Corporate wellness entrepreneurs: Carrot and the stick is the wrong model

As I said at the close of the first day of ENGAGE, I heard this phrase much more often than I expected to: We have to meet people where they are. I am surprised at how fast this “how do we get employees to be healthy?” conversation has shifted, even since ENGAGE 2013. The focus […]

As I said at the close of the first day of ENGAGE, I heard this phrase much more often than I expected to: We have to meet people where they are.

I am surprised at how fast this “how do we get employees to be healthy?” conversation has shifted, even since ENGAGE 2013. The focus is not so much on signups for fitness programs or penalties for smokers, but building the right support system. Each member of the “Direct From Big Employers: How Can Healthcare Help Them?” panel described the most effective strategy they have seen: building a support structure that includes navigators to help people make good decisions and traverse the healthcare system.

Just this summer the California Healthcare Foundation sponsored a contest to help physicians understand a patient’s life outside the four wall of the doctor’s office. It is clear that many big employers see that part of the healthcare system – family situation, money issues, caregiving, transportation problems – as one that needs attention too.

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A Deep-dive Into Specialty Pharma

A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.

The people working for these companies — HealthWays, Accolade, Eliza Corporation — and their clients — Medtronic, WalMart, Lowes, Target — seem to have put together a nuanced and true-to-life picture of what it’s like to be a healthcare consumer. All that talk about “big data” seems to be paying off in specific changes about how to help employees stay or become healthy.

Brad Kirkpatrick is the president of the employer and government market at Healthways, Inc.. He made a point that I haven’t heard in a discussion about corporate wellness programs. He said that companies have to build consumer-grade solutions that people value and that meets them where they are at that moment in time.

“Only about 20% of any population is ready to get into a behavior change program,” he said. “The real question is how do we drag those other people along until they are ready?”

He said that analytics have helped the company identify people who are most likely to rack up the biggest healthcare bills.

“If a person’s BMI is too high and they have a social risk and financial risk, he is 50% more likely to be in the category of a big healthcare expense,” Kirkpatrick said. “We can define that 5% and hope that we get to 1% of them.”

Moderator Dr. Harry Greenspun, senior advisor at the Deloitte Center for Health Solutions, pointed out that on the “who do you trust?” list, employers are at the bottom, along with payers and big pharma.

Jack Stoddard, Chief Operating Officer, Accolade said that Accolade addresses the trust issue by assigning an independent navigator to each employee.

“We insert a trusted resource into a family — someone independent from the employer and payer — to help engage people, explain benefits and understand the complexity of delivery system,” he said.

Accolade’s customers include Lowes, Time Warner, and Medtronic. The company announced this week that Accolade’s Health Assistants are now available to the employees and families of some employer groups insured by Independence Blue Cross. Health Assistants work with a team of nurses, doctors, social workers, and other specialists to build relationships with individual members and develop personalized healthcare plans that take into account health status as well as emotional, financial, and social issues.

Stoddard also said that the problem is not the individual’s level of engagement but the overall complexity of the system.

“Consumers are actually very engaged in their healthcare, they just don’t know where to go and they have nobody who can help them make sense of the system,” he said. You have to be there at that point in time to be the trusted resource to help them calm down and make a good decision. Bad choices lead to waste in the healthcare system.”

Stoddard surprised me also when he said that analytics are only useful if it is enabling human-to-human conversations. Until recently, the high touch part of healthcare analytics has not been part of the conversation.

Stoddard was focused on moments when patients are actively engaged with the system. Kirkpatrick, on the other hand, said he thinks the bigger challenge is engaging people when they are not in an acute situation. He said one insight that Healthways has pulled from its database of 2 million data points about well being is that money – the lack of it – has a tremendous influence on health. Financial advice from employers has to move beyond how to manage a 401K.

“How do we help them with tools? These people don’t even have a 401k,” he said. “They have tremendous financial stress in their lives and that’s causing healthcare costs.”

Mark Manning, Chief Revenue Officer, Eliza Corporation said that big data analysis has identified the risks of being a caregiver (something the people doing that unpaid work already knew).

“If you are a caregiver, you are much more likely to become a patient, because often if you are taking care of someone, you’re not taking care of yourself,” he said.

Manning said that insights like this and the potential of big data have brought the industry to a point where tech can make insurance and healthcare more personalized.

[Original Lego bunny picture from flickr user Alan]