What the Best Do Better eBook-2016

REDBRICK HEALTH

What the Best Do BetterLearn the best practices that drive meaningful health engagement and get better results

2 © 2016 RedBrick Health Corporation

Let’s face it: getting people to engage in their health can be challenging.

It’s also essential for organizations seeking to improve program performance

and achieve stronger program outcomes. With so many things competing

for people’s attention, the optimal path to cut through the clutter is unclear.

The answer? While there is no magic bullet, there is a

path for achieving success. This eBook summarizes

practical, evidence-based advice that is the product of

sophisticated research—conducted over the past year

by the RedBrick Insights research team on the broad

and diverse populations we serve. It includes some

recommendations that seem intuitive, and others that

may surprise you. It offers a window into a broad,

data-based consulting approach, which begins with

the identification of the factors that are within each

organization’s control and tunes the organization’s

strategy based on the RedBrick best-practice model.

Our goal in preparing this eBook is to help you develop

a more tailored and successful approach in your

program, based on our emerging understanding of

what the best do better.

INTRODUCTION

3© 2016 RedBrick Health Corporation

Let’s start with an important question: Is all

engagement meaningful engagement?

Leaders of health and well-being programs—and the

providers that serve them—tend to judge success by

what’s easy to measure. Some look at things like portal

registration rates, others at portal login events, or

mobile app downloads. We call this the “clicks and calls”

method. But are these metrics predictive of driving

objective health improvement outcomes?

While there are many ways consumers engage in

improving their health, we at RedBrick Health are most

interested in meaningful engagement. As it turns out,

there are significant performance-related differences

between traditional wellness program models (that focus

on “once and done” reward-driven actions), and those

that focus on creating habitual health engagement.

Simply put, meaningful engagement drives better

outcomes. And the simplest metric for characterizing

meaningful engagement is the level of sustained

engagement over time. We found that some

organizations that have high overall engagement (for

example, in one-time activities) fell down when it came

to getting meaningful engagement.

So how do you get your population to be meaningfully

engaged? The Insights research team used advanced

statistical methods and set out to answer that question

scientifically. We started by identifying the engagement

patterns that are most predictive of positive program

outcomes, such as clinically meaningful improvement in

objective biometrics as well as self-reported improvement

in essential lifestyle habits.

Next, we characterized the amount of engagement

achieved across a broad and diverse set of organizations

into three groups: low-performers, middle-performers,

and top-performers. We then analyzed the contribution

of a wide range of controllable and non-controllable

factors to the level of engagement achieved.

Finally, we found consistent patterns across a group of

factors directly linked to meaningful engagement.

Based on these findings, we identified a set of program

design best practices. We call these best practices

What the Best Do Better.

What are top-performing organizations doing di erently?

Which individual and organizational attributes drive meaningful engagement?

What are the best moves I can make—considering the attributes that are in and out of my control—to increase my program performance and avoid budget-sapping mistakes?

?This eBook shares highlights of this year-long

research project, so that you can get answers to the

questions you might be asking yourself right now:


1LET PEOPLE CHOOSE

“I like RedBrick Journeys® … I am working on

three right now. They give you different activities

you can do, and there are recipes I’ve tried.

I learned if I choose little steps at a time, each

time I do a step, I can move forward and it’s

going to benefit me.”

DARLENE T.COMPUTER OPERATOR


Health improvement is personal. Choice architecture

is the art and science of providing relevant choices

(not too many, or too few) that nudge individuals in a

desired direction.

Using data to offer relevant choice presents a powerful

way to put the person back into the personalization.

Use data to present relevant options, but ultimately

allow people to select the focus of their intervention as

well as the modality for its delivery. Modalities can

include digital coaching, using a wearable device or

popular app, working with a personal coach by phone,

taking advantage of opportunities in your own

community, or using on-site resources. As it turns out,

choice matters. It intensifies commitment and

engagement. And it works.

Many conventional programs use risk identification

and stratification to stream people into intervention

modalities. Applying choice architecture provides

consumers with a set of suggested options, and the

power to choose how and when they want to engage.

Our findings suggest that allowing individuals to choose

the mode of intervention and focus area can result in

stronger engagement and clinically meaningful outcomes.

In a recent large-scale analysis, the Insights research

team found equivalent positive results across intervention

modalities. We even found crossover effects: Participants

at elevated health risk improved biometrics—even when

the selected topic wasn’t the top health risk factor. The

positive impact of engagement in one area spilled over

into the higher risk areas—the data showed the impact.

In other words, the RedBrick mantra is: Do anything. The

more engagement and the more specificity the better,

but even a small change in another area makes a positive

difference in health. Even a small change in health habits

in an adjacent area can catalyze health improvement

related to the target risk factor. Success breeds success.

Choice also increases engagement among those with

chronic conditions. The net result was far more

condition-relevant coaching, given the traditional low

rates of enrollment in disease management interventions.

Choice-Based Model Health Improvement

≥ 10% Reduction innon-HDL cholesterol

41% 41%

Categorical reductionin blood pressure

34% 31%

≥ 5% Weight loss

20% 20% 40%33%18%RedBrick Phone Coaching (started any)

Activity tracking (after 30 days tracked)

RedBrick Journeys (started any)

In a choice model, di�erent intervention modalities are similarly e�ective at producing clinically meaningful change.

80%Nearly 3xmorecondition-relevant coachingengagement

More than 4xincreasein total coachingengagement

of coaching participants choose to start by managing lifestyle

LEADING TO

6 © 2016 RedBrick Health Corporation2 “I didn’t realize by just talking to somebody on

the telephone you could really get motivated and

encouraged to do better for yourself.”

DIANA M.CLIENT MANAGER

MAKE IT SOCIAL,

AND OFFER SUPPORT

7© 2016 RedBrick Health Corporation2Though many companies are turning to a broader

focus on employee well-being, national surveys

regularly confirm that their primary reason for investing

in employee health is to manage healthcare costs.

Ironically, most programs focus on the individual

employee, overlooking spouses and significant others,

who often have higher healthcare costs and nearly

always have a strong influence on the health behaviors

of the employee.

We recommend including spouses and significant others,

and including a focus on the family as a unit for behavior

change. Social support is not only a predictor of

meaningful engagement, but also, a catalyst for more

meaningful engagement.

Support can come in many forms. Sometimes it comes

from family and friends, and sometimes we need help

from experts. A quick call with a warm and caring

expert can be just the right thing to get started on the

right path. A long-term coaching relationship can be

profoundly helpful. However, our research found that

even a “concierge-style” single session can drive

significant and sustained engagement. We call that type

of encounter a Next-Steps Consult™.

Designed to educate, motivate and engage, the

Next-Steps Consult provides a human connection for

those participants who are unsure what they should

do next. Our research found that organizations that

offered a Next-Steps Consult to participants increased

and achieved meaningful engagement—even without

increasing the rewards for engaging in activities. In fact,

in a multi-employer comparison study we found that

a single consult out-performed sizeable incentives and

that the result persisted after the consult.

O�er programs to spouses, significant othersand dependentsas well as employees

Spouses nearly always have a stronger influence on health behaviors than employer-sponsored programs

Spouse population often has higher healthcare costs

Meaningful Engagement Increases with Next-Steps Consult

Online programs

14% 28%

Phone coaching

3% 16%At 30 days At 30 days

Activity tracking

35% 51%At 30 days

Without Next-Steps Consult call

With Next-Steps Consult call


3COMMUNICATE STRATEGICALLY

“I like getting the email notifications to remind

me, ‘You have a Journey to complete’ or ‘You

have an activity you need to update.’ I do enjoy

those. I get them throughout the day.”

DANIELLE Y.PROJECT MANAGEMENT OPERATIONS SPECIALIST


5-10%

30-35%

20-25%

20-25%

10-15%

Use a Mix of Messages

HEALTH TOPICSLower open/click,

but bolsters awareness, culture of health

CHALLENGESSupports culture

of health, diversity of ways to engage

REMINDERSHigh response rate; date-driven, involves dollars/deadlines, helps maintain momentum

EVENTSHighest response rate; drive specific action, typically involve reward

AWARENESSIntroductory; typically provides date-driven call to action with rewards

We know it’s important to cut through the clutter. Our

research focused on pinpointing those communication

practices most likely to produce success, which in this

case means higher rates of meaningful engagement.

It’s important to keep in mind how your messages are

communicated, what they are saying and how often they

are being delivered. Our research team found three

factors mattered most:

1. Is your population reachable by email?

It’s perhaps obvious, but the data make it clear: The

stronger your email coverage, the higher your chances

are of driving meaningful engagement. We found

digital communication essential, especially for digitally

delivered engagement modalities. Operating without

a strong, clean email list means facing an uphill battle

in achieving initial and ongoing engagement. Those

reachable by email have 92% more engagement. Our

best practice organizations had at least 75% email

coverage for their target population.

2. How often do you communicate?

Frequency matters, and the math is simple: The more

you expose consumers to insightful communications,

the better response you’ll get. Top-performing

organizations have a consistent communications plan in

place, which effectively builds awareness and triggers

actions. Our top performers follow the RedBrick best

practice of communicating at least monthly. The lower

performers in our analysis communicated less than half

as frequently.

3. Are you delivering the appropriate mix of messages?

Our research found that top-performing organizations

use a broad mix of messages, such as: personalized

reminders, health topic-specific content, invitations to

participate in challenges, awareness-related content and

promotion of relevant activities. Not all messages will

connect with all audiences, so mix it up. Include specific

event and deadline-driven messages, and don’t forget

general interest messages tied to national health events.

10 © 2016 RedBrick Health Corporation4USE INCENTIVES...WISELY

“To earn 60 points per quarter, that’s about a

dollar per point. I say to myself, ‘I’m going to earn

another dollar now’ and it gets me out of bed.

It’s like the little angel on your shoulder—your

conscience—to get you to go do it. Without that,

I wouldn’t have a goal.”

BILL H. SUPPLY CHAIN SPECIALIST


When designed effectively, rewards can play an

essential role in your program design. However, poorly

designed rewards can have unintended consequences,

waste precious budget dollars, or even backfire relative

to their intended effects.

When it comes to effective reward design, more isn’t

always better. But more frequent generally is. And

rewarding outcomes may, ironically, not be the most

effective way to ensure population outcomes. Our

research revealed the following best practices in reward

design. Follow these recommendations when designing

a cost-effective rewards strategy and avoid making

budget-sapping mistakes.

1. Incent ongoing engagement—Not just initial clicks.

By rewarding consumers for consistent, ongoing

participation over time (rather than just focusing on

one-time events like health assessments), you can

achieve higher meaningful health engagement.

2. Reward early and often—and avoid designs that

postpone payout.

Organizations that rewarded their consumers on a

regular basis, rather than just one time at the end of the

year, yielded higher engagement rates and ultimately

better population outcomes. Quarterly rewards models

out-perform annual reward models at producing

meaningful engagement.

3. Balance reward allocations between up-front and

ongoing reward opportunities.

Many organizations spend the bulk of their incentive

budget rewarding participation in up-front activities

(like health assessments). Our research team found that,

paradoxically, organizations with the largest budgets

for health assessments, achieved poorer results in terms

of meaningful engagement. The research found that

the optimal incentive range for health assessments

is $50–$100, with diminishing returns for each $1 spent

above $50. In fact, a health assessment completion

incentive of $50 produced similar rates of sustained

engagement as a completion incentive of $250 among

our study organizations.

For best results, offer at least $200 per participant

for ongoing healthy activities, allocating the bulk of your

incentive budget for participation subsequent to the

health assessment.

4. If you’re interested in outcomes, reward participation.

Many organizations have begun rewarding for biometric

outcomes, along with reasonable alternative standards,

as required by law. It certainly seems logical to do so—

after all, you’re paying for the result you want. However,

our research found that participation-based rewards

worked equally well in producing biometric outcomes,

and we found evidence that outcome-based reward

designs depressed participation, especially among those

at elevated risk.

Health assessment reward of

50-100dollars Health screening rewardof at least

50dollars

Healthy activity reward of at least

200dollars


5RECOGNIZE AND LEVERAGE

THE ROLE OF CULTURE

“We had a company-wide challenge over the

holidays. We had six members per team and

there were about 10 teams. Everybody signs up

and we all do a weigh-in on the first and last

day. The highest average percentage of weight

loss determines the winning team.”

WILLETTE B. PAYROLL ACCOUNTING ASSISTANT


BOTTOM-U

P C

HA

NG

E

ENVIRONMENT

TO

P-D

OW

N C

HANGE

HEALTH-FRIENDLY CULTURE5If we were to survey your population today, would your

respondents agree that the organization promotes a

culture of health? Do leaders walk the talk? Are healthy

habits contagious? Can you see visual signs of your

organization’s commitment to health and well-being as

you walk the halls on campus?

Our research found that organizations whose employees

report that the organization actively supports their

health improvement efforts are rewarded with the highest

rates of meaningful engagement.

In top-performing organizations, approximately two

out of three employees reported that they were

actively supported by their organization in their health

improvement efforts.

Building a culture of health doesn’t happen overnight,

but it also doesn’t need to be hard or complex. Start

by testing employee perceptions, and looking at

workplace environment and patterns against criteria you

would expect to see at a company focused on creating a

health-friendly culture.

Here is our advice for enhancing a health-friendly culture:

> Make top-down support visible

> Empower local wellness champions

> Include spouses and families

> Publish success stories regularly

> Change the physical environment

> Offer healthy food choices

> Sponsor healthy competitions

> Create well-being “winners”


Successful engagement is not just about personalization,

or mobile access, or social connections, or rewards,

or reminders, or culture. It’s about all of these things.

Each organization’s unique success formula can be

different. If your company doesn’t enjoy strong culture

of health ratings, all is not lost. Our research found

you can still achieve top-performer status simply by

emphasizing the other best practices outlined above:

offering choice, making it social, communicating smartly

and rewarding wisely. On the flip side, a strong health-

friendly culture is wind in your sails—you can be less

aggressive with your rewards and communications and

achieve a similar result.

And these factors aren’t independent of each other.

Communications influence culture and vice versa.

Likewise, the social dimension serves as a form of cultural

and communication support. Understanding underlying

population demographics as well as each individual’s

intrinsic motivation can help you tailor the best approach

at both the population and individual level.

Start with the assets you have, size up your current

practices relative to the best practice recommendations

in this eBook, and determine which best practice you

can dial up most quickly and easily in your environment.

Remember that success breeds success.

Most importantly, focus your tactics on sustained

engagement over time—that’s the key to achieving

meaningful program results.

CONCLUSION


APPENDIX


A summary of our methodology, from the RedBrick Insights™ research team

RedBrick Health’s purpose is to help people be healthy. To that end, the

RedBrick Insights research team studied and identified program design

elements that are directly linked to high rates of health engagement.

There were three steps to this analysis:

STEP 1 Investigate engagement patterns associated with increased

health improvement and identify the best predictors of health

improvement.

STEP 2 Estimate the effects of program design elements on

engagement patterns associated with health improvement.

STEP 3 Determine best practice recommendations for program

design elements based on organizations that achieve the best

patterns of health engagement.


STEP 1

The first step consisted of identifying what type of

engagement was most associated with health

improvement. We looked at 71,592 individuals who had

health screening measures in both 2013 and 2014, and

160,777 individuals who completed health assessments

in both 2013 and 2014. We observed successful health

improvement over a variety of health indicators:

> Weight loss ≥5%

> Non-HDL cholesterol reduction ≥ 10%

> Blood pressure reduction to less than 140/90 mmHg

> Physical activity increased by at least

60 minutes/week

> Increased fruit and vegetable consumption of at

least one serving/day

> Improvement of at least 1 point on a stress

coping scale

We matched health improvement observations with

detailed program engagement data between the

measure dates for each participant, and used logistic

regression models to test the association between

each health improvement measure and several

engagement descriptors.

Our team found that the characteristic of engagement

that most consistently predicted health improvement

was the number of actively engaged months between

measurements. Individuals were considered actively

engaged in a month if they had any interaction in the

calendar month. These interactions included completion

of the RedBrick Compass® health assessment,

completion of a biometric health screening, completion

of a Next-Steps Consult call, completion of phone

coaching calls, completion of steps in a RedBrick

Journey (digital coaching), recording activity in a

physical activity tracking tool via a wearable device or

through an app or web page, or completing another

client-specific healthy activity. The number of actively

engaged months became our key dependent variable

in Step 2 of the analysis.

STEP 2

In order to understand which program design elements

were associated with sustained engagement (and

therefore with more health improvement), we examined

engagement data for over one million individuals from

more than 50 organizations. We included both employees

and dependents that were eligible to participate for the

entirety of 2014 and used a multi-level regression model

to isolate the effects of particular program design elements

while controlling for other differences. A zero inflated

negative binomial model best fit the observed data.

We examined the effect of many factors on active

participation months, such as age, gender, relation type,

email availability, median income decile in ZIP code of

residence, population density in ZIP code of residence,

and the number of various types of messages received

at the individual level. We included incentive amounts

associated with various health improvement activities

as well as incentive design characteristics. At the

organization level, we included industry groups, a culture

index, geographic dispersion categories, and the average

number of communications sent per participant.

The regression model identified program design

elements associated with either increased or decreased

engagement.


STEP 3

The purpose of Step 3 was to understand what the

top performing organizations were doing with respect

to each program design element identified in the

regression analysis. In the absence of a clear definition

of the “best,” we ranked all organizations in our book

of business according to the average months of active

engagement that they had achieved in 2014, and divided

them into thirds. The top third of organizations were

defined as “the best.” We compared program design

choices among the top third of organizations with

program design choices among the middle and bottom

third of organizations. For continuous variables such

as incentive amounts and communication frequency,

we examined differences in the means between groups.

For categorical variables such as whether a range of

program offerings is in place, we examined differences

in proportions between groups. Recommended ranges

for each program design element were based on

what we observed the top third of organizations doing

with respect to each program design element.

SUMMARY

Through this multi-step methodology, we identified

a measure of engagement predictive of health

improvement. We then isolated program design elements

that were associated with better engagement, while

controlling for differences in population demographics,

industry and other program design choices. Finally,

we developed a set of best practice recommendations

based on what the most successful organizations did

with respect to each of these program design elements.


Do you want to learn more about driving meaningful engagement within your population? Are you interested in a detailed benchmark-based recommendation on ways to improve? We can help.

Contact us for a free best practices review today at:

www.redbrickhealth.com/bestdobetter

[email protected]

855-776-5515

RBH-136 4/16

© 2016 RedBrick Health Corporation

RedBrick Health Corporation 510 Marquette Avenue, Suite 500 Minneapolis, MN 55402

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What the Best Do Better eBook-2016

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