Engaging Employees with Chronic Conditions Improves Health Outcomes

Using multiple communication channels, personalized messages, promotes healthier behaviors

By Stephen Miller, CEBS Jul 14, 2016
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Five health-related behaviors ward off chronic diseases, according to the Centers for Disease Control and Prevention. Most adults say they manage only two or three. The use of multiple communication channels by wellness programs can improve that score.

According to one recent survey, 44 percent of consumers enrolled in wellness programs report having a diagnosed chronic condition. However, just 14 percent of program participants say that their employer's wellness program is helping them to better manage their disease.

The survey, fielded in May and sponsored by Dallas-based HealthMine, a provider of wellness IT platforms, received responses from 750 insured employees currently enrolled in an employer's wellness program.

Adults in wellness programs suffer from a range of chronic conditions.

Chronic Conditions in Wellness Populations
Condition Percent
Heart disease30%
Diabetes/prediabetes29%
Chronic neck, back, shoulder pain23%
Obesity23%
Mental illness18%
Autoimmune disease13%
Poor oral health12%
Eye disorder11%
Other11%
Cancer10%
Eating disorder8%
Alzheimers/dementia8%
Pulmonary disease8%
Osteoporosis7%
Source: HealthMine

Despite this high incidence of disease:

  • Only 29 percent of respondents report that their wellness program offers a disease management program.

  • 11 percent say they participate in disease management through their wellness program.

"Health plans and wellness programs need to guide each member on health actions," said Bryce Williams, CEO and president of HealthMine. "Programs that do that can provide an early warning system for members, helping them take action before it is too late. Avoiding diabetes for just one person saves a health plan more than $11,000 per year. Of course, the real bonus is that the member leads a healthier life."

Five Key Behaviors

How important is encouraging healthy behaviors? Five key health-related behaviors ward off heart disease, cancer and other chronic diseases, according to research findings reported in May by the federal Centers for Disease Control and Prevention (CDC). Only 6 percent of U.S. adults practice all five.

The five behaviors shown to have the greatest impact on preventing disease are:

1. Not smoking.
2. Exercising regularly.
3. Drinking in moderation, or not at all.
4. Keeping at a healthy weight (within the range of recommended body-mass index).
5. Getting at least seven hours of sleep a night.

Most adults say they manage only two or three of these practices.

"Additional efforts are needed to increase the proportion of the population that engages in all five health-related behaviors and to eliminate geographic variation," the CDC research team wrote. "Collaborative efforts in health care systems, communities, worksites and schools can promote all five behaviors and produce population-wide changes, especially among the socioeconomically disadvantaged."

Texting and Other Channels

One way to encourage health behaviors, especially among those living with chronic conditions or most at risk for developing them, is by sending text messages promoting healthy behaviors and compliance with medication. A study published last September in the Journal of the American Medical Association found evidence suggesting text messages help patients to improve their health and make needed changes to their routines.

For example, patients receiving texts were more likely to be active and to quit smoking.

But the use of multiple communications channels is also shown to effectively nudge employees toward healthier behaviors. Based on interactions from the past 13 years, Burlington, Mass.-based Silverlink, a health communications firm and part of Welltok Inc., found that diabetes-care behaviors were improved by 20 to 25 percent with multichannel strategies (such as information provided via phone and mail) versus single-channel communications.

Many plans use traditional mailed communications to ask members to close gaps in their diabetes care, for instance by reminding them they need to get their lab work done, or that it's time for an eye exam—diabetes being a leading cause of blindness—explained Kathleen Ellmore, vice president of engagement sciences at Silverlink. But adding tailored calls that personalize messaging around specific care needs "increased the number of members who closed gaps," she said.

Using an automated call instead of mail as a "second touch" reminder also saved costs "because postage and printing almost always cost significantly more than automated calls to the same size population."

For a multichannel communications strategy to be effective, Ellmore recommended these steps:

  • Ask consumers their communications preferences. Starting with their preferred channel when possible increases the chance of reaching the individual and also creates a better member experience. But keep the option of stepping outside of their preferences to try and engage them in different ways that may prove to be more effective.

  • Identify the health goals you are trying to drive and match them with the channel that fit best. For instance, use texts for sending quick, short health messages to help members manage their chronic conditions. A program for a Medicaid population that delivered a weekly text messages to help members manage their asthma and diabetes had over 80 percent of enrolled members stay involved for the entire length of the program (1 year).

  • Tailor the sequence of the messages depending on the action you want consumers to take. If you want them to click through to a portal, you might call first to let them know you will be sending them information via e-mail. If you are asking consumers to speak with an agent, you might use an automated call for easy transfer.

  • When possible, capture members' communication histories. Understanding what was successful in engaging members in the past can indicate what will be successful in the future.
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