Motivating Employees Toward Wellness: There’s an App—and a Program—That Really Works
Employers are the main payer of healthcare in the United States. But although they are the most financially at risk, employers tend to have the least amount of influence over the costs of healthcare. To change this trend, many employers have launched employee wellness programs designed to motivate employees to make better health choices. In fact, approximately half of U.S. employers offer some kind of wellness program. Research shows that many employees who participate in such programs do make meaningful improvements on health measures such as exercise frequency, smoking, and weight control. However, the same research shows that employee wellness program participation remains limited.
A 2013 Workplace Wellness Programs Study by the RAND Corporation distinguished three types of activities to define these programs:
- screening activities to identify health risks
- preventive interventions to address manifest health risks
- health promotion activities to further healthy lifestyles
The lack of participation in these programs indicates that employers have yet to discover the secret for influencing their team members’ health behavior through wellness initiatives. At Health Catalyst, we are working to figure out that secret—and we’ve made some big strides.
Our company mission is to improve the health outcomes of patients throughout the country and transform healthcare. For the most part, our solutions focus on empowering providers to reduce waste and improve the quality and cost of care they deliver. But we also recognize that healthcare delivery determines only 10 percent of an individual’s overall health, whereas 40 percent of a person’s wellness is determined by behavior.
Because individual health habits are the greatest determinant of overall health, we’ve developed what we believe is an effective wellness program for Health Catalyst team members and their families. Incorporating principles of gamification and behavioral science, this program uses teamwork, competition, rewards, and fun to truly motivate all of us to adopt healthy behaviors and sustain those changes.
Get Fit Stay Fit: A Program for Team Members, Their Families, and Friends
For several years, Health Catalyst had a typical wellness program. We simply used the one offered by our insurance broker. The program featured points, a website, the ability to set goals, and training videos. But we found that it wasn’t the least bit engaging and, not surprisingly, it really didn’t have much impact.
That’s why, in 2013, we decided to develop our own program called Get Fit Stay Fit, or GFSF for short. The program, developed for our team members by our team members, provides a framework and motivation for all of us to get and stay healthy.
To structure the framework, we asked ourselves the following question: What are the things that impact health the most? What would encourage people to engage in a wellness program? We came up with the following four answers:
- Eating/Sleeping right
- Motivation (Similar Activities, Team Dynamics)
- Physical activity
We turned those four things into the major categories of the program. Participants improve their behaviors in those categories and earn points accordingly.
We also needed technology to help make the program a success. We developed the GFSF app for iPhone and Android devices that participants use to track their activity. The app connects with fitness wearables including Garmin, Fitbit, Apple’s HealthKit and Google Fit for automated tracking, and allows for manual tracking of other activities (like a yoga class or a trip to the climbing gym). We collect that data in our database and then do a number of analyses on the backend that help us assess the program’s effectiveness.
Another foundational aspect of GFSF was to include team members’ friends and family in the program. We wanted everyone’s health to improve, and we also knew that it would be easier for our team members to maintain lifestyle changes if their friends and loved ones were also participating in the challenge. Building positive peer pressure into the program has proven key to its success.
Gamification: Making Healthy Habits Fun and Rewarding
We believed that in order for Get Fit Stay Fit to succeed, it would have to be both fun and motivating. Our goal was to turn healthy habits into a fun, competitive team and personal experience. So we implemented a system of competition and rewards. The program offers individual rewards and incentives—including discounts on health insurance premiums—as well as team incentives.
Participants earn points in quarterly challenges by exercising, sleeping and eating right (both defined by personal goals), and practicing mindfulness. Individuals work their way through several levels of point totals, earning badges and monetary rewards at each level. According to gamification theory, these incremental rewards are important motivators. Participants can redeem rewards for gift cards, merchandise, and event tickets, or they can donate them to charity. Forming teams and having them compete against each other is a key element of GFSF. The program assigns all participants to teams, which compete for team prizes on top of individual rewards.
Past challenges have had up to 15 teams, each with about 25 to 30 members. However, we have found that having fewer teams is more effective. When too many teams were competing, two or three of them would ultimately pull ahead of the others in a fierce competition while the remaining teams lost motivation. That’s why our Q4 2015 challenge features only two teams. To make the teams as evenly matched as possible, we analyzed data from the previous quarter as we assigned participants to teams. As of this writing, it’s halfway through the first two-team challenge and both teams are separated by less than one percent in total points. The change in overall activity levels has yet to be determined.
An Illustration: The Structure of our Q4 2015 Challenge
We’ve now been operating GFSF for seven quarters. Through trial and error, we’ve come up with an effective program structure that we’ll illustrate here.
Our Q4 Challenge has two types of rewards:
- Drawings: Everyone (friends, extended family, neighborhoods, arch rivals, etc.) can participate in these rewards and earn chances to win better and better prizes. For example, depending on the amount of points individuals earn, they are entered into different prize drawings. Members of the winning team are entered into bonus drawings for great prizes. Thus, the rewards per quarter are predictable and distributed through drawings at the end of the competition.
- Motivosity Dollars: Some rewards are only available to Health Catalyst team members, immediate family members on the Health Catalyst insurance plan, or significant others or roommates living under the same roof. We use a program called Motivosity to distribute these rewards. Reward examples include insurance premium discounts and gift cards to dozens of online retailers.
To keep things fresh, we give GFSF a new theme each quarter. The theme of this quarter’s challenge is Star Wars (a nod to the new movie coming out in December). We have two teams: The Galactic Empire and The Rebel Alliance. We feel that Yoda gives all of us particularly appropriate counsel on the app’s welcome screen.
This quarter, we’ve introduced at-risk mini challenges where participants can put a certain number of points at risk and compete against other players (who can agree or disagree to accept the mini challenge). These mini competitions can be head to head between two people or between groups of individuals all putting points at risk individually.
Our Q3 2015 GFSF Challenge, which ended on September 28, was the most successful to date. Of the 374 employees at Health Catalyst, 353 enrolled in the program and 315 reached at least the first reward level. That’s an 84% participation rate. More than 640 total participants—including more than 286 friends and family—walked over 120,000 miles, biked over 17,695 miles, slept right 19,764 nights and had over 7,218 hours of mindfulness. The Q3 GFSF rewards ended up at $13,890!
One of the most striking results we’ve seen is the amount of very active minutes among GFSF participants. Through the first three challenges of 2015, participants reported a total of 1,665,954 minutes.
In fact, GFSF has had a significant impact on the lives of many Health Catalyst team members. One of those, our Technical Director John Simmons, shares his story here:
John Simmons, Technical Director:
I began working at Health Catalyst in February 2013. When I received my XXL Health Catalyst dress shirt, I realized something needed to change. My weight had increased by about 10 pounds per year for several years. I was eating whatever I wanted and wasn’t exercising. That big shirt was the last straw. Something clicked, and I decided to do better.
I decided to start using MyFitnessPal to track everything I ate. When I saw the amount of fat grams, sugar grams and sheer calories I had been consuming, I was shocked. I began eating healthier and smaller portions (and I tracked everything). Almost 1000 days later, I haven’t missed a day tracking each day’s food items. I also started playing basketball for 4-6 hours a week.
Several months later, I had lost 70 pounds. Then the real work began—maintaining. Luckily, Health Catalyst had begun its Get Fit Stay Fit program, and I found that this friendly competition helped keep me focused and motivated to continue to set aims for calories and exercise. While I haven’t been perfect (meals on the road are my current challenge), I have a formula for success, and tools at my disposal.
Michael Barton, VP, Knowledge Development:
I recently became very conscious of the need to manage my own type 2 diabetes by the numbers. Historically, my A1c had been well-controlled, but when I had it measured a couple of years ago, it had gone up to 7.8. I felt fine, but my A1c was clearly trending in the wrong direction, putting me at a higher risk of complications. So I set a personal goal of getting into the lowest-risk category with an A1c of less than 7.
My goal was straightforward but, of course, it took discipline and effort. I determined to lose weight by making sure I took at least 10,000 steps a day—the equivalent of walking about five miles daily. I also was more careful with my intake of carbohydrates – a key intervention for any diabetic. The Get Fit Stay Fit program motivated me to exercise, eat right, and to track my progress. Since beginning the exercise regimen, I’ve lost 18 pounds and decreased my A1c to 6.3, as of my last measurement.
Extending GFSF to Health Catalyst Clients
We’ve had so much success with GFSF that we’re making the program and application available to existing clients interested in promoting it to their patient population and employees. Like us, most of our clients are self-insured, and we want to help them be successful with their employees. We provide the app and we coach leaders on how to set up a contest that meets the organization’s needs while meaningfully moving the health needle.
A study by Towers Watson and the National Business Group on Health shows that organizations with highly effective wellness programs report 9% voluntary attrition; organizations with low effectiveness programs report 15%.
Our first foray into extending GFSF to clients will be a charity competition between Health Catalyst and several health systems. In addition to hosting its own internal competition, each company will put itself at risk for its favorite charity. We’ll each put money into a pool, and whichever organization wins the quarterly challenge will choose which charity the money goes to. We’re very excited about what expanding this program can accomplish—not just for our favorite charities, but for all employees and their families.