With the weak economy and strong pressure from healthcare reform, employers are investing in new approaches to lower healthcare costs and lift employee productivity. Increasingly employers are investing in strategies to engage employees in their own health and reward them to motivate needed behavior change.

According to the recent Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Healthcare, employers indicated that two of their top three healthcare strategies for 2012 are to “develop/expand healthy lifestyle activities” and “adopt/expand use of financial incentives.”

In July 2011, Humana launched their HumanaVitality program, which is designed to both guide and reward the employee for participating in their health and making better lifestyle decisions. “Our members tell us that they are hooked as soon as they use the Vitality Age app to determine their age and learn about how their behaviors influence their health. And as they participate in the HumanaVitality program, members interact with the Vitality Age app to see how they are positively impacting their age,” explains Stuart Slutzky, chief, product innovation, HumanaVitality.

Although employee incentive programs around health are not new, Humana has incorporated several innovative strategies into their Vitality solution.

Personalized Program Design: “We are using information from the employee’s health assessment, claims information and online health behaviors to personalize their pathway,” describes Stuart. Each member sees a set of recommended activities and has the option to select any of over 30 activities to gain points.

In addition to an individualized approach, Humana has decided to test a segment strategy after determining that the pathway is similar for members that are moving through a life stage change. Humana has created a special pathway for expectant mothers, as their first target segment. This means that members who are pregnant view a special set of activities and programs that are relevant to remain healthy throughout their maternity.

Program Reward Structure: Humana has designed their program with different status levels for reward attainment. “Our members begin with a blue status and can move up four tiers to platinum over time as they collect enough Vitality Points™.  When climbing to a new status level, they unlock a larger discount in the rewards mall,” shares Stuart. “Humana is also working closely with small group employers in select states to offer a premium reduction based on the percent of employees that achieve silver or higher Vitality Status. Employers may choose to pass the premium reduction to employees reaching silver, gold or platinum Vitality Status."  This premium discount is in addition to rewards individual employees can redeem in the HumanaVitality Mall based on their own points earned.  

Humana has defined the mall to appeal to members that have different motivations. “Spenders” can get instant gratification by purchasing with their Vitality Bucks.  “Savers” can accumulate their bucks for larger prizes. Soon “Givers” will be able to donate their rewards to charity.

Through their “Jackpot Rewards,” Humana uses a gaming mechanic of randomness to select a program participant to win prizes, which are based on their status level. For example, blue status member can win movie tickets or yoga mat but a platinum status member can win a flat-screen television or iPad.

Program to Program Connection: “Our members get rewards points when they enroll in one of our health programs. We are working on rewarding the member with more points for ongoing participation in our health program such as Weight Management. In addition to tying rewards for coaching program usage, our coaches can see the member’s efforts and earnings to date and can promote different point opportunities during their interactions to motivate the member,” Stuart explains.

Consumer-Driven Program Development: The HumanaVitality team listens closely to members participating in the program. They have set up a process to gather feedback that members share through the email and call center channels, as well as Facebook and Twitter, and the team discusses these ideas and suggestions to define program enhancements. “Recently, we heard one of our members ask us to provide points when their kids participate in athletic events.  This was a great suggestion and is now another activity that we reward under the program.” 

Program Success Evaluation: One key program measure is participation. Humana has expanded the ways that members can participate to earn points including obtaining preventive screenings, exercising regularly, donating blood, getting CPR-certified and quitting smoking. The newest way for members to earn points is by playing their Ubisoft “Your Shape” fitness game on their Xbox.

HumanaVitality’s Future Direction for Engagement

The HumanaVitality team is working on developing a deeper personalized experience by looking at the member’s past behaviors and recommending healthy activities, which match her interests. This is similar to the way Netflix suggests movies based on past viewing behavior.

Humana is also gathering lots of data on how consumers are using their rewards program. “We are applying data analytics to evaluate program engagement beyond participation. We will look at status level movement and actions tied to behavior change,” explains Stuart.

“In the future we will continue to expand the program to ensure we’re providing support and optimizing outcomes for all members – from members with severe conditions to marathon runners,” added Stuart.  “New reward partnerships will ensure the program provides relevant and aspirational rewards that foster improved health.”

In early 2011, Group Health set out to find ways to use mobile to help members manage their health and make better decisions about where, how and when to get care. “We view mobile as another channel of delivering patient care which is important to us given our mission of serving the greatest number of people”, explains Colby Voorhees, Senior Product Manager at Group Health. 

Group Health launched their award winning mobile application with key capabilities such as care management with “My Care”, care guidance with “Consulting Nurse” and care planning with “Wait Times” for Pharmacy and Laboratory services.

Group Health’s app moves beyond the mobile capabilities enabled by other health plans which let consumers look up health information, check symptoms or find urgent care.

“We’ve received very positive feedback from members on our version 1.0 app but were surprised that members expected our mobile application to have more capabilities out of the gate such as refilling a prescription or accessing information on the entire family”, Colby reports.

     “Love the new app but am frustrated that I have to go to the full site to reorder meds. Will this be available on the new app soon?”

     “Please provide a Parental Access feature in the next update, soon.  I have to take my kids in much more than I go in so most of the time I end up using a web version on my phone (not fun)  instead of the app.”

Last summer, Group Health released their 1.5 version with prescription refill and parental access capabilities. Their mobile app now has over 36K downloads (iPhone 25+K) and Android 11+K) by 14% of their web access users and 5% of their total members.

The two most used mobile app features are “My Care” (37%) and “Wait Times” (36%) followed by “Symptom Checker” a distant third (10%).

In “My Care”, consumers can now see their personalized list of care reminders for preventive and chronic conditions (if applicable), communicate with their clinicians (e.g. primary care and specialists), review their ‘after visit summary’, refill a prescription and access care information for children under twelve such as immunization timing. Members can also use the scheduling feature to check available appointments and book them with their PCPs. “It’s like picking a seat on the plane that you want instead of having someone else select it for you”, exclaims Colby.

Within “My Care”, the top three features used are Reading Messages (32%), Viewing Lab Results (25%) and Making Future Appointments (16%).

Group Health’s Mobile Motivation

The product team at Group Health remains focused on taking complex tasks that the consumer is trying to do and making them simple. Group Health collaborates with consumers to get input on mobile concepts and works closely with them through usability research to make sure the capabilities meet expectations and the interface is intuitive. 

While Colby discussed their mobile research, I heard members voice their desire for increased convenience and an improved customer experience.

“If they had an app that made it that easy to interact with healthcare, I would choose Group Health.”

"My spouse would absolutely download that app to take care of his health since he can use it while commuting to work on the bus or while he is waiting in line.”

“I absolutely appreciate the forward thinking technological advances that Group Health has. Something seemingly as simple as an iPhone app to access my health records, completely changes and improves my experience in a way that other knuckle dragging change adverse medical providers just can't comprehend. Thank you.”

What is next for Group Health on the mobile front? Colby reminded me that they are only on their 1.5 mobile app version and there are opportunities ahead such pushing communications to consumers instead of relying on them to access their My Care dashboard.

As an integrated care system, Group Health has the advantage of leveraging their common platform for patients and providers to support care collaboration and self- management. Consumers can use mobile to access a single source for their care communication and transactional needs.

“We are thinking about the continuity of the care interaction with the clinician. There is a big divide between phone calls and in person visits. We already have secure messaging and can see where video might be the opportunity to bridge the gap in a low cost and high convenience way for patients and providers” shares Colby. 

Within healthcare, the consumer demand for mobile services is quickly outpacing the apps being supplied by organizations. Consumers want all the features available on their specific mobile device, which poses a big challenge to organizations that don’t have the resources to fund all of the mobile platforms. The key will be to identify, prioritize and deliver the most meaningful features which will enhance the member experience, enable care collaboration and empower consumers to simply engage in their health. 

Health care companies today are following in the footsteps of the retail-oriented, information based financial services industry.

What financial services companies have discovered is that in order to build their business, they must build a personal relationship with the consumer.  They accomplished this by creating a consumer-centric database, monitoring shopping behavior through reporting and analytics, motivating activity through multi-channel communications and launching a loyalty program to reward consumer spending,

I was part of this customer-centric transformation as the Director of Database Marketing at GE Capital, which provides private label credit card programs for Disney and Apple, to name a few marquee brands. My cross- functional team started with the consumer in mind. We envisioned the experience that our retailer customers needed to deliver to their consumer card holders to differentiate themselves in the marketplace and capture a larger mind share and business share.

This is the same path that health care companies are marching down to get ready for new customers.

Consumers Are Coming!  Health Care Companies Invest in Retail Strategies 

In their report on “The Era of the Health care Consumer,”  Accenture describes the shift in responsibility from the employers to the consumers and the resulting health care company investment changes from BTB to BTC. Accenture cites the opportunity to learn from the retail sector, especially the segmentation, profiling, loyalty and cross channel communications.

A few health care organizations are making the needed investments to move closer to the consumer in order to better understand their needs for information and tools to support health management.  Aetna, for example, has partnered with Best Buy to sell wellness programs to consumers within the retail store and deliver their wellness coaching program online. In addition to store fronts, Florida Blue (previously BCBS Florida) has invested in their Guidewell online initiative to build a relationship with consumers beyond their member base.

Most health care companies, however, are still trying to figure out where to begin.

Barriers for Data-Driven Retail Health Care

There are several key barriers that Health care companies must overcome in order to effectively engage these retail consumers. 

• Knowledge about the New Consumer: Health care companies have limited or no information about their newest customer that is either considering their health product/service or has just come onboard. As a result, the interaction can feel less satisfying.  Using best practices from the financial industry, health care organizations can utilize segmentation and profiling to deliver a more personalized experience while gathering knowledge about the consumer through each touch. 

• Knowledge about Consumers' Data Needs: During their recent research, IDC Health Insights learned that “despite large investments meant to extend the organizations’ consumer-centric model, health plans know little about how consumers want to consume information…”.  Financial Services companies remain aligned with their customers by inviting them to participate in their own private branded online research community. The company captures consumer input and feedback on their product road map and new marketing initiatives.

• Knowledge about Proactive & Personalized Communications: Many health care organizations wait for consumers to come to their online marketing destinations including their website and social media and then wait for them to return. Although these companies maybe have tools in place to capture the contact information of interested consumers, they tend to send out the same information to everyone. Financial Services companies segment these target consumers and stream content of interest across their preferred communication channels to bring them back and engage. 

• Knowledge about Developing a Personalized Incentive Program: One way that health care companies can differentiate themselves is with an incentive program that rewards a consumer for healthy lifestyle behaviors that fit her profile. One of the reasons that some credit card loyalty programs (e.g. American Express) are so effective is that they target personalized offers based on each consumer’s spending behavior profile.  

Health care companies can learn from the leaders in the Financial Services industry about how to leverage technology to build a retail consumer relationship through ongoing personalized communications and programs which are aligned with the consumer’s ongoing data needs. 

World Congress Leadership Summit on Mobile Health, July 25-27th in Boston

Over the past three years, I have participated in this interesting event by running a workshop or panel.

Health Plans are finding new ways to bring value to consumers by empowering them with tools and guidance to manage their health while on the go.

At many conferences, health plans present their newest mobile application or texting campaign to engage consumers.

UnitedHealth Group announced their latest move at the recent Consumer Electronics Show to integrate several mobile health applications into their OptumizeMe solution, through partnerships with CareSpeak Communications, FitNow and FitBit. UnitedHealth is integrating content and tools to bring new capabilities to both consumers and caregivers.

Through the CareSpeak Communications’ partnership, consumers sign up to receive two-way texts to help them manage their medication and condition. UnitedHealth delivers CareSpeak’s personalized messaging to provide relevant content to each consumer segment ( e.g. asthma, diabetes, cancer, etc). A patient with diabetes opts in to receive customized education and reminder messages and can give a caregiver permission to monitor her health. The patient’s clinician is also kept in the loop with medication and condition management data to discuss during patient interactions. Patients are further engaged by receiving text based educational quizzes and viewing online reporting showing their effectiveness in managing their medication and condition over time.

With the integration of FitNow’s Lose It! mobile app, consumers can better manage their weight through fitness and food tracking tools, educational nutrition information, motivational reminders and social peer support.

From the FitBit integration, consumers automatically track their physical activity instead of having to key it in. Since this activity data is no longer self reported, UnitedHealth Group can use validated information to drive their rewards program. The FitBit app also tracks the consumer’s sleeping behavior for a more complete view of their health.

Integration Delivers Insight

UnitedHealth Group has invested in this set of mobile technologies to capture and connect multiple sources of data for a holistic view covering the consumer’s physical activity, dietary behavior, medication adherence, biometric and mood information.

“With these partnerships in place, we are connecting all the pieces of data across our platform for a common view for the consumer to self manage and share with their coach while creating a personalized experience”, explains Nick Martin, VP Innovation and R&D, UnitedHealth Group.

This supports the trend for “integrated end to end health to care solutions” where technology connects with care management platforms and programs, as noted by IDC Health Insights’ analyst Janice Young.

Coach/CareGiver & Consumer Collaboration

Nick Martin describes how the OptumizeMe application is being used by the consumer with their coach.  “Let’s say you are trying to lose weight. Your coach can push messages to your mobile which are educational and supportive. And if you give your coach permission, she can see your tracked physical activity”.  Think about how much more motivated and accountable the consumer will feel when her coach is monitoring and responding to her daily progress.  On the health side, the asthma patient can give access to her caregiver to monitor and address medication compliance issues. Her caregiver can also send encouraging and educational messages between visits.

UnitedHealth’s partnerships deliver new capabilities to their OptumizeMe mobile app giving consumers a new way to remain in close contact with their coach and to self manage with the social support from caregivers. With the power of the personalized information pushed and pulled from the consumer’s mobile phone, UnitedHealth Group can successfully generate both stronger consumer engagement and better health outcomes.