherever they go, enabling employers to support their workforce efficiently and at scale.

4. Offer personalized programs adapted to employee needs

Programs to raise awareness, prevent and manage diabetes must be adapted to the needs and preferences of the workforce.

In particular, workforce efforts must take into account potential barriers such as health literacy – the capacity to make informed health decisions based on one’s understanding of health information.

According to the National Assessment of Adult Literacy, nearly 90 percent of adults lack proficient health literacy. Low health literacy is associated with higher rates of chronic conditions, more frequent preventable hospital visits, and less use of preventive services.

These outcomes are in turn associated with higher health care costs.

Programs that equip people of all health literacy levels with the ability to manage their health are more likely to be successful in helping employees change behaviors and avoid costly complications.

5. Support programs through policies, benefits and environment

A healthier work environment is a more productive work environment.

Evidence suggests that outcomes are best when individually-focused programs are supported by organizational-level policies.

This means creating a climate that is conducive to wellness: providing flextime for exercise, coverage for preventive services and screenings, and on-site resources such as fitness facilities, healthy foods in cafeterias and support from the organization’s leadership.

This article originally appeared in BenefitsPRO.