T H E C A S E F O R G E T T I N G A C T I V E A N D

D R I V I N G W E L L

An analysis of the impact of Vitality Active Rewards for the three year period to August 2018

Executive summaryFour behaviours (physical inactivity, poor diet, smoking and excess alcohol intake) lead to four chronic diseases of lifestyle that contribute to an estimated 70% of the deaths among economically active South Africans.

Another key risk that South Africans are exposed to relates to driving behaviour. Road accident fatalities in South Africa are 45% higher than the global average, with motor vehicle accidents being one of the leading causes of death among economically active South Africans aged 18 – 29.

The majority of these deaths in South Africa are directly or indirectly related to behavioural factors. Vitality Active Rewards is designed to address these risks.

Key findings of the paper

Vitality Active Rewards enjoys high levels of take-up and engagement, across a broad range of individuals. The programme has over 5 million members across ten countries, including over 500 000 members in South Africa.

The programme has significantly increased activity levels amongst members. Members exercise, on average, 24% more frequently after activating Vitality Active Rewards, with a 9% increase in the proportion of high intensity workout sessions.

Vitality Active Rewards uses a combination of goal setting, various incentive structures and peer motivation to increase activity levels. Micro-rewards such as coffees and smoothies typically result in members increasing the frequency of physical activity by ~20%, with longer-term, higher-value rewards (e.g. Apple Watch benefit) linked to increases of 35%. Members with friends have, on average, a 70% higher goal achievement rate than members without friends, highlighting the impact of peer motivation.

The impact of Vitality Active Rewards is greatest amongst members of poorer health. These members stand to gain the greatest health benefits from increasing their physical activity levels and engaging in other healthy lifestyle behaviours. Members with a complex chronic condition, on average, increased their exercise frequency by 26% and their exercise intensity by 25%.

Higher engagement in physical activity is directly correlated to better health outcomes. Members that start to exercise experience 14% lower healthcare costs and 69% lower mortality rates than members who remain unengaged. Engaging in Vitality Active Rewards also triggers other lifestyle behaviour changes such as quitting smoking, purchasing healthy food and engaging in preventive screening.

The programme has applicability in modifying other behaviours, such as driving ability. Members engaging in Vitality Active Rewards and Vitality Drive decrease their harsh events and typically have a higher Driver Performance Score, resulting in fewer and less severe accidents.

A cohort of members who complete an average of at least 3 Vitality Active Rewards goals per month in the six months post Vitality Active Rewards are used as the basis of the analysis. The change in their Vitality Age differential from six months prior Vitality Active Rewards to six months post is used to quantify the life years gained.

The difference in road fatalities per 100,000 motor vehicles between South Africans in general and Discovery members with short-term insurance has been used to estimate the road fatalities that can be avoided.

M E T H O D O L O G Y

352 500 cumulative life years gained 110 road fatalities can be avoided

The broad appeal of the Vitality Active Rewards programme and its positive impact on primary health risks and driving behaviour provides an opportunity to extend Vitality Active Rewards to all South Africans. If achieved at scale, healthy habit formation can have a material impact on society.

For every 1 million South Africans that become engaged in getting active and driving well

2 3

Vitality Active Rewards in numbers

> 500 000 members engaging in Vitality Active Rewards in South Africa (physical activity and driving)

1.2 million total parkruns by members

Over 80s 36 members older than 80 have achieved goal streaks of at least 10 weeks (longest streak was 96-weeks)

8.0 millioncoffees and smoothies earned

28% members that were smokers stopped smoking

> 150 000shoes, devices and gym memberships boosted

69% lower mortality rate for members who start exercising

457 786 MoveToGive donations by members

R7.2 million donated to charity through MoveToGive

+35% average increase in exercise days per month for members with the Apple Watch benefit

39 million gym visits by members since activating Vitality Active Rewards

810 billion steps by members since activating Vitality Active Rewards

6 993 members who have achieved at least a 52-week goal streak

As of July 2018

50%female members

7 228 members have not missed a goal since activating Vitality Active Rewards

+24% average increase in exercise days per month

Fittest CityPretoria

Cape Town

Johannesburg

1st

2nd

3rd

Longest goal streak:149 weeks and counting

51 year old male in Johannesburg

7 members (aged between 35 and 53 years, based in Bloemfontein, Cape Town, Johannesburg and Pretoria) with streaks of 148 weeks38 year old female

in Johannesburg

1st

1st

3rd

4 5

Four behaviours (physical inactivity, poor diet, smoking and excessive alcohol intake) lead to four chronic diseases of lifestyle (cardiovascular disease, diabetes, chronic lung disease and various cancers) that contribute to an estimated 70% of the deaths among economically active South Africans. A similar picture is shown globally, where non-communicable diseases account for 71% of the 56.9 million global deaths.

Another key risk that South Africans are exposed to relates to driving behaviour. Road accident fatalities in South Africa are 45% higher than the global average, with 25.1 road deaths per 100 000 lives. Motor vehicle accidents are one of the leading causes of death among economically active South Africans aged 18-29.

The problem

Causes of death by age

32%

32%

7%

5%

16%

All ages Ages 18 – 29

Endocrine disease

Cancer

Respiratory disease

Motor vehicle accidents

Other

Cardiovascular disease Vitality is a health programme that encourages and rewards members as they get healthier. In September 2015, Discovery introduced Vitality Active Rewards, a behavioural change programme which utilises personalised goal-setting and micro-rewards to create habit formation around physical activity and driving behaviour. This paper summarises the key results of this programme, and discusses the applicability of expanding the programme to all South Africans.

Discovery research highlights the impact of optimism and overconfidence.

Drivers who believe their driving is excellent

81%

Obese members who view their health as very good or excellent

64%

The majority of these deaths in South Africa are directly or indirectly related to behavioural factors, and up to 90% of motor vehicle accidents are due to driver error.

Key contributions to these statistics are:

Low levels of awareness around the impact of lifestyle behaviours on health and life expectancy

Quality of health and driving are difficult for individuals to track objectively

Overconfidence and bias in assessing one’s own health and driving ability.

7

Members are defined into health risk categories according to the number of chronic conditions they have, as well as the state of the conditions i.e. stable or unstable.

Take up rates are defined as the number of members in that segment as a proportion of the eligible base.

Since the introduction of Vitality Active Rewards three years ago, the programme has expanded globally to over 5 million members across 10 different countries, with members receiving micro-rewards for engaging in physical activity.

- The countries with the greatest number of members are China, South Africa and the United Kingdom.

Take-up among Vitality members is higher in younger individuals and individuals of better health status, however there is still strong representation among individuals of older ages and individuals of poorer health.

- Take-up is highest in the 30-39 year old age band, with 50% of Vitality members engaging in the benefit.

- Over 20% of members with multiple unstable chronic conditions engage in Vitality Active Rewards and 23% of members over the age of 50 have joined Vitality Active Rewards.

Vitality Active Rewards enjoys high levels of take-up and engagement, across a broad range of individuals

M E T H O D O L O G Y

Vitality Active Rewards members in South Africa

100 000

200 000

300 000

400 000

500 000

Sep-15

Nov-15

Jan-16

Mar-16

May-16

Jul-16

Sep-16

Nov-16

Jan-17

Mar-17

May-17

Jul-17

Sep-17

Nov-17

Jan-18

Mar-18

May-18

Jul-18

Mem

bers

Month

Take-up rates by health statusTake-up rates by age

29%21%

38%44%

Healthy Stable chronic

condition

Significant chronic

condition

Complex chronic

condition

39% 39%

23%

50%

18-29 30-39 40-49 50+

Finding 1:

8 9

A cohort analysis has shown that members’ activity levels increase significantly after activating Vitality Active Rewards:

- 24% increase in the number of exercise days per month to 7.0 days per month

- 9% increase in the proportion of high intensity workouts to 40% of all workouts

Research highlights the benefits of higher intensity workouts with Nes et al (American Journal of Medicine, 2016) commenting that “fewer sessions, if performed at higher intensities, provide similar or larger health benefits compared with frequent, low-intensity activity of longer duration”.

- Vitality incentivises members to perform physical activity at higher levels of intensity by offering a greater number of Vitality points for workouts completed at a minimum of 80% of a member’s maximum heart rate.

After joining Vitality Active Rewards, members with heart-rate devices typically exhibit a steady increase in the proportion of workouts that are classified as high intensity. This trend typically continues for at least 24 months after activation, and emphasises the healthy habit formation of the programme, and how regularly adjusting members’ short term goals can result in continued progress.

Vitality Active Rewards significantly increases activity levels among members

Physical activity levels of approximately 250 000 members have been tracked over the past three years to understand the impact of Vitality Active Rewards. The analysis compared physical activity levels six months before and six months after activating the Vitality Active Rewards benefit in terms of both frequency and intensity of physical activity:

Frequency refers to the number of gym visits a month, in order to standardise for take-up in wearable devices. Only members that had activated the gym benefit were considered.

Intensity refers to the proportion of workouts performed at 80% or higher of a member’s maximum heart rate. Approximately 30 000 members had heart rate devices in the six months before and 12 months after Vitality Active Rewards.

Before

Vitality Active

Rewards

Before

Vitality Active

Rewards

Exercise days per month Proportion of high intensity workouts

After

Vitality Active

Rewards

After

Vitality Active

Rewards

+24%

5,6

7,0

37%40%

+9%

M E T H O D O L O G Y

Finding 2:

1 11 0

A combination of short and long-term incentives is most effective in changing behaviour

Vitality Active Rewards uses a combination of communication, feedback and incentive structures to drive behaviour change. Each of these product characteristics is critical in driving and incentivising engagement. The largest behaviour change is seen among individuals with the Apple Watch benefit, where regular goal achievement over a 24-month period results in the device being fully-funded.

Product construct CharacteristicsPersonalised goal setting Activity goals based on health profile and exercise history

Tracking, monitoring and feedback Real time tracking of activity levels in app

Short-term micro-incentives Weekly micro-rewards for completing exercise goals

Long-term benefits Higher value rewards (e.g. cash back on running shoes, devices) based on number of exercise goals achieved per month Shoe, device and gym membership boosters Apple Watch

•

Members have been segmented for this analysis based on the type of incentives that each member regularly engages in. The frequency analysis considers only members with the gym benefit activated; the intensity analysis considers only members with a heart-rate device before and after activating the benefit. The cohorts are defined as follows:

Goal-setting, tracking and monitoring feedback: Members who achieve their goals but infrequently selected a reward are used as the basis for this cohort. App login activity across this cohort has increased from once per month pre-activation to five times per month post-activation, highlighting that these members are engaged around tracking, but not motivated by the micro-rewards.

Long-term benefits: ~80 000 members have at least one long-term benefit linked to their goal achievements.

Apple Watch: ~17 000 members have the Apple Watch benefit activated.

M E T H O D O L O G Y

Increase in exercise days per month

+7%

+20%

+31%+35%

Goal setting, tracking, monitoring and feedback

Short-term micro-incentives

Long-term benefits

Apple Watch benefit

Goal setting, tracking, monitoring and feedback

Short-term micro-incentives

Long-term benefits

Apple Watch benefit

+5%+7%

+11%

+21%

Increase in proportion of high intensity workouts

Finding 3:

1 2 1 3

Vitality Active Rewards incorporates social elements into the incentive programme, using peer motivation to further encourage members to reach their goals. Members are able to add an unlimited number of friends to compete against weekly and stay motivated.

Members with friends have, on average, a 70% higher goal achievement rate than members without friends (1.9 goals per month versus 1.1). Adding friends and being able to monitor their progress towards their goals is seen to further improve the goal achievement rate.

Instead of redeeming weekly rewards for coffees and smoothies, members are able to choose MoveToGive, a donation to a person in need. A total of R7.2 million has been donated through MoveToGive rewards.

Members who frequently select philanthropic-based weekly rewards are seen to increase their exercise frequency by more than the average member.

Features such as social interactions and donations to charity increase levels of engagement

This analysis considers all Vitality Active Rewards members over a 12-month period (August 2017 to July 2018) and groups members according to whether they added at least one friend in the app in the 12 months. The average number of goals earned per month has been calculated for these two groups over the 12-month period. The period August 2017 to July 2018 has been selected to remove the impact of team rewards on the analysis.

Philanthropic: ~1 300 members regularly choose MoveToGive (donation to a person in need) as their weekly reward, selecting the charity at least once in a month when they meet their goal.

M E T H O D O L O G Y

Average number of goals achieved per month

Number of friends

0 1 2 3 4 5+

1.4

1.6

1.9

2.52.7

2.8

Increase in exercise frequency

Average Philanthropic

+20%

+30%

Finding 4:

1 5

The impact on activity levels is greatest amongst members most at-risk

Changes in the frequency and intensity of physical activity are highest amongst members of poorer health status. These members stand to gain the greatest health benefits from increasing their physical activity levels and engaging in other healthy lifestyle behaviours.

For example, members with a complex chronic condition on average increased their exercise frequency by 26% and their exercise intensity by 25%. This increases are off a lower base, with the levels of physical activity after activating Vitality Active Rewards comparable across the different health statuses.

Condition-specific cohorts demonstrate similar patterns:

– Members classified as overweight or obese experienced the greatest increase in exercise frequency after activating Vitality Active Rewards. This amounted to an increase of 32% in exercise days per month

– Members with diabetes experienced a 29% increase in exercise frequency.

Proportion of exercise sessions classified as high intensity

Stable chronic condition

Before After Before AfterBefore After Before After

Healthy Significant chronic condition

Complex chronic condition

+11%

37%

41%

+24%

31%

38%

+25%

28%

35%

+9%

38%

41%

Healthy Unhealthy

Stable chronic condition

Before After Before AfterBefore After Before After

Healthy Significant chronic condition

Complex chronic condition

+21%

5,6

6,8

+22%

5,5

6,7

+24%

5,4

6,7

+26%

5,3

6,7

Exercise days per month

Finding 5:

1 71 6

Engaging in Vitality Active Rewards triggers other lifestyle behaviours

Members who engage in Vitality Active Rewards tend to adjust their behaviours in other areas of the Vitality programme. Engaging in Vitality Active Rewards is directly correlated with higher prevalence of health screenings and assessments, and other Vitality benefit activations.

Overall, the Vitality Active Rewards base experienced the following lifestyle changes after engaging in the programme:

– 28% decrease in the number of members that are smokers (i.e. ~1 300 members quit smoking)

– 12% increase in the number of members engaging in the HealthyFood benefit

– 24% increase in the number of members undergoing a Vitality Health Check (VHC).

After activating Vitality Active Rewards, three in four members engaged in HealthyFood and half engaged in a VHC.

The impact is greatest amongst members that were previously unengaged in physical activity but drastically changed their lifestyle, post engaging in Vitality Active Rewards. The following changes were observed across ~2 200 members:

– 45% decrease in the number of members that are smokers

– 20% increase in the number of members engaging in the HealthyFood benefit

– 71% increase in the number of members undergoing a VHC.

These behavioural improvements translate directly into a lower relative risk and improved health outcomes:

– Overweight and obese members experienced a 1.5% and 5.4% reduction in their BMIs respectively

– Lower relative mortality risk, as reflected by the Vitality Age differential decreasing from 3.0 years older than their actual age to 1.7 years older than their actual age

– Hospital admission rates amongst these members decreased from 22% to 19% in the 12 months after activating Vitality Active Rewards.

The number of smokers is a self-reported result, based on the Vitality Age online assessment.

The number of members with the HealthyFood benefit activated is analysed 12 months prior to activating Vitality Active Rewards and 12 months thereafter.

The number of Vitality Health Checks is over the period of 12 months prior to activating Vitality Active Rewards compared to 12 months after.

A cohort of 2 200 members was analysed where these members increased their physical activity levels from fewer than four gym workouts per month to an average of at least 16 gym workouts per month after activating Vitality Active Rewards.

The Vitality Age online assessment collates health and lifestyle behaviours of a member into a risk-adjusted age known as a Vitality Age. The Vitality Age differential is the difference between Vitality Age and actual age with a positive result relating to a higher mortality risk and a negative result relating to a lower mortality risk.

M E T H O D O L O G Y

Impact of Vitality Active Rewards on other lifestyle behaviours among members previously unengaged in physical activity

Smokers

-45% HealthyFood activation

+20%

Vitality Health Checks

+71%

Vitality Active Rewards

Inactive Active

Finding 6:

1 8 1 9

Higher engagement in physical activity is directly correlated to better health outcomes

Members that increase their levels of physical activity experience materially lower healthcare costs and mortality rates, irrespective of the member’s historical level of engagement in physical activity.

– Inactive members that start to become physically active experience 14% lower healthcare costs and 69% lower mortality rates than members who remained unengaged throughout the period.

– Members that were already physically active and increased their activity levels lowered their healthcare costs by 22% and their mortality rates by 31%.

A longitudinal study over a five-year period performed across Discovery Health and Vitality members tracked engagement levels of physical activity across the period. Members were classified based on their levels of physical activity over the initial six-month period, and the change in activity levels over the subsequent four and a half years. Hospital claims and mortality rates in the final year were used as the outcome of the analysis.

M E T H O D O L O G Y

14% reduction in morbidity rate

69% reduction in mortality rate

Inactive

Remains inactive

Active

Remains active

Very active

Inactive

7% increase in morbidity rate

49% increase in mortality rate

22% reduction in morbidity rate

31% reduction in mortality rate

Active

Morbidity and mortality impact of members starting to exercise

Morbidity and mortality impact of members already exercising

Finding 7:

2 0 2 1

Vitality Active Rewards has achieved similar outcomes in improving driver behaviour

Vitality Active Rewards uses a similar structure to incentivise members to drive well, tracking their driving behaviour and rewarding them for 100 consecutive event-free kilometres every week. The programme has 158 000 drivers and has collected over 9.5 billion kilometres of driving data.

Drivers that are engaged in the programme have seen a reduction in the number of harsh events across all driving trips, relative to their experience before Vitality Active Rewards was introduced. Members achieving three goals a month decreased their harsh events by 34%, harsh acceleration by 32%, and harsh braking by 24%.

Engaging in Vitality Drive Active Rewards is correlated with a higher Driver Performance Score. A higher Driver Performance Score is directly linked with a lower frequency of accidents and a lower severity of accidents.

The Vitality Drive Driver Performance Score is calculated based on a driver’s acceleration, braking, cornering, speed, average distance driven and cellphone use.

M E T H O D O L O G Y

Driver Performance Score

0

25

50

75

100

0 - 100 100 - 200 200 - 300 300 - 400 400 - 500 500 - 600 600 - 700 700 - 850

Relative average claim amount

Relative number of car accidents

Finding 8:

Number of goals earned per month

Dri

ver

Perf

orm

ance

Sco

reRe

lati

ve

77%

1

87%

2

95%

3

100%

4

70%

0

Relative Driver Performance Score by number of Vitality Active Rewards goals per month

Relative severity and frequency of accidents by Driver Performance Score

2 2 2 3

Discovery Vitality

Contact us 0860 99 88 77 | www.discovery.co.za

GM_54511DHV_11/09/18_V17

Discovery Vitality (Pty) Ltd is an authorised financial services provider. Registration number: 1999/007736/07. Please note all information displayed in this brochure is only a summary of the Vitality benefits. Specific limits, terms and conditions apply to each benefit. Visit www.discovery.co.za to stay updated. Discovery Insure Ltd is an authorised financial services provider. Registration number 2009/011882/06. Product rules, terms and conditions apply.

@TeamVitalitySA@Discovery_SADiscovery Vitalitywww.discovery.co.za

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