The Yin and Yang of Incentives

The lure of free money is hard to resist. That’s the thinking behind the growing popularity of incentives for participation in wellness and health management programs. The approach is logical, which is why over half of U.S. respondents to a recent survey currently provide financial rewards for participation in health management programs, and fully 80 percent plan to do so this year.¹

In an effort to translate the investment made in incentives — $375 annually per employee on average² — into measurable health improvement, employers are moving toward outcome-based incentives (and disincentives). This shift gained momentum following healthcare reform changes that authorized the use of incentives contingent on “satisfying a standard that is related to a health status factor.” The idea is to reward (or penalize) employees who meet (or fail to meet) goals for healthy ranges of various physical metrics such as body mass index, blood pressure, physical activity or biometric measures.

But here’s the hitch. Financial incentives sound good in theory, but there is no clear evidence that they alone motivate sustainable behavior change.

“The effectiveness of outcome-based wellness incentives is uncertain, and their use raises concerns about distributional equity; nevertheless, these approaches are gaining momentum because of rising health care costs and payers’ belief that incentives should work in health care as they do in other spheres.”³

When it comes to health behaviors, people are human. The decisions we make are not always logical. What’s more, health status is a complex product of lifestyle choices, physiological and genetic components. People start from different places in health status; if the outcome goal is viewed as unachievable, those who could benefit the most from health improvement may not engage, even if they initially participate to get the cash incentive (there’s a difference between engagement and participation).

We know from behavioral economists that people place more priority on the present (the immediate gratification of overeating, for example) than the future (the risk of gaining weight). It’s not logical, but it is reality. It’s also why financial incentives alone don’t achieve long-term behavior change.

By applying the lessons learned from behavioral economics, we can improve incentive program design. Employers should resist putting all of their incentive “eggs” in an outcome-based basket. Rather you should consider a balanced strategy that integrates extrinsic rewards and intrinsic enticements. A successful incentive strategy should start with the end in mind and be focused to achieve three primary goals:

This holistic framework considers the duality of how people make decisions and provides both tangible and intangible incentives to achieve multiple program goals. Extrinsic rewards such as cash, gift cards, prizes and discounts appeal to the emotional need for immediate gratification. Intrinsic enticement such as peer support in a walking club, working with a health coach to set and achieve health goals, friendly competitions, or recognition in a company newsletter appeal to psycho-social needs to be accepted.

At Nurtur, we believe that a strategic incentive program is a cornerstone to any effective and successful wellness initiative. At the same time, we understand the business imperative to demonstrate value. To learn more about Nurtur’s approach to incentive design, call us at 800 293 0056 or email us.

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1. Towers Watson and National Business Group on Health, 2011/2012 Staying@Work(TM) Survey Report, Pathway to Health and Productivity

2. ShapeUp, Inc., Social vs. Financial Incentives, 2012

3. Kevin G. Volpp, M.D., Ph.D., David A. Asch, M.D., M.B.A., Robert Galvin, M.D., M.B.A., and George Loewenstein, Ph.D, Redesigning Employee Health Incentives — Lessons from Behavioral Economics, New England Journal of Medicine, August 4, 2011.

Engagement is a two-way street

There are two sides to every conversation. First, there is a person with something to say. Second there needs to be a person who is willing and able to hear and respond. In this way, engagement is a two-way street. It requires that both people be actively involved in moving the discussion.

Optimal engagement is give and take, back and forth. It’s the difference between “talking at you” and “talking with you.” When it only goes one way, it’s impersonal and leads to a dead end.

The way to tell if optimal engagement has occurred in wellness is if a closed-loop communication exists and a personal connection has been made. This is more than submitting an online HRA, which is a one-way communication. Optimal engagement requires communication that goes both ways and establishes a relationship, such as a telephone conversation to follow up HRA results, an email string in response to a member question, or a reply to a mail correspondence.

If an employee doesn’t respond to an offer to engage, it could be because they don’t feel the offer is relevant, or they may feel they don’t have the ability to respond because of barriers that exist in their life. In either case, engagement can’t happen. It’s that simple.

So what’s the secret to breaking through the resistance and achieving optimal engagement? First, provide an offer that is relevant and compelling. This starts by understanding that health and wellness are innately personal. People are guided in the decisions they make as much, if not more, by emotion than by logic or reason. The most effective communications need to connect with people at an emotional level.

Once you’ve provided a compelling emotional offer, the next step to optimal engagement is to create opportunities that make it easy for people to initiate a dialog.

The traditional interface of an EAP and work-life resources offers a perfect opportunity to be a welcoming front door for engagement. This familiar and trusted channel can create a frictionless on-ramp to build personal connection.

People are human and real life happens – children with day care or school issues, caring for elderly parents, mortgage payments and college tuition bills that need to be paid, juggling work, family and other priorities. All of this stress and more creates the “traffic noise” that prevents people from responding to an offer to engage. EAPs break through the noise by talking to people directly and helping them with the real life issues that get in the way of engaging in wellness. Communications that rely exclusively on electronic messages and automated response systems may be more efficient but not more effective.

Meaningful participation in health and wellness can only occur when people have truly engaged. Half measures won’t provide sustainable results.

Nurtur has long believed the way to health is through life. It is the basis of our strategic vision of Nurtur PeopleCare™. We recognize that people are human and that every individual should be treated as a person. To learn more about optimal engagement strategies and our integrated approach with EAP and work-life, call us at 800 293 0056 0r email us.

Accreditation Demonstrates Nurtur as a Best-in-Class Provider of Health and Wellness Programs that Meet the Nation’s Highest Standards for Value and Quality

Farmington, Conn. – Nurtur, the behavior change company serving multiple market segments, today announced that it has received two-year Wellness and Health Promotion (WHP) Accreditation from the National Committee for Quality Assurance (NCQA) for its wellness and health promotion programs. Additionally Nurtur received renewed three-year Disease Management Accreditation for its coronary artery disease, diabetes, heart failure, asthma and chronic obstructive pulmonary disease (COPD) programs. Accreditation status is awarded to organizations that have excellent programs that meet or exceed NCQA’s rigorous standards.

NCQA Accreditation is a voluntary review process. Its standards are designed to encourage organizations to continuously enhance the quality of their programs and allow employers to make informed comparisons.

WHP Accreditation comprehensively evaluates key areas of health promotion, including how wellness programs are implemented in the workplace, how services such as health coaching are provided to help eligible individuals develop skills to make healthy choices and how sensitive health information of eligible individuals is properly safeguarded. NCQA is one of the industry’s highest accrediting bodies and no other comparable evaluation exists for wellness and health promotion programs.

“Nurtur is proud to earn NCQA Accreditation for Wellness and Health Promotion. We are committed to delivering the highest value to our clients by helping members to achieve healthy behavior change,” says Daniel Cave, President and CEO of Nurtur. “Participating in the extremely rigorous NCQA review successfully demonstrates the value of our programs.”

WHP Accreditation includes on-site and off-site evaluations of 12 standards:

• Employer and Plan Sponsor Engagement
• Privacy and Confidentiality
• Engaging the Population
• Health Appraisal
• Identification and Targeting
• Self-Management Tools
• Health Coaching
• Rights and Responsibilities
• Measuring Effectiveness
• Delegation
• Incentives Management
• Reporting Wellness and Health Promotion Performance

“NCQA’s Wellness & Health Promotion Accreditation requires organizations to demonstrate their compliance with well-defined standards and quality measures, said Margaret E. O’Kane, NCQA President. “The NCQA seal will provide employers and consumers with the information they need to choose the best program in their markets.”

About Nurtur: Nurtur is the behavior change company dedicated to helping individuals improve their health and wellbeing. The company offers wellness programs and health coaching to educate, enable and motivate people at all life stages address the life issues that get in the way of health, as well as the health issues that complicate living. Nurtur life and health management programs include wellness, disease management (including Back Pain, Depression, Diabetes, Heart Disease and Asthma), episodic/catastrophic care management, work-life resource and referral, employee assistance and professional training. The company provides services to multiple market segments including employers, plan sponsors, Third-Party Administrators, commercial health plans and government agencies.

About NCQA: NCQA is a private, non-profit organization dedicated to improving healthcare quality. NCQA accredits and certifies a wide range of healthcare organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing healthcare quality information for consumers, purchasers, healthcare providers and researchers.

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Media Contact
Kristen Knappi
marketing@nurturhealth.com
20 Batterson Park Road
Farmington, CT 06032
800 293 0056
860 678 1600 fax
www.nurturhealth.com

Ask Your Clinical Pharmacist

In an ironic twist, one of the leading trends behind the decline in health status is the explosion in new healthcare technologies and treatments that have been developed to improve our health. While new therapies and medicines have improved care and mortality, it has created more choices for consumers already overwhelmed by the complexities of pharmacy benefits. And when people are confused about prescription drugs, it often leads to non-adherence.

There are more prescription medications on the market today for more conditions than ever before. The average adult fills about a dozen prescriptions every year, and seniors 65+ fill more than 30. If this weren’t enough to keep track of, consumers are also presented with a continuous stream of news and advertising about new drugs, generic alternatives, side effects and drug shortages. Top this off with changes in prescription benefits and economic pressures, and it’s no wonder as many as half of consumers often don’t take medicines as prescribed.

Clinical Pharmacy is a healthcare discipline that has emerged to help fill the adherence gap. It blends the specialty knowledge of a pharmacist with the caring insight of a clinician. Part educator and part coach, the new role of Clinical Pharmacist is an essential component of the Nurtur multi-disciplinary coaching model.

Click to enlarge image.

The primary responsibility of Nurtur’s Clinical Pharmacist is to research, generate, disseminate and apply new knowledge about drug therapy to improve the health and quality of life for members. An on-call resource for our health coaches, the Clinical Pharmacist also develops criteria to conduct drug utilization reviews.*** Beyond this, the role also includes working with our Clinical Informatics and Quality Assurance teams to maintain and update medication databases, identify gaps in care, and ensure adherence to evidence-based guidelines.

At Nurtur, we believe having a Clinical Pharmacist as part of our multi-disciplinary coaching team is just good medicine. To learn more about Nurtur’s approach to Clinical Pharmacy and our multi-disciplinary coaching team, call us at 800 293 0056 or email us.

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*Kaiser Family Foundation, Prescription Drug Trends, May 2010.
** New England Healthcare Institute (NEHI), Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease.
***Drug Utilization Review programs help to ensure that prescriptions for outpatient drugs are appropriate, medically necessary, and not likely to result in adverse medical consequences.

2 Faces or a Vase?

Perspective is everything. Depending on your lens, a glass can be half full or half empty. In the same way, gaps in care can be seen as lapses in healthcare delivery or as opportunities to engage. The latter view considers each instance of a missing claim or questionable lab result to be an opening to start a conversation.

Gaps in care (GIC) is a broad term that encompasses any and all instances in an individual’s health profile where compliance with, access to or utilization of evidence-based treatment fell short. The purpose of GIC programs is to identify where gaps exist based on eligibility demographics, medical and pharmacy claims, and lab result data. That knowledge is then used to provide meaningful and timely interventions. It is a population-based service to benefit those with chronic conditions and also those who are well.

Thanks to advanced analytic technologies, it is now possible to create GIC data infrastructures to enable more effective identification and communication with individual members. Best practice predictive modeling calculates health risk scores in four areas to identify, stratify and profile individuals who could most benefit from proactive intervention based on evidence-based rules and algorithms:

1. Risk Profiling: View individual-centric profiles and forecasted expenditures based on available data inputs — eligibility, medical claims, pharmacy claims, and lab results.
2. Opportunity Identification: Predict risk accurately for time horizons as short as three months facilitating early engagement and intervention.
3. Gaps in Care: Review a participant’s compliance with evidence-based and clinically accepted guidelines.
4. Individual Profiling: Access a single, unified profile of a participant’s historical and predicted health.

By evaluating scores generated at a condition-specific level for stratification, individuals can be assigned into risk categories based on their individual disease burden.  This facilitates the segmentation of the population based on the opportunity to intervene.

The data management challenge of finding and filling gaps in care is the Holy Grail of health management. Data at the individual level is rife with mixed signals such as false-positives and omissions. For example, the presence of a cardiac stress test claim identifies an individual as a candidate even though the test result may have been negative. On the other hand, the absence of a medical claim for a flu shot identifies a gap when the individual may have gotten a shot from a provider that doesn’t submit it as a claim, such as a pharmacy. To ensure no one falls through the cracks, it is essential for GIC programs to cast the widest possible net.

Once identified, all gaps are opportunities that can be acted on through written and telephonic outreach communication and health coaching. Coaches are able talk with participants to explain what the gaps mean and support scheduling appointments with their physicians. Coaches also are resources to guide participants regarding appropriate conversations with their physicians and also to facilitate peer-to-peer discussions between physicians and medical directors. In this way, every gap is leveraged as a teachable moment to engage people in being actively aware of their health.

The goal of any effective health management or wellness program should be to ensure that every participant achieves positive health outcomes through adherence with recommended treatment plans and evidence-based guidelines. To learn more about Nurtur’s approach to gaps in care and the power of matching analytical insights with health coaching, call us at 800 293 0056 or email us.

What makes a great wellness champion?

The job of wellness champions is to encourage a culture of health through leadership, enthusiasm and camaraderie. They are go-to resources for co-workers to answer questions, provide information and promote the benefits of actively engaging in your organization’s wellness program.

Wellness champions gladly participate in program planning, assist with promotion within their work unit or location, organize on-site events and coordinate activities. They are also there with a shoulder to lean on, a pat on the back or a kick in the pants to support their co-workers when they need it.

Like any job, being a wellness champion requires certain skills and character traits for people to be successful in the role. Here are seven qualities to help you identify the best candidates in your organization:

1. Passionate about health and wellness but not fanatical. Someone who models desired behaviors but doesn’t judge those who are just starting on the path to wellness. Not every champion on your wellness team should be a marathon runner or drill sergeant, though calisthenics may sometimes be required.
2. Confident and credible. Someone who co-workers look to and trust. In order for employees to buy-in to a wellness program, they need to have a familiar person they can turn to. This means that your wellness team should include champions throughout the company from hourly workers to senior executives, men and women, old and young.
3. Friendly and approachable with a positive attitude. Someone who inspires and encourages others with contagious enthusiasm. These are the natural leaders in any organization. Outgoing people with a sense of humor.
4. Effective communicator and good listener. Someone who can impart information about the program and provide feedback. A key role of a wellness champion is to advocate for policies and initiatives that enhance the wellness program for their team or unit. For example, offering suggestions for healthy options in vending machines or sponsoring on-site classes.
5. Walks the talk. Someone who practices what he or she preaches and leads by example. It is important to have people with diverse health status on your wellness team. Having champions who walk different paths to wellness ensures that every employee will have someone to follow.
6. Caring and committed to the goals of wellness. Someone who is empathetic and truly believes in the benefits of the wellness program. A great wellness champion takes their job seriously and makes herself/himself available to help others achieve healthier lifestyles.
7. A team player. Someone who recognizes that building a culture of wellness requires getting everyone on board. Being a good teammate requires the ability to contribute to the overall performance of the team.

Once you have identified potential wellness champions, be sure to give them the tools and resources they need to succeed in their new roles. First, provide clear expectations about responsibilities, time commitments, training, etc. Ensure the wellness champion knows the importance of the role and that it is not a “if you have time” request. Depending on your organizational commitment to wellness, consider writing wellness champion responsibilities into job descriptions.

Second, create a wellness program manual with contact information for everyone involved with the wellness program, program details, benchmark goals, incentives offered, frequently asked questions, quick reference guide and meeting schedule.

The beginning of a new year is a perfect opportunity to renew your commitment to wellness. To learn more about recruiting wellness champions and worksite wellness programs,  call us at 800 293 0056 or email us.

Moves in the Right Direction

As 2011 comes to a close, there are positive signs that we’re on our way to achieving a healthier society…

• More employers get moving with wellness. Employer wellness programs are well beyond the tipping point with 90% of employers1 offering at least one specified wellness program2. And with 2011 health reform provisions beginning to take effect, more small employers are looking to add wellness programs to their benefits mix. From walking clubs and gym memberships to smoking cessation programs and health coaching, companies have come to recognize that building a culture of health is not just good for the waistline but also for the bottom line.
• New cigarette warning labels get graphic. In June, the FDA introduced new requirements for larger, more prominent health warnings that must appear on all cigarette packaging and advertising in the U.S. The labels include nine different messages and full color images designed to remind consumers of the negative health consequences of smoking cigarettes.
• MyPlate dishes up clear portion sizes. The USDA gave new meaning to the old food pyramid with the introduction of MyPlate.  Served up in July, it is a simple, clear-language illustration that shows what a balanced healthy diet looks like and puts portion sizes in perspective. Overcoming health literacy is a primary obstacle in the effort to combat obesity. As a centerpiece in public health campaigns, MyPlate is an easy-to-understand tool to help people eat and live healthier.
• Social networks enable more connections and stronger engagement. Who knew that going viral would be a good thing for healthcare? According to the Pew Internet & American Life Project , 78% of Americans are online. When they are, 80% of internet users look online for health information, and 65% of internet users regularly use a social network. The growing prevalence, and relevance, of cyber connections in our daily lives is fundamentally transforming how those in the healthcare industry can communicate and engage individuals to take personal accountability for health.

What’s the common denominator here? Collectively, these individual milestones are evidence of the growing wellness movement. They also are leading indicators of changing attitudes in public health, consumerism and personal accountability.

At Nurtur, we’re dedicated to helping people change behavior and transform their lives by taking personal accountability for their health. As a company, our strategic framework is built around core values that are central to fostering a cohesive organizational culture and encouraging consistent individual behaviors.

This holiday season, take time to celebrate the joy of good health and good life.

To learn more, download our perspective on health, behavior change and personal accountability at www.nurturbehaviorchange.com or call us at 800 293 0056.

1. Employers with 200 or more employees.
2. Source: Kaiser Family Foundation and Health Research Educational Trust, Employer Health Benefits 2011 Annual Survey.

]]> http://www.nurturhealth.com/journey/?feed=rss2&p=847 0 http://www.nurturhealth.com/journey/?p=937 http://www.nurturhealth.com/journey/?p=937#comments Thu, 01 Dec 2011 20:41:54 +0000 Nurtur Health, Inc. http://www.nurturhealth.com/journey/?p=937 PRESS RELEASE

Programs include Diabetes, Coronary Artery Disease (CAD), Heart Failure, Asthma and Chronic Obstructive Pulmonary Disease (COPD)

Farmington, Conn. – Nurtur®, the wellness behavior change company serving employers, plan sponsors, health plans and government programs, announced today that it has been selected by the State of Louisiana Office of Group Benefits (OGB) to provide integrated disease management services to state employees. OGB is an agency of the state of Louisiana authorized to provide health and other benefits to both active and retired state employees and their dependents.

Approximately 180,000 beneficiaries are eligible under the contract, which includes employees, pre-65 retirees, spouses and dependents. Services for these members are expected to begin January 1, 2012. “Nurtur is honored to be selected by the State of Louisiana Office of Group Benefits,” said Dan Cave, Nurtur President and CEO. “Our purpose at Nurtur is to improve the health and productivity of our members through proven and innovative Nurtur PeopleCare™ coaching services that educate, enable and motivate them to achieve their maximum human potential.”

Nurtur has been a leading innovator in health management services since pioneering the disease management industry in the mid-1990s. In the ensuing years, Nurtur’s programs have been offered to millions of Americans, ranging from employees of some of the nation’s largest and most well-known corporations to Medicaid and special needs governmental programs throughout the country. Nurtur’s clients include health plans, unions, third party claims administrators (TPAs) and nationally known employers covering over 2.5 million eligible lives.

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Media Contact
Jennifer Funaro
marketing@nurturhealth.com
20 Batterson Park Road
Farmington, CT 06032
800 293 0056
860 678 1600 fax
www.nurturhealth.com

Living Color Health and Wellness communications campaign and Nurtur’s disease management participant newsletter recognized for logo design, consumer focus, and quality health content

Farmington, Conn. – Nurtur®, the wellness behavior change company serving employers, plan sponsors, health plans and government programs, was selected as a winner in three categories in the 18th annual National Health Information Awards™. This program recognizes the nation’s best consumer health information programs and materials.

Nurtur was recognized with a bronze award for the Living Color Health and Wellness communications campaign developed for a national media production technology company. In addition, Nurtur received a merit award for the Living Color logo design and a bronze award for its TransFormations newsletter, which is sent to Nurtur’s disease management program participants.

Living Color is based on the Nurtur Good Health communications campaign. It is a unique brand identity and promotional campaign that applies the principles of consumer marketing to inspire engagement and motivate behavior change by connecting people with positive emotional destinations. The Living Color logo and brand is distinctive to reflect the unique company culture. It is designed to engage and motivate employees to actively participate in the company’s new Health & Wellness program and encourage healthy behaviors and overall wellness. The campaign components included program identity, promotional posters and email messages, a welcome kit, e-health website portal, printed materials and premium items, and health coaching materials to introduce employees to lifestyle and disease management programs.

“Strong, effective communications are essential to the success of any workplace wellness program,” said Jennifer Funaro, Director of Marketing and Communications. “We love working with our customers to capture the spirit and culture of their organizations in our communication design work, and are proud to support their efforts to build cultures of health. It is an honor for Nurtur – and by extension, our customers – to be recognized by the National Health Information Awards with these awards.”

The awards program is coordinated by the Health Information Resource Center, a national clearinghouse for consumer health information programs and materials. It is the most competitive award program of its kind. According to Patricia Henze, Executive Director of the Health Information Resource Center, “These awards set an industry standard of quality for consumer health materials, and this ‘seal of quality’ helps health professionals find the best consumer health information resources for their programs.”

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Media Contact
Jennifer Funaro
marketing@nurturhealth.com
20 Batterson Park Road
Farmington, CT 06032
800 293 0056
860 678 1600 fax
www.nurturhealth.com

From Mad Men to Smoking Bans

To consider how far we’ve come in changing behavior when it comes to smoking, just watch an episode of Mad Men, the Emmy-winning television series that authentically depicts the life of advertising businessmen in the 1960’s. Nearly every actor on the popular program smokes – in the office, at home, in cars and on airplanes. That was life in America before smoking bans.

As a country, our attitude about smoking has changed since the first Great American Smokeout in 1977. What was once socially acceptable is increasingly shunned. Just look at the new cigarette warning labels introduced by the FDA earlier this year.

We have changed our tolerance for second-hand smoke, and even third-hand smoke, because of the dedicated efforts over time by those committed to social change. It didn’t happen overnight.

Timeline from the Great American Smokeout

“Those are just a few of the remarkable changes in the age-old acceptance of smoking as our cultural norm. What we have been doing can be characterized as the denormalization of smoking as an acceptable behavior, and positioning it for what it actually is – a killer of nearly half a million Americans every year.” said Dileep G. Bal, MD, MS, MPH, national president of the American Cancer Society.*

The approach of leveraging public health campaigns to change behavior works. We can take the same approach to change our tolerance for other unhealthy behaviors, like over-eating. The culprit behind rising obesity rates is less about physical health and more about behaviors and societal influences. The good news is that it’s already started with more workplaces adopting wellness programs to support healthy lifestyles.

Nurtur is dedicated to helping people change behavior and transform their lives by taking personal accountability. To learn more, download our perspective on health, behavior change and personal accountability at www.nurturbehaviorchange.com or call us at 800 293 0056.

We have changed our tolerance for second-hand smoke, and even third-hand smoke, because of the dedicated efforts over time by those committed to social change. It didn’t happen overnight.

Sources: * www.cancer.org / ** www.smokingstatistics.org