In the US health care market, factors are converging to shape a general trend toward consumer-directed health care. However, these types of initiatives require a certain level of employee engagement, which can be difficult to garner.

Could the key to driving employee behavior change for the sake of better health outcomes lie in centuries-old philosophical theory? The theory of social contracts may be the best way to motivate your employee base in taking ownership of their health care.

How important are incentives when it comes to encouraging healthy behaviors?

As any HR practitioner knows firsthand, getting employees to engage with their health benefits can be an uphill battle due to the complexity of the health care system and general lack of employee education.

As such, providing incentives has been shown to be instrumental in increasing employee engagement. Employers must look for opportunities to continually engage and drive the behavior of their workforce through action-forcing events, with tools like incentives. These incentives must be personalized and relevant to each individual. For some, it may be hitting 10,000 steps on their Fitbit, while others would like to see a decrease in their cholesterol levels.

Sometimes when it comes to health and fitness, social contracts are often more motivating than other incentives like rewards. For instance, are you more likely to stick to a workout class because you've committed to going with a friend, or if you're going to hit your Fitbit daily step goal? The theory of social contracts tells us that most people in this situation are likely to be motivated primarily by the promise made to their friend, and this is a theory that employers can utilize when it comes to their employee health and benefits programs.

How do social contracts fit into the broader health care incentives landscape?

To get philosophical for a moment, our entire society is, in some part, built upon the theory of social contracts, which states that a person's moral and/or political obligations are dependent upon implied agreements among groups to which they belong.

So, if social contracts can function as the ideological glue that holds a society together, why can't they do the same for a successful benefits strategy? Application of this theory would imply that an employee commits to improving or maintaining their health not only for their own benefit, but also for the benefit of the greater good and their stakeholder status within the population.

The key to this strategy is putting time, energy and attention into building a benefits program that is personalized and omnipresent. While owning the open enrollment process is crucial, if the employer does not develop a year-round relationship with the employee in regard to health and benefits, the center will not hold.

It's all about sustained, personalized and above all, truly helpful outreach and education. This creates a relationship dynamic which motivates both parties to uphold their end of the bargain—cutting health care costs while identifying and working towards each person's definition of “healthy.”

In short, personalized outreach can increase engagement with health and benefits and motivate healthier behavior choices, creating a happier, healthier and ultimately more productive employee base.

What steps can organizations take to implement a benefits engagement strategy that utilizes the theory of social contracts?

Taking full advantage of the open enrollment period is the first step. Employees already participate in open enrollment each year. However, most companies do not leverage this essentially captive audience to collect information that may help influence employee behavior, such as a person's preferred mode of communication.

Employers must recognize the inherent value of this open enrollment period as an opportunity to collect behavioral information and educate employee audiences to further engage populations. Theoretically speaking, this interaction during open enrollment is the start of the social contract. To build that relationship in a way that drives real change, employers must work with the employee, leveraging data to personalize health and benefits programs to the individual as much as possible.

By personalizing employees' health and benefits, they're more inclined to stick with their programs. By engaging with employees early and often, health, wellness and benefits stay front of mind in a positive way, as opposed to being thought of as a burden.

The goal for employers should be to become a second nature resource for the employee, and maybe even an extension of their personal care network, which would typically include only close friends and family.

What role should employers play when it comes to encouraging healthy behaviors?

It's generally believed that Americans spend at least a third of their adult lives at work. That implies a certain level of employer responsibility to create a healthy work environment as well as encourage healthy behavior outside of the office. It's common sense that healthy, happy people are better equipped to meet and exceed job expectations, therefore the employer truly is (and should consider itself) a major stakeholder in any employee's health and well-being.

For example, today millions of people are unknowingly walking around with pre-diabetes, and if employers correct that trend in their population before it becomes full-blown diabetes, they'll be able to avoid the expenses that would be tied to chronic condition management and avoid turnover and/or time out of the office by keeping their employee healthy and happy. However, being able to identify at-risk populations within an employee base is the key to this approach, which requires data. A self-funded benefits program gives employers better visibility and control over their health care spending data, allowing them to identify and address pain points before they become more costly.

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Nancy Reardon is Chief Strategy and Product Officer at Maestro Health.

Instant Insights /

Understanding social contracts and benefit engagement

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