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The Heart of the Matter

Improving Your Health Benefits ROI

ditor’s note: For the purposes of this article, the author employs the term “health” as defined by the World Health Organization in 1948 as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” With this definition in mind, the author uses the terms health and wellbeing interchangeably.

Here’s a fact that might make you a bit uncomfortable: Your employees aren’t as enamored with your employee well-being program as you are. In a recent conversation on this topic, Shelly Wolff, the health and workforce effectiveness leader at Willis Towers Watson (WTW), summarized the firm’s 2017 research findings this way: “Over half of employers surveyed thought their wellness design works to improve employee lifestyles, but most employees surveyed felt differently — with only about a third agreeing.” In fact, WTW’s research found a startlingly low average U.S. net promoter score (NPS) of -51 for employer-sponsored well-being, when rated by employees. (NPS is a measure of the likelihood that people would recommend a product or service to a friend.)

That’s the bad news. The good news? Among those employees surveyed, nearly two in three confirmed that managing their health is a top priority for them, echoing most employers who reported they intend to continue investments in employee total well-being.

More to the point: Nearly three-quarters of the employers reported plans to re-tool their health strategies to better compete for talent. That’s a significant shift from the days when cost-saving was king, as it underscores the importance of emphasizing employee experience as an essential element in overall strategy.

So how can you design a strategy that achieves a better, more meaningful experience for your employees? What’s the secret to a benefit your people will love? There’s no magic bullet, but we can share a success formula.

Health Plan Designs that Work in the Real World

For many, success begins by breaking bad program design habits that can generate toxic results in your employees’ experience and your workplace culture. These bad habits consist of over-incenting things like outcomes, and under-focusing on things like choice, communications, community and fostering a culture of health.

Let’s start by looking at designs that make aggressive use of incentives to achieve initial engagement — say, in an assessment or screening — followed by penalties for failing to achieve certain biometrics targets, such as healthy blood pressure, BMI and cotinine-verified nonsmoking. We’ve seen such design produce more than 90% participation by employees, and statistically meaningful reductions in weight and even smoking rates. But here’s the dark side: We also saw stress levels rise, workplace culture scores plummet, and numbers of angry calls to our call center, as well as to the client’s HR team.

So, can you get the high engagement, and health improvement, without the collateral damage on stress, satisfaction and culture?


To dig deeper and uncover designs that work in the real world, we revisited our 2016 study on “What the Best Do Better.” This time we analyzed the impact of designs on engagement and experience — measured in the form of satisfaction with the employer’s program. We looked at dozens of designs, and tens of thousands of employees.

The most contrarian finding from our research? You can’t assume that health-contingent incentives (sometimes referred to as outcome-based incentives — for example, offering a financial reward for giving up tobacco or losing a certain amount of weight) are the best way to motivate your employees to achieve specific outcomes. In fact, most employees respond better when you reward them to take steps in the right direction, rather than rewarding them only if they achieve a measure — such as getting their blood pressure down — or penalizing them when they don’t.

It turns out that progress-based incentives performed as well or better than outcome-based incentives at producing clinically meaningful outcomes. And they did so without the collateral damage caused by outcome or penalty-based designs. Outcome-based incentives produced lower program satisfaction rates than progress-based incentives.

Let people start where they want — which might be talking about financial stress rather than diabetes care plans.

Culture of Choice

Perhaps more important than program design and incentives structure, organizations must create and deliver a benefit their employees love. This means offering plenty of choice with respect to how people can participate and reinforcing positive behaviors outside the bounds of formal program design.

Choice means offering digital options (both web and mobile) as well as live support (such as coaching and health benefits navigation). It means supporting local community resources, as well as letting employees “BYO” devices. If employees prefer to use Runkeeper, Garmin, Fitbit or Apple Watch, make sure your platform integrates and gives full credit for data captured by these apps, wearables and platforms.

Choice also means starting with the employee, not the condition or risk factor. Successful designs that produce higher experience ratings demonstrate this. Let people start where they want — which might be talking about financial stress rather than diabetes care plans. By doing so, good things happen: more people participate, and for longer periods of time. In fact, it turns out your high-risk population wants to talk lifestyle, not disease. Fully 75% of those with a chronic physical health condition, given the choice, will choose to engage around nutrition, stress or exercise, rather than an intervention focused on their specific condition. Let them. When we did, we ended up doing three to four times as much condition-relevant coaching with these individuals compared to what would have happened in a nonchoice-based model that offers only condition-centric programs. (See “What Our Health Data Reveals about Employers, Employees and Well-Being Programs.”)


Culture of Health

What is the most striking difference between a benefit that employees love and one that is self-defeating? It often comes down to your company’s culture of health — that is, organizational conditions such as environment, leadership, recognition, peer support and modeling that are conducive to better individual health. If your employees would say they work in a high-stress, overworked and exhausted culture, or one with low trust, there’s almost no health program that can overcome those headwinds.

Though it sounds abstract, a culture of health is something you can measure. You do so by asking employees and leaders questions and seeing if the answers align. You scan the physical environment of your workplace for signs and signals. You’re setting your employees up to fail when you encourage them to make better food choices, but when they visit your company cafeteria they mainly see fried food and other unhealthy options. And when you focus on a financial incentive around blood cholesterol, the flip side may be the impression that you’re penalizing employees who fail to reach that outcome.

When it comes to a culture of health, you can start with small, inexpensive tactics and still have an impact. Healthier food choices, well-labeled and properly placed, will immediately move the needle. So will signage around walking routes and encouraging social activity around healthy steps. Getting leadership and employees aligned around the value of health takes more effort, although starting with middle management helps. Keep managers informed on health engagement within their departments, and in other departments. Find ways to reinforce their own health and encourage them to do likewise. (See “Five Steps to Create a Better Health Experience.”)


The Ultimate Benefit

Don’t lose sight of the role of employees in your benefits design, even as you sponsor one or more apps or platforms. Our research found that employers that offered a single concierge-style health navigation session by phone saw dramatic increases in downstream participation — even outperforming large financial incentives offered by other organizations. So, beware of a program that’s simply a “click for points” game. Ironically, in this age of digital wellness apps, the human component, such as providing health coaches to employees, united with technology, creates the greatest impact on employee health.

Lastly, be transparent with employees. If you’re implementing an employee health program to get better control of spiraling health-care costs, tell them that. Let them be partners in that effort since, after all, they are bearing an increasing proportion of that cost in many instances. Making it an adult conversation can turn it into a win-win proposition and engender higher trust.

A well-constructed well-being program can be the ultimate benefit for your company, paying dividends in improved health and experience. Done right, the program amplifies engagement in many of your other benefits. And that’s one of the best ways to get a better return on your benefits investment.

Rajiv Kumar

Rajiv Kumar , M.D., serves as chief medical officer and president of Virgin Pulse Institute, and oversees the Virgin Pulse Science Advisory Board.