You cannot turn on the television or look at a newspaper today without being reminded of the obesity epidemic facing our nation. According to a CDC study, over 37% of U.S. adults are obese, while about 70% are overweight.

 Obesity has been associated with certain chronic conditions such as diabetes (type 2), cardiovascular disease and stroke. Last summer, American Medical Association classified Obesity as a disease, and the National Heart, Lung and Blood Institute recently published guidelines recommending that primary care physicians provide obesity counseling to all patients with Body Mass Index over 25 (which classifies them as overweight).

Many Americans try to lose weight but do not have the tools or professional guidance to be successful. Most physicians don’t have the training or tools to provide a comprehensive weight management program in their practice, and sometimes refer patients to commercial programs that are not clinically supervised.

RediClinic has stepped in to help. “We have developed a medically supervised program which is not just about weight loss but about health management”, explains Danielle Barrera, Chief Operating Officer at RediClinic. “When we developed this program in 2009, we noticed that many programs on the market were missing critical elements of a successful weight management program, and did not incorporate healthcare professionals, who are well positioned to have a significant impact on their patients’ lifestyle and health decisions.”

According to IDC’s Connected Health 2014 Predictions, “Retail Clinics Will Disrupt the U.S. Healthcare System”. Most people think about Retail Clinics as a place for getting flu vaccinations or addressing acute problems such as strep throat or ear infections. Retail Clinics are bringing more services to the community and some are now offering preventive services (i.e. physical exams) and chronic disease monitoring.  

Over the past two years, RediClinic has been offering a weight management program called Weigh Forward. Shoppers walk into one of their 30 locations inside grocery stores to sign up for the 10- week program. During the initial visit, the clinician does lab work to establish a base line to monitor progress in key health measures.  Throughout the program, the clinician provides guidance and teaches life skills not only to lose weight, but keep it off.

“Our program is a ‘Connected Health’ model. Participants use the MyWeighForward  platform to access educational information, track food and physical activity, and receive online coaching and social support between visits to the clinic. During weekly visits to RediClinic, the clinician reviews the participant’s program information (i.e. goals, lab work, tracking information and eCoaching activity) to deliver personalized guidance.”

RediClinic’s Weigh Forward program incorporates four key components which are reinforced both in- person and online through the program’s technology platform – myWeighForward.com: 

RediClinics Patient Portal on MyWeighForward Platform

1. Medical. Initial medical assessment with a comprehensive set of lab work, regular biometric monitoring and measurement, and weekly counseling by healthcare professionals.

2. Behavior Modification. Proprietary assessment tool developed at Yale's Prevention Research Center by Dr. David Katz (WeighForward’s Medical Director) to identify and address individual barriers to success and readiness to change, to create a personalized weight loss plan.   

3. Diet & Nutrition. Online educational information on food choices, weekly meal plans with 500+ recipes, and access to a diet/nutrition e-coach.

4. Physical Activity. Customized activity plan based on preferences and abilities, access to fitness videos and the capability to collaborate with a fitness e-coach.

Consumer Experience with the Weigh Forward Program

Deborah Hastings signed up for RediClinic's 10- week Weigh Forward program to start shedding 60 pounds. Deborah's daughter is getting married in six months and Deborah wants to get around without pain in her knees and to fit into a new dress for this special event.

During her first appointment, she meets with a clinician for a comprehensive evaluation to discuss her health and weight loss goals and determine her overall health status and readiness for change. She learns that her cholesterol and blood pressure are both high and that she is at risk for Metabolic Syndrome.

She uses the MyWeighForward.com portal to follow a meal plan suggested by the clinician and dietician eCoach, view exercise videos, and to track both her food and physical activity.  

Patient prepares for visit with clinician at RediClinic

Deborah is preparing for week #5 visit which is teaching her that it “takes a village” to help her achieve her goals, and she needs support from family, friends and office co-workers. She inputs her Visit objective, completes her checklist of specific tasks and selects a "Barriers to Bust", how to deal with family when they are sabotaging her diet. This barrier is posted on her Visit Plan which she will review with the clinician during her RediClinic visit. While Deborah finishes her homework, her clinician reaches out to the eCoach that Deborah has been working with to discuss nutrition concerns. Within the private clinical portal on the Weigh Forward platform, they discuss strategies for Deborah. During the upcoming visit, Deborah will work with the clinician on the barrier she has selected and will consider suggestions from her eCoach. 

Deborah has taken advantage of the social community capabilities on the Weigh Forward platform. She created a profile with demographic information and indicated how much program information to share with other participants. Deborah has decided to share the “Busting the Barrier” badges that she has earned each week. Deborah searched to find others like her and has connected with over a dozen new friends. She has also found an online group with her same barriers and is looking to gain some new real life strategies to address them.

During her week #9 visit, her clinician will take a blood sample to compare key biometric markers to those measured at the beginning of the program. She will be able to view these measures and see her progress in reducing her cholesterol and Metabolic risk in her MyWeighForward program account .

With several months before her daughter’s big event, Deborah is motivated to extend the program. She is planning on paying for the "Boost Maintenance Program with ongoing access to MyWeighForward with e-coaching as needed, monthly clinician visits and weekly in-clinic visits for "body composition analysis/biometrics".  

Connected Health Program Engagement & Results

Although the Weigh Forward Program was launched in 2011, it wasn’t until RediClinic moved to the new MyWeighForward Platform powered by Wellness Layers in October 2013 that they were able to offer enhanced functionality and support for patients and clinicians including: 

• Personalized Consumer Experience & Outcome: Participants create their own mini- electronic health record which collects program information, preferences, visit planning, tracking data, social engagement and progress through health measures. Program participants have the convenience of seeing different clinicians within the same clinic based on appointment availability or in a different location since all RediClinic clinicians have access to the participant’s program information to deliver a consistently high quality and personalized experience.
• Social Engagement: WeighForward participants use the platform 24x7 for ongoing emotional and educational support through their weight loss journey.
• Clinician Support and Collaboration: Clinicians have their own portal, giving them access to information to support and consistently deliver the program and to privately and securely collaborate on care. RediClinic's Clinician Portal on MyWeighForward Platform
• Care Continuum: Participants can access a Program Summary with their program health measures to send to their own doctors. “If the patient has secure messaging with their physician, they can share this information to include in their EMR”, adds Barrera.

“Our results have been very positive. On average, our patients are losing 1- 2 lbs per week which is considered to be a healthy rate of weight loss, and are significantly improving their cardio-metabolic risk factors. In many cases our patients have moved from pre-hypertensive and hypertensive to normal and pre-diabetic to normal”, exclaims Barrera.

Comments from Program Participants 

What I liked about the online part of the program was that it gave me homework to do to keep me accountable and focused.

I had been the 'queen of couch potatoes.' The best things about the program were the accountability each week, recipes and shopping list, and incredible support from the staff

Dr. David Katz's lesson on Trial by Aisle taught me to check ingredients lists for hidden sugars and salts, and to pick the shorter lists. The best thing about the program was it provided me with information to change my unhealthy lifestyle into a healthy lifestyle.

Future plans: New Business Model, New Technology Platform Capabilities

Today, most program participants walk into to RediClinic. However, RediClinic is now licensing the Weigh Forward program to other healthcare providers. “We’ve had significant interest and many pilot commitments from large healthcare systems and physician groups, as well as companies that operate retail, urgent care and worksite clinics. Everyone is looking for a turn-key weight and lifestyle management solution for their patients because obesity is so pervasive and expensive. Weigh Forward is one of the few comprehensive programs that is designed to be delivered by clinicians with no previous background in weight management,” Barrera adds.

Regardless of where the consumer is seen, in the clinic or in their PCP’s office, RediClinic is extending the capabilities of the WeighForward technology platform. “We are continuing to enhance the social networking capabilities of the platform, will introduce a mobile version later this year, and are beginning to develop modified versions of Weigh Forward that address chronic diseases, since the platform we’ve built is flexible and extensible”, concludes Barrera. 

Aetna's Lifestyle Social Community on CaféWell

According to CDC research, over 30% of U.S. adults have Metabolic Syndrome, a set of five risk factors including high blood pressure, high blood sugar, large waist size, high triglycerides and low (good) cholesterol.

"I do not want to disengage with my life to engage with my health…you want me, find a way to weave it into my life.“ ~ Quote from 2010 Health 2.0 Conference

As I viewed an in-depth demo of Aetna’s new social solution, I immediately noticed the unique approach they are taking with the Mindbloom platform.

My Tree

Mindbloom uses a tree metaphor to represent the different areas or branches of a person’s life. Let me share my thinking as I envision “My Tree”.

I am empowered to design my tree with branches that are important to me; health, relationships, lifestyle, leisure, finances, spirituality, creativity and career.

As I identify and complete an action of my choice, a new green leaf appears on the related branch. For my health, I may decide to add my own action to “complete my dance class this week”.  When I overlook an area of my life, over time my leaves turn brown on that branch.

There are other trees from friends and family that I have invited to join my forest. I control what each of them sees. My closest friends and family view each leaf and can comment to acknowledge my accomplishments and support me when there are setbacks.

As I grow my tree, I strive for balance. I begin with a few branches and get them strong before adding others. In time, I envision having a vibrant tree.

When completing actions, I receive rewards that unlock new features including the option to select a new forest background or the ability to upload my own photos for inspiration. 

Through my mobile phone, I can update my actions, journal my progress, view my friends' progress and send messages for encouragement. This lets me “grow on the go”.  Beyond the existing mobile web capabilities, Mindbloom will be launching a much more robust native iPhone application in the fall timeframe. 

“People will not track every day” explains Kyra Bobinet, Medical Director eHealth & Wellness at Aetna. “This tool is a repository where they will come in and out. We will give consumers reasons and stimuli to continue their journey for a healthy balance”.

Elements of Engagement

Although I have seen many health related games, this one is customized, comprehensive and compelling.

Here are five elements to drive consumer engagement:

1) Personal. My tree looks different than yours. It has specific branches and leaves that are important to me.

2) Holistic. I extend my tree with branches from different aspects of my life beyond health. In fact, the growth of one branch influences another. When my health branch is under stress, my relationship branch is impacted.

3) Social. My forest has trees representing my friends and family. We are all there to support and strengthen each other. This forest is changing all the time and I am drawn back to take a look.

4) Rewarding.  As I reach new milestones or succeed in maintaining a healthy balance, I am rewarded in many ways. In addition to feeling better, I receive points as well as recognition through my private forest and public social communities (e.g. Facebook). And I am also rewarded seeing my “Tree Summary” displaying my accomplishments.

5) Fun. Like any interactive game that keeps my attention, this one is full of surprises. My points take me to new levels which reveal new opportunities for growth.

Engagement By Design

Before designing this solution, Aetna conducted extensive research with consumers. They learned that consumers want Aetna to make it “more fun”, “easier” and “rewarding”.

I am most interested in seeing how engagement grows and which segments of consumers are motivated to develop and nurture a balanced tree of life.

Disclosure: I worked with the Aetna team on concepts before the Mindbloom partnership.

While attending health care conferences, I often hear presenters describe their pilot programs and share what they have learned from new and expanded engagement initiatives delivered through online (social communities, social media, portal), mobile phone, telephone or email channels.

Many companies are in the “experimentation” phase. They are determined to discover the effectiveness of each channel in generating consumer awareness, interest and participation in their health and wellness.

When discussing their channel plans, I tend to hear companies say “once we have learned about how the channel can be leveraged, we will be ‘operationlizing’ it into our programs”.

During my conference panel last week on multi-channel engagement, I emphasized the importance of incorporating an interim phase to “Consumerize” the channel strategy before moving into the operations phase.

“Consumerizing” entails understanding the needs of each priority consumer group or segment (e.g. adult patients with diabetes, children with asthma) and determining how mobile for example can be utilized with other channels to meet their needs.  Specifically, companies need to determine the “role” that each channel plays such as enable access, educate, motivate, guide decision making, deliver emotional support or help with care collaboration.

With a clear understanding about the set of channels and how each one brings value to the consumer segment, providers/plans/employers can effectively orchestrate consumer engagement for maximum results.

Channel Challenges

This is not easy to do.  Channels are converging. For instance, consumers are using their desktop to upload pictures into a  social community and then getting messages on their mobile from the community.  They are receiving an email with a link into the online portal for their lab test results. Consumers are viewing mobile messages about preventative care with an option to click to connect for appointment scheduling.

With this convergence, the channels are becoming intertwined and integrated which brings complexity to planning, implementing and evaluating channel initiatives.

• Channel Planning:  Many organizations have separate committees for each channel (e.g. mobile, online/social media) planning their own strategy. Instead of looking at one channel, organizations need to take a more strategic and holistic view by starting with a consumer segment and understanding their channel preferences and behaviors in order to define the role that each channel can play in meeting their needs.
• Channel Implementation: Companies tend to spend more time thinking through the internal processes for sending content over these channels and not enough time thinking about how the consumer receives and interacts with it. They need to consider the information that is presented and captured within each channel and how it is shared across channels. All channels must be connected and synchronized to deliver the best consumer experience.
• Channel Evaluation: Although many organizations are still looking at engagement one channel or campaign at a time, it is essential to evaluate the effectiveness of the channel at the consumer segment level. Each channel needs to be evaluated based on the role it was designed to play for that specific segment.

Consumer- Centric Channel Strategy

Companies outside of the health care industry have a big head start. They have an established consumer segmentation approach. Consumer centric businesses in the financial services and hospitality industries are overlaying their channels onto their segmentation to deliver a relevant and meaningful consumer experience. These companies are also focused on driving consumer engagement. A colleague at a large financial services firm told me about the “O2O” trend and how they are focusing on optimizing the “online to offline” experience (e.g. using targeted social media to drive card members to an event).

There is so much that health care organizations can learn and they are beginning to look outside of the industry for new strategies.  Health care companies are starting to realize the powerful role that new channels and approaches can play in motivating consumers to take on more responsibility in managing their health and wellness. 

While many companies are busy putting new online health resources and tools in place, Zeo is laying out the path to engage and empower consumers through social and mobile technologies and personalized information and education.

Zeo’s sleep management solution helps consumers get better sleep by providing a view into their own sleep behavior, delivering expert education and leveraging the wisdom of the crowds. Sleep is not a ‘nice to have’. Sleep is a ‘need to have’. Studies have shown the link between sleep deprivation and its impact on productivity and health problems such as obesity and high blood pressure.

How is Zeo designing their data driven path to attract and engage consumers?  

Awareness

In collaboration with Julien Smith, NY Times best seller author, Zeo has developed and distributed the “Sleep is Awesome” infographic to wake up the world to benefits of getting more sleep. The graphic is informative since it has facts about problems associated with sleep and shows how sleep varies by age group and gender.  Zeo is spreading awareness about sleep virally across personal networks through Twitter and Facebook.

Education  

Through the Zeo Product. I had an opportunity to try the Zeo sleep monitoring system. When I took the clock display out of the box, I remember thinking that I already have an alarm clock so why do I need another one?  A few days later, I could not wait to bounce out of bed and seem my ZQ score (e.g. quality and quantity of my sleep) and how long it took for me to fall asleep. After reading an article on  “7 Sleep Stealers”,  I made improvements to my sleep environment to move my ZQ score up and time to sleep down. Zeo has also built their sleep coaching platform (see the blog visual) on these 7 steps to sleep fitness and recommends personalized education based on my profile.

Through Social Community. Zeo has recently launched their community which is currently in “forum” mode.  The forum participants have a strong motivation to learn how to manage their sleep. Some are experimenting with the use of napping in place of or in addition to their current night sleep. Others are sharing strategies for maximizing their deep sleep. Zeo will be bringing in sleep experts to further educate the community.  

Through Mobile. Last Spring, Zeo launched the first version MYZeo iPhone app which displays ZQ score charts, a daily night graph and a Personal sleep trend report showing changes in sleep patterns. Zeo is planning mobile enhancements to help consumers make better lifestyle decisions throughout the day in order to sleep better at night.

Insight

In November, Zeo partnered with Digifit which has health and fitness tracking with heart rate monitoring and Withings with their digital scale. With this partnership, sleep data, exercise data and weight data are brought together at the individual level through a “Dashboard of Healthy Living” SM .

Zeo is partnering with consumer- centric health sites such as DailyBurn to bring consumers their own aggregated data.

This is an emerging opportunity. Think about how other stakeholders can benefit. What if health coaches and clinicians could get a more holistic view into the consumer's activities of daily living and use this information to guide and engage the consumer?

Imagine how self- management tools can enable the consumer to interact with their aggregated data to support health decisions, set goals and manage their health.

There is tremendous value in health and wellness information that is aggregated and accessible by consumers and the many stakeholders that are supporting them.

Have you seen my post on “Follow the Value Brick Road” with the benefits of playing the aggregator role with all this consumer data?