Podcast: 2016 Wellness Trends with Dr. Catherine Bass
In this episode of the Well-being Experts podcast, we’re discussing the role data plays in a wellness program and how it unlocks the power of predictive analytics. We sat down with Dr. Catherine Bass, Director of Informatics at Onlife Health, to talk about how to use all the data that's becoming available, including design, implementation, reporting, and most importantly how users, employers and health plans fit the data together.
“We're creating more data in one year these days with our devices than we've created in a lifetime previously. So, leveraging that data, weaving it into your product, whether it's at the beginning through implementation, in the middle as you adjust, at the end when you're looking at results, is definitely the way to go.”
Want to dive deeper into this Well-Being Experts podcast? Here's the full transcript from our discussion with Dr. Catherine Bass, Director of Informatics at Onlife Health.
Dr. Bass: Wellness really started being a thing that people did when people began realizing that their healthcare spending was out of control. There was something that needed to be done differently. I think what ended up happening was, people were like, “Oh, they need to be healthier. That's the thing. If they're healthier, then costs will be contained to some extent.”
Host: This is the Well-Being Experts podcast, and you just heard from Dr. Catherine Bass, Director of Informatics at Onlife Health. She's talking about the role data plays in a wellness program and how it unlocks the power of predictive analytics. On our second episode of the Well-Being Expert podcast, brought to you by Onlife Health, we're picking up a thread from episode one where we heard Abby Griffin mention one of the insights gained by analyzing user data.
Abby: People who own a Fitbit and have at least one friend on Fitbit in their social forum, they take, on average, 23% more steps a day. Just one friend.
Host: In this episode, Dr. Bass takes us deeper into understanding how to use all the data that's becoming available.
Dr. Bass: We're creating more data in one year these days with our devices than we've created in a lifetime previously. So, leveraging that data, weaving it into your product, whether it's at the beginning through implementation, in the middle as you adjust, at the end when you're looking at results, is definitely the way to go.
Host: Catherine's master's and doctorate are in public and community health and program planning.
Dr. Bass: And public health is just really the public sector side of corporate wellness. It's the same concepts, you're just doing it for different populations.
Host: In this episode, she's talking about the design, implementation, reporting, and most importantly how users, employers and health plans all fit together.
For more content like this, go to onlifehealth.com/resources. Enjoy the conversation!
Host: You've seen over the last 10, 12, 13 years, over a decade, you've been working really closely with the data, and the data is really interesting because the more you understand it, the more you understand the story that it tells.
Dr. Bass: That's exactly right.
Host: When someone's first thinking about implementing a wellness program, based on the data that you've seen over the past decade plus, what are some of the most common needs that they're facing? Then we'll talk a little about how that relates into making sure you have a really strong implementation and adoption.
Dr. Bass: Right. Wellness really started being a thing that people did when people began realizing that their healthcare spending was out of control. There was something that needed to be done differently. And there were a lot of different perspectives and a lot of different trial and error things that we went through, really. Honestly, the evolution, all the way back to the late '70s you're talking about when this really started being a thing, kind of evolved over the '80s, and really began taking hold in the late '90s.
So, companies and entities that are controlling benefit costs in health plans, structures and those kind of things, they tried a lot of different things. They tried giving people really rich benefit programs and hoping that that was going to help. “If they've got all of this stuff available to them, they'll be healthier.” That didn't work, and it cost a lot of money. So then, we tried different things. We tried giving them really stripped-down benefits like, “You're going to have to take responsibility for your health. You're the one that's going to be paying for it.” That didn't work either. People were mad. It didn't work.
So, I think what ended up happening was, people were like, “Oh, they need to be healthier, that's that thing. If they're healthier, then costs will be contained to some extent,” and so that was really when you started seeing disease management come into play. You started seeing wellness come into play. So, what ended up happening– what's prompting all of this is really the bottom line. People are looking for cost containment as related to healthcare spending. So, one of the things that people are coming to us for is to figure out, “How can people be healthier?” Because if they're healthier overall, we're going to have more appropriate spending.
One of the things we've really had to, and we still work on, is adjusting expectations around that healthcare spending. So, a lot of times they'll say, “I want you to lower my healthcare trend.” Well, healthcare trends have been increasing at double digits over the last ten years. And this is not to diminish wellness, but getting someone to exercise is not going to bend that trend down across a huge membership. Those people can save money and they can use the plan more appropriately, but we have had to kind of set expectations, or reset expectations, I should say, with what the actual outcomes of this will be. So, some of the conversation we have is them coming to the table, talking about how much money they're spending, wanting to lower that trend, and us responding to that by saying, “We hear you and here's what we can do for you, and let's talk about what that's actually going to look like at the end.”
Host: When they come to the table, when someone is like, “We need to do something with our spending and we want to have a healthier workforce,” and all those things, what are some of those items on a piece of paper that they come to the table with as they're thinking about what they're trying to achieve?
Dr. Bass: Right, so they want, a lot of times what they're saying is that we want people to be healthier. So then, we help them, “Let's operationalize what does healthier look like for you.” For some people that is, if you're looking at people who have already been diagnosed with chronic illnesses, so those would be things like high cholesterol, high blood pressure, diabetes; we can look at those people and say, “For those people, that can mean a couple different things.” Maybe it's that they're better managed because if you're diabetic, you can be diabetic and be very well-managed, meaning you are taking your blood sugar on a regular basis, you're checking your feet and your extremities on a regular basis, you're making sure you're seeing your doctor twice a year. You're having medication compliance so that your levels are staying normal so that you're not developing all these kind of things in your body that are going to cause really serious illness or emergency room visits, inpatient stays, that kind of thing. So, it might be that they are better managed. And that's one version of healthier. There are times, if they were really intense with their treatments and their lifestyle behaviors, they actually might also have better levels – might have levels that even might take them out of the threshold of criteria where they would be considered to be diabetic, or high cholesterol, or high blood pressure. So, it's talking to them about, “What does that look like when they're healthier?” Then we can measure that with the data and say, “Yes, you've achieved these things.” Or, “Here's what's not working. Let's make sure we do some things that are different.”
Host: What do you think have been some things that you've seen over this past year as relates to implementation? Have there been any trends or interesting data that you've seen on what has the implementation process looked like on wellness programs across the board and maybe there are some insights from there?
Dr. Bass: With implementation what we're looking at is, again, “What are your goals?” And then, how can we best meet those things? So, evaluating the population at the start. Sometimes we'll get their claims data at the beginning, or data on their program that they've been doing with their previous vendor and kind of saying, “Okay, in order to meet these goals, here are some things we need to be doing. We need to kind of, we've got a huge group of people here, for example, that might have risk for metabolic syndrome, which is a huge indicator if you're going to be diabetic.” If they've got a huge percentage of that in their population, then we might work with them to say, “We need to make sure that we're hitting X, Y and Z components in your program. We really need to make sure we're doing the exercise piece, because that's the thing that's going to hit all of those different criteria and improve them.” We really put a lot of incentive points around [the design]. And when I say points, we've got a matrix of things that we usually say, “These are the items that would be great for you to make sure you're really incenting to make sure that they're doing these behaviors that are going to affect these different criteria and impact their health in a positive way.” We might say, “Gosh, you really need to make sure you're putting a bunch of points on making sure people are doing exercise,” or, we can look at their device, their wearables, and their apps that they're using and collect data there and make sure they're getting a certain number of steps per day. We can take in data that they're creating by going to different classes. Even at gyms or other things that are totally outside of the wellness program, we can take that data in. If they're doing certain races, we can take all that information in and say, “When you incent something, that's really what's going to be done.” Let's make sure they we're incenting the activities that we know are going to get the best impact for you. So we take their goals, we look at what needs to be done with the data, and then we create their program from there.
Host: How has the role of incentivizing changed over the years? Especially, how have you seen incentivizing change in this previous year as it relates to thinking about how a wellness program is implemented? I'm thinking about this all across the country, not even necessarily people that you're working with.
Dr. Bass: Right. I think one of the things, when we really first started – again, just wellness industry in general – there were these trinkets that were kind of the incentive, like, “If you do this, then you can have a t-shirt.” It was sort of like if you run this race you get a t-shirt at the end. And they were trying to apply that to wellness and that was just not effective. So, I think pretty early on we realized through experience that trinkets weren't really the way to go. So, we started thinking, what would be more meaningful to the individual that also gets us to our goal of really tying this into them being healthier and having a direct kind of correlation for the individual to their health plan dollars?
One of the things that we started working on was how to integrate this into really the benefits, and that ended up being a term that was used pretty frequently is, benefits-integrated incentive design. So, what you're doing there is you're actually building the incentive into the premium cost that a member might pay. The employer might say or even within ASO group within a health plan, they might offer an incentive to say, “This is your premium for 2016. You're going to pay $200 a month.” I'm just making that up. “They're going to pay $200 a month, but if you will agree to be in the health plan and do some activities you can pay $180 a month, so you're saving some money right there.” So, what that does is provides them money every paycheck. It is also a reminder every paycheck, and it's also a tie-in to their insurance and helping them kind of remember there's a direct link here between the way you use the plan in your health and the money that it costs you. And that was a much more effective incentive design.
I think the other trend that we're seeing – and this nut has not yet been cracked, it's one thing that we are still working on – is incentives or really designing things so that you've got much more intrinsically-motivated people. So, how can we design things so that you're not required to put money upfront for people to do this stuff? They're more intrinsically motivated to do this, versus the extrinsic motivator. So, what we have had over the last 10, 15 years is very much becoming experts on the best extrinsic motivators: how much money to give, when to give it, and in what way. What the industry is calling for, what consumers of wellness programs are calling for is, how do you build that in intrinsically, because that's what's going to sustain the same behavior long-term and really making sure people are ingesting wellness. How am I going to make this a part of my day every day, not something I'm doing and checking a box for my employer?
Well-Being Experts is sponsored by Onlife Health. As a wellness provider with 20 years of comprehensive wellness experience and over 10 million covered lives nationwide, Onlife knows what drives significant results and what doesn't.
It's easy to be fooled by flashy new features that won't impact your clients' populations. Onlife works with health plans and large employers nationwide to create the solutions needed to drive real engagement and real results. Find out more at onlifehealth.com.
Host: Alright, back to the interview with Dr. Bass. What has the role been for wearables with that intrinsic motivation, so moving away– You mentioned earlier that the trinkets don't work, “get a t-shirt, run a race,” or “run a race, get a t-shirt” doesn't really work that well, but what are some of the things that you've seen this previous year, especially with wearables?
Dr. Bass: Wearables have been a great boost for the wellness industry, because it's something that the individual's choosing. They're choosing to wear something every day that's giving them their own information about how they are doing related to their health. So, the great thing about that is that it's an individual choice and that the wellness industry can kind of leverage that data without having to say, “I want you to be exercising every day and log into this website and tell me about it.” Instead of that, the individual's saying, “I'm going to choose this device or this app and that's what fits into my life. Those are my particular interests. This tracker is the best way for me,” whether it's someone who's a runner or someone who's a walker or someone who's trying just to get a little more physical activity with their day every day because they're very sedentary. They can choose whatever's the best thing for them.
There are ways to consume that data so that you can weave that into your product and you integrate seamlessly with what the individual has already chosen to do, so that really leads back into this intrinsic value. This is not something where we've had to say with an extrinsic motivator like, “I'll give you this specific device and if you use this, then I'll give you money to award you for it.” That's a very different experience than me as an individual saying, “I sit all day long. I drive to work and I'm sitting. I go to my office and I sit at my desk. I walk one minute to a meeting and I sit in my meetings.” You know what I mean?
So, one thing for me is choosing a device that'll jingle or vibrate every once in awhile to say, “Stand up,” because you’re just sitting most of the day. So, that's me choosing what works best for me versus maybe like a device that my employer gave me that only tracks steps. Well, that's fine, if I'm taking steps. What I really have to focus on is that incidental activity throughout the day. So, if I can choose a device that will remind me to stand up and maybe take a lap or use the printer downstairs so I walk up and down stairs, that's more effective for me. That's much more of an intrinsically motivated choice versus an extrinsic motivator, which is where we're really trying to go in the industry.
Host: Do you have data that shows– Or do you have any specific types of data about what the impact has been with wearables this past year?
Dr. Bass: Yeah. We've seen a lot of participation with wearables and are able to take in that information, so I think the impact has been more people are aware of what they're doing, and that is a huge first step into making behavior change. They know what their numbers are, they're getting feedback on a regular basis, and then they also know what they need to do to impact those numbers. So, it's one thing if I know my cholesterol is higher or I know my weight is higher than it should be. If I am not doing anything to impact that, then it doesn't really matter. When you get that constant feedback loop that you're getting with a wearable or with a device where it's telling you, “Walk some more,” or, “Hey, you set a goal and you met it,” that's so encouraging for people.
We have a program where we can look at that data and see people are using this, they're reaching their steps. We've seen people who have increased their steps and some impact that they're seeing there, and we've been able to look at that data and also give information back to our clients and say, “You've got people here who on average are doing 5,000 steps a day versus people who are doing 10,000 steps a day. 10,000 steps is a great goal to achieve, but we've also seen that when these people are doing just 5,000 steps a day, that they're also costing less than people who are not exercising. They have fewer ER visits, they have fewer inpatient stays in hospitals.” So, you can give some consultative input back to the client and say, “You've also got this group of people who are still not doing anything, and they can add in 15 minutes a day and have lower costs, hopefully, than people who are not exercising at all.” So, it's again back to that consultative nature. You're setting up the program, talking about their goals, and then counseling and evaluating and adjusting what you're doing.
Host: So, from the user perspective, what I'm hearing from you is there's a really strong intrinsic motivation, because you get the direct feedback. It's making a noise or your wrist starts vibrating, you're doing a good job, or need to go, it's prompting you to do something. How is wearables making an impact with employers and health plans?
Dr. Bass: Wearables is making a strong impact with employers and health plans in, first of all, that they know a lot more about what people are actually doing. You can capture information on a health assessment once a year, or by asking people a couple times a year how much exercise they're doing.
Host: Good luck, right?
Dr. Bass: Yeah, and you're not getting the whole story. You're not getting a story that is defined consistently. What I view as exercise may be different from what you view as exercise, may be different from what another person views as exercise. If you're using devices, there might be some differences here and there, in like if they count steps as accurately as others or whatever, but generally speaking, you've got steps, and steps are steps are steps, so you know more about the person, you know more consistently and more accurately what that person's doing, and that leads you into more consultative and purposeful plan design. That's a huge impact there.
And then you also understand more when you look at this data and analyze it, you can understand the very direct links between certain levels of activity and costs, and if you know that information, again, that leads you back into information you can funnel back to your members and say, “Hey, when you're doing this little bit of exercise, you have better use of the medical plan and you cost less and that's great.” I think that's a message that's helpful for the individuals to hear as well as the health plan to have.
Host: I loved how you talked about a more purposeful plan design, because the designing going into the implementation process, that has to be done in a particular way to make sure it's done correctly. How powerful– this might sound like a silly question, but what does the role of that design of the plan play when you're thinking about doing an implementation?
Dr. Bass: It's everything. So, one of the things that we have just done consistently over the years – and this is across the industry – is create a one-size-fits-all plan. And one size does not fit all. One size might fit 10% of the population, and so then what you have is maybe 90% of the population that it's not effective for. And that results in no one being happy. In the end if the client's not happy, the vendor's not happy because the client's not happy. It wasn't effective for the member so they're not happy and they don't care about it. So, what we have – even though you know one size doesn't fit all – that's kind of what we have done. And some of that was of necessity. There wasn't a lot of information about it. Wellness is still a relatively new topic, if you think in kind of relative terms. It's only been around about 30 or 40 years – three or four decades – which is not a lot time to have gathered a lot of information, to figure out best practices, especially because everything about a wellness program, very lifestyle-focused, behavior change-focused, is so individual.
If you talk about a disease management program, that is very grounded in allopathic medicine, like Western medicine. So, it would be like if you're a diabetic, I know you need to do X, Y, and Z things to make sure that you are healthy, or well-managed, or don't cost a lot and have to go into the hospital. It's very different, if you're saying, “Okay, you need to lose weight.” While you can say, “You need to make sure you're eating this and you're exercising, and to some extent that you are handling stress well, and that you're making sure you sleep well,” you can say a handful of those things, but the behaviors that drive people to actually do those activities are so individual. You haven't had a ton of time over the years to actually develop these really honed best practices and putting that in place. So, a lot of this is derived from the fact that that you're just putting these things in place and doing the best you can at the time.
But what has been great about the evolution of the industry, the huge evolution of the data industry that includes wearables, is that you can design these things that are much more tailored, much more specific. It's a wide suite of products and features. It's different points of entry. You've got actual, live people you can talk to. If you don't ever want to talk to somebody, you can do everything on your own on the portal. If you don't want to use any of our things, you can use your own choice of device and app, and we can integrate with that as well. The purposeful plan design means everything as far as success and efficacy.
Host: I love that. Because when you have that design, then you are going to implement it, you're going to have a better use from that. And then, get to the most important part, in some ways, the recording so then you can adjust what is doing well, what's not going well. So, have there been any insights on how reporting has been changing, especially as it relates to the increase you've seen with wearables and other devices like that?
Dr. Bass: Yeah, for sure. When you have more data, then you've got reporting that can be more precise. One of the things has been figuring out how to actually best use that data. Because we've only been using this data for about a year-and-a-half ourselves, and it's really been interesting to see what's the best way to report on it and the standard metrics that you may look at from an operational perspective. But then the other great piece of it – and we've worked through what is most meaningful to our clients and what's not confusing – but the best thing is having all this data that we can incorporate into an efficacy analysis. So, when we're looking at– one of the things that we've talked about for years is return on investment for wellness and that has been a very controversial topic. People want to talk about it in really different ways, there's a lot of scrutiny on it.
One thing that I'm very happy about is that I felt the industry, to some extent, is moving away and having a little bit less emphasis on return on investment. Return on investment's often talked about as ROI, just as an abbreviation – I think there were a lot of expectations around ROI that probably were not realistic, but then you're being held to these standards, and so there's a lot of craziness around that. One of the things that it allows you to do is look at actual outcomes of what people are doing and verifiable data, and that speaks volumes to your clients.
So, if you can look at this and say, “I can pull this in, I can tell you that these people had these levels when they first started and we did this number of activities with them that are categorized this way.” You might have people who are doing certain activities, talking with coaches, using devices and wearables, you have all this really rich data, and then you can say, “And then these are their levels at the end.” That's really powerful. Then you take that one step further and you actually marry that up with claims and pharmacy data and say, “This is the way that they behave differently with their medical plan,” which is where the rubber hits the road for a lot of the health plans; “this is how they use the health plan differently,” then that's really effective as well. It very much feeds into a richer story all along the way and gets away from reporting numbers of things people did, which is not as helpful.
Host: So, things are moving away from the whole conversation around ROI and some of that, where it's either a yes or a no and there's not much of a customization. Now with the technology changes with wearables, now we can be thinking more dynamically about how that data can be used to have prediction on behaviors. What are some of the things you are expecting to see in the industry as it relates to predictive analytics?
Dr. Bass: I think that is the next huge thing that we're looking at here because, again, as humans we are creating more data in one year these days with our devices than we have created in a lifetime previously, so leveraging that data, weaving it into your product, whether it's at the beginning through implementation, in the middle as you adjust, at the end when you're looking at results, is definitely the way to go.
The best thing about that is when you have all of this data, you can look at it historically and you can start predicting what people are going to do. That's the ultimate, at least right now as far as I can see, that is the ultimate thing. If you can go in and talk to a client and say, “I can tell you with 80% certainty, 90% certainty, that people are going to behave in this way, if they've been doing these things,” then you really know what levers to pull, what things to change, how to get your population to do different things, and you have your expectations. At that point, it's just a beautiful handshake between the client and the vendor. You can tell them exactly what you think people are going to do, they're probably going to do that, and then you can affect it.
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