Engaging Hard to Reach
Employees in Health
Improve Health, Reduce Costs, Increase Productivity
Brenda Schmidt, MS, MBA
Engaging Employees in Health
• Carrier Programs
– Armed with data and resources, programs are deployed
– Difficult to optimize and reach individual members
Carrier
Programs
(Chasm)
Employers
Members
• Employers (with help) Enhance Health and Reduce Cost
– Employers can successfully engage and incent employees
– Employers are uniquely positioned to benefit from 2-5 year gains
– Coaches reach employees on a personal level
– Coaches build bridges between members and programs
Carrier
Programs
Coach
Employers
Members
Engagement drives Behavior Change and
Risk Reduction
Program Orientation
Employee Orientation
Screening /
HRA
Risk
Reduction
Disease /
Condition
Support
Health
Management
Programs
Wellness
Programs
• Validation of Outcomes
• Mitigate Risk
• Lower Costs
Lifestyle
Management
Care
Coordination
Behavior
Impact
• Leverage Existing
Programs
• Channel at-risk Members
• Provide Onsite support
• Gap Fill
Employee
Engagement
• ID and Lower Barriers
• Communications /
Messaging
• Peer and Health Coach
Relationships
Multi-Channel Integration Needed to Reach
Membership and Impact Cost Drivers
Multi-Channel Coverage
Employees with Oppt’y
Typical Distribution of Health Care
Costs in a Commercial Population
Sources: Data from Serxner, et al. (Art Health Promot, 2006)
and JourneyWell analysis (*) 2006.
Challenge: Hard to Reach Participants
• Geographically widespread / rural
– Truck drivers
– Construction workers
– Sales Force
• Language barriers
• Shift workers
– Manufacturing
• Cultural differences
• Limited access to and comfort with technology
• Wide range of education and literacy levels
Technology-based health promotion interventions may not be suitable
for many employees.
Understanding Your Target Population
Known:
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Age
Gender
Race / Ethnicity
Job type
Less obvious:
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Literacy level
Preferred language
Preferred way of getting information
Current health practices
Health beliefs, values, knowledge
Family roles
Iceburg Concept
of Culture
Age
Race / Ethnicity
Gender Language
Sense of self
Rules for social interaction
Concept of time
Approaches to problem solving
Value individual vs. group
Perceptions of mental health, health, illness, disability
Patterns of superior and subordinate roles in relation to
status by age, gender, class
Emotional response patterns
Child-rearing practices
Notions of modesty
Concept of cleanliness
Laying the Foundation for Success
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Design Effective Program
Program Design
Set Goals
Effective Use of Incentives
Create Metrics
Communication Plan
•
Data Collection
–
Biometrics and Health Assessment
Improve Metrics
•
Data Action
–
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Health Coaching / Disease Management
Outcome Measurement
Measure Improvements
Relationships Engage Employees
Health Beliefs
“It affects me”
Self - Efficacy
“I can do it”
Social Learning
“I have support”
Evidence-based Approach to Health
Coaching
Health Belief Model
“It affects me”
Health Screening
Educational Sessions
Supportive Materials
PREDISPOSING
Self-Efficacy
“I can do it”
Social Learning
“I have support”
Self-monitoring Tools
Health Coaching
Incentive
Management
Team Activities
Social Support
Group Classes
ENABLING
REINFORCING
PERSONAL – INTERPERSONAL – EVIRONMENTAL FACTORS
Health Coaching Context
Who:
• Nature of relationship
• Level of commitment
• Position of influence
When:
• Time available for intervention
• Willingness to engage in dialogue
Where:
• Adequate privacy
• Ability to provide resources
Input for Engagement Strategy
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What are the barriers to participation and engagement?
Are the programs relevant?
Are the images and messaging culturally appropriate?
How am I including low / lower literacy employees and
other languages?
How can I maximize participation?
Who will be the most appropriate person to deliver health
education?
Who is respected in the community?
Who are the informal leaders?
How can I engage family members?
Engaging More Employees in Health
• Evaluate employee demographics and work environment
• Design program to eliminate employer, process, and
employee barriers
• Introduce relevant communications and messaging
• Relationship-based engagement (coaching or onsite
classes)
• Leverage existing carrier programs
• Fill gaps with supplemental program and services
Employer Focus: Developing a Healthy Culture
Coach Engages Employees in
Programs to Improve Health
Behaviors
• Brief Health Interventions
• Onsite Classes / Events
• Increase Health Awareness
• Improve Health Behaviors
• Develop Supportive Peer
Networks
• Monitor biometric measures
to document program results
Employer Focus: Developing a Healthy Culture
• Wellness Challenges /Events
• Celebrate Successes
• Wall of Fame
• Wellness Champions /
Support Groups
• Walking groups
Employer Strategy: Identify and Reduce Risk
Coach focus is on lowering
risk through achievable
behavior modification
• Driven by biometric / HRA
data to prioritize outreach
• Targeted individual coaching
• Coach relationship drives
accountability
• Integrated with health plan
programs
• Focus on outcomes
Communication Strategies
• Simple & Direct
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Clear program information
Language specific / Language at Home
Culturally competent messaging
Branded for consistency
• Multiple Mediums
– Print, Web, Email
• Multiple Opportunities
New Hire
Orientation
Hallway Demonstrations
Car Windshields
Wellness Champions
Home mailing
Email
Staff Meetings
Industry-specific: QualCom
Strategies to Improve Engagement
• Marketing and Communications
– Understand the intended audience
– Consider literacy and health literacy
– Use pictures that reflect target population
– Use relevant / culturally competent messaging
– Limit the use of idioms / acronyms
• Recognize and involve the family, worksite, and
community networks as important systems of support
and intervention
• Home mailings / family activities
• Community resources guides
Program Branding Examples
Strategies to Increase Biometric
Screening Participation
Identify and lower barriers to participation:
• Time constraints
• Fear of confidentiality or financial impact
• Lack of access (night shift, lack of transportation)
Solutions:
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Offer multiple options
Incentive design
Clearly communicate confidentiality
Utilize informal leaders “ Wellness Champions” to
encourage participation
Reducing Health Assessment Barriers
Offer options for Low Literacy Employees or those
with lack of comfort with technology
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Proctored sessions
Coach-assisted
Telephonic outreach
Paper-based assessments
Stress confidentiality
Translate assessments
Incentive Programs
• Sends a message
• Needs Assessment
• Cultural Considerations
• $$$ ≠ Participation
Health Coaches Significantly Increase
Screening and HRA Participation Rates
Food
Processing
n = 9,600
Dairy
n = 2,400 / 350
Trucking
Baseline
n = 1,150
Year 1
Manufacturing
Year 2
n = 2,200
0%
20%
40%
60%
80%
100%
Engagement and Risk Reduction Outcomes
Program Engagement
Risk Reduction
N = 350
3-Year Outcomes Data
Risk Reduction
% employees with biometric or lifestyle risk
Health Coach Connects Member,
Employer Strategy and Health Plan
Coach connects
employer strategy
to health plan
programs
Coach engages
and activates
employees to
support employer
health strategies
Employer
Strategy
Health
Coach
Health
Plan
Programs
Member /
Employee
Integrated Engagement Process
Capture
Data
Wellness
Processes
Data
Health
Status
Feedback
Coach
Improvement
Status
Identify
highest
impact
behavior
change
opportunities
Triage
Action
Plan
Engages
Assign most
relevant
health coach
or program
to engage
employee
Engage
and
Activate
Reward
Learn about
Employee’s
Health
Status
Health
Personalize
Promotion
Screening
Assessment
Health
Prioritize
Registration
Enrolls
Completes
Risk
Survey
Employee
Track
progress
toward
incentive,
and
administer
incentive
Track
Progress
Lessons Learned
• Importance of communications
– No literal translations
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Include all shifts
Adapt to the physical location
Cultural brokers / peer health educators
Focus groups
Stress confidentiality
Use existing informal leaders
Combine health screenings with other events:
– new employee orientation
– safety fair
– flu shots
Keys to Program Success
– Connection with Population
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Engage Employees as Stakeholders
Address Occupational Barriers to Engage
Connect Health Plan Programs to Employees
Educate, Support and Empower
– Focus on Outcomes
• Partner with Employer, Employee, Health Plan/Vendors
• Isolate Meaningful Behaviors
• Leverage Scarce Resources
Successful Approach to Engaging
Hard to Reach Populations
• Creativity and insight to achieving outcomes
• The vision to overcome barriers and increase engagement
• Blend root cause analysis, successes and agility to match
population needs
• Adapting content and coaching to overcome barriers
• Customize communications, programs and materials
• Targeted, Proactive Health Coaching
• Collaborative 360 Degree Approach
• Health Plan/employer/participant integration
Questions?
Brenda Schmidt, MS, MBA
Diversity Wellness
602-443-5264
bschmidt@diversitywellness.com