In my meetings with benefit managers and consultants over the past few months, they have emphasized several wellness themes again and again. Making progress on these issues, they told me, will be among their top priorities for 2019.

Here's an overview of those priorities.

1. Measuring engagement.

Vendor A claims that its wellness coaching program engages 80 percent of employees on average, while Vendor B's engagement rate is 25 percent. Clearly, Vendor A's program is superior, right? Not necessarily. That's because an employer considering both options may essentially be comparing apples to oranges. For example, Vendor A includes mail contact, telephonic outreach and possibly enrollments in its definition of engagement, but Vendor B takes a more conservative approach by only measuring active two-way engagement with a coach or platform, or achieving behavioral goals.

Employers and vendors have been immersed in how to ramp up employee engagement in health and wellness programs, but not enough thought has gone into how to measure it and for which populations. Employers will push hard this year to define the term more precisely and to begin standardizing engagement measurement. This will allow them to create a consistent basis of comparison across vendors, products and performance.

Employers understand that all engagement is not equal. The amount of engagement required to drive value varies by product. There are also different levels of engagement—administrative (such as enrolling in a program, measuring how often a participant is in contact with her coach) and value-based, which is the degree of interaction required to achieve key health, behavioral or cost outcomes. I expect employers to increasingly demand more granularity regarding these issues.

2. Promoting health literacy.

Employers want their employees to be more savvy and confident when interacting with the health care system. Too many of the current solutions attempt to solve a specific issue in time, but don't help develop employee skills so that they can address the issue on their own in the future. In furtherance of those goals, employers will be asking vendors to incorporate simple terms and easy-to-use instructions in multimedia formats into their products and services.

Enhancing the workforce's health literacy is critical because it is a predictor of deeper patient engagement and better health outcomes. Conversely, low literacy drives high health costs through less use of preventive services, poor treatment plan compliance and more emergency room visits, hospitalizations and readmissions.

Unfortunately, health illiteracy has reached epic proportions in the U.S. According to the National Assessment of Adult Literacy, only 12 percent of adults have proficient health literacy – the skills needed to manage their health and prevent disease.

How can health literacy be improved? Some ideas: integrate organic opportunities for learning through video and chat with robust consumer tools such as plain language glossaries, cost estimators, telephonic and written reminders and alerts, provider quality ratings and written materials that are culturally and linguistically sensitive. Communications should also minimize the need for high-level numeracy skills.

3. Rethinking obesity.

Addressing obesity—a significant risk factor for chronic disease—will continue to be at the forefront of employers' health and wellness initiatives this year. Despite widespread efforts to manage obesity, adult obesity rates remain stubbornly high – 39.6 percent, the highest rate ever documented by the State of Obesity 2018 report by the Trust for America's Health and Robert Wood Johnson Foundation. Obesity costs our health care system $147 billion annually, according to the Centers for Disease Control.

While traditional solutions—providing healthy weight programs, promoting nutrition and offering incentives for physical activity—have achieved some success, employers view this challenge more broadly. They understand that, in addition to being a medical issue, obesity has social, psychological and environmental implications. Thus, employers will seek new approaches that leverage lessons from the public health sector as well as behavioral and nutritional science.

This strategy might include, for instance, subsidizing healthy food in corporate cafeterias, offering discounts for buying healthy foods at local supermarkets, educating employees about the connection among metabolics, nutrition and physical health, and offering mindfulness programs on moderate eating habits. This represents a shift to a wider social-cultural perspective in combination with established medical and behavioral interventions.

According to the Optum Wellness in the Workplace study, 56 percent of employers have already made changes to their physical work environment, such as providing healthier food in cafeterias and vending machines, on-site fitness centers, ergonomic programs and standing desks.

4. Personalizing the health experience.

Conditioned by the likes of Amazon, Netflix and other high-tech innovators to receive offers for goods and services tailored to their interests and needs, today's employees expect their experience with the health care system to be similarly personalized and relevant.

To be blunt, the industry can't continue to limp along on outdated data and analytics infrastructure. That's why employers are encouraging health plans and wellness vendors to leverage artificial intelligence to make that goal a reality. Advanced analytics, for example, can help health plans better understand employees and identify gaps in care, thereby enabling care managers and wellness coaches to provide support and resources that will have meaningful impact.

Providing that personalized experience requires the integration of all available data associated with a particular employee, including claims and clinical data, plus non-medical data such as engagement history, channel preference, psychographic needs and purchasing behaviors. Using AI and analytics, relevant, actionable offers can then be made to the employee.

Suppose, for example, the analytics indicates that a middle-aged male has diabetes, hasn't refilled his prescription medication, recently saw a doctor for back pain and has a high propensity to enroll in wellness programs. He might receive prioritized recommendations – based on clinical hierarchy and consumer behavior data – to provide a reminder to fill his prescription, an offer to join his health plan's healthy back program and a discount coupon to a local fitness center.

Ultimately, by applying smart data and analytics, the goal is to be able to predict which employees might develop diabetes or other common chronic conditions, thereby enabling early, relevant and personalized interventions.

Employers are realistic. While they don't expect all these priorities to be fully realized this year, they will push the industry to make considerable progress as part of their ongoing effort to keep their populations healthier and more productive.

Read more:

Seth Serxner is Chief Health Officer at Optum.

Instant Insights /

4 wellness priorities for employers in 2019

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