Anyone doubting the sustainability and projected growth of mobile technology should take heed of these statistics from technology and communication leaders Qualcomm Life and Virgin HealthMiles:

* There will be more mobile devices by the end of 2012 than there are people in the world.

* More people will have access to mobile devices than currently have access to clean water, electricity or toothbrushes.

* Most people are never further than three feet from their smartphone, 24 hours a day.

Combine such accessibility with innovations in wellness plan design, and you have a mobile wellness revolution on your hands - or in them. In fact, by 2020, 160 million Americans will be monitored and treated for medical conditions remotely, according to Qualcomm Life.

"I think these are transformational times that we're in," says Dr. Ron Loeppke, vice chairman, U.S. Preventive Medicine, Inc. "We're now in health care coming of age to really begin to leverage technology, and even more so how to leverage the power of prevention in the wireless world that we're in. These mobile apps that are emerging are going to be a predominant part of how health care is delivered going forward."


Health data in hand

According to Mike Mulvihill, CEO of health care technology company Orcas, there are more than 12,000 mobile health apps on the market. A staggering number that's only expected to grow over the next few years, as much as half of all medical care moves out of the brick-and-mortar model into what the company refers to as "brick-less" care. "People will be using self-management, mobile health applications for every day kind of medical health- and wellness-type issues," says Mulvihill.

With a strong research background going back more than 20 years, Orcas predicts "a revolution in the way that health care is going to be managed and distributed in the next three or four years," Mulvihill adds.

To meet the coming demand, U.S. Preventive Medicine, in partnership with Qualcomm Life, built a mobile health app called Macaw that integrates other wireless devices and wireless mobile health apps such as blood pressure monitors, glucometers and weight scales into one program. The integration attribute is critical, says Loeppke, adding that too many people are "information rich but knowledge poor. In other words, they're overwhelmed with data."

Macaw aims to stand out from the thousands of other apps on the market by assimilating the various data points into a personal health monitoring program that turns the collected information into actionable knowledge through a personalized prevention plan.

When developing its new app, My Mobile Benefits, Buck Consultants made integrating data points a key attribute as well. "It leverages content and resources from wellness vendors into a mobile application branded for the employer - creating an awareness and appreciation for the programs that the employer provides," says Jennifer Whitlow, a principal in the communications practice at Buck.

There are three components to the program. One, users - typically employer groups of 2,500 or more - track their personal health information such as immunizations, allergies and medications. Two, access to benefits information for employees to use at the point of service. Three, wellness incentives and information that are linked to rewards such as a premium discount for meeting biometric measurements.

Opening the app up to the larger clients allows Buck to integrate data from a variety of the clients' vendors and populate the app automatically, says Whitlow. Small employers with less data are not shut out, but Whitlow says a more cost-effective solution for such groups is to use a consumer app that Buck created with many of the same features, but it requires more user input.

Before launching any wellness apps for clients, Blue Shield of California tested apps on its own employees through its Wellvolution program, says Bryce Williams, program director, to see what would work and what wouldn't.

The employee test run led Blue Shield of California to truly embrace social media and gaming technology in the company's wellness apps. One app, Shape Up Shield, is an eight-week program that uses social media to let employees form teams, set goals and gain encouragement from each other. More than 1,800 participants tracked more than 600 million steps in 2011 - about 300,000 miles.

Combined with the exponential rise of social media in general, Williams points out that there is "a lot of research out of the health industry demonstrating that our health is actually connected. Our health behaviors, our health outcomes are actually transmissible amongst our friends and family," he says.

For example, if a family member or close friend gains weight, one is 40% to 60% more likely to gain weight as well. Statistics are similar for smoking, happiness, depression, and others, Williams says.

Orcas's Mulvihill says the company is seeing "a great deal of interest" in mobile health apps, and is "working with several large national health plans putting together their portfolio of wellness-oriented apps, preparing to role them out to their employer groups."

Like Blue Shield of California, Orcas is keeping the apps "simple, social and fun" to build an engagement strategy.

"A lot of wellness programs historically have suffered from low engagement," says Mulvihill. "Employers and health plans have big concerns around how effective is the app, A, and then B, how engaging is it?"


Keeping employees engaged

In preparing their My Mobile Benefits app for the market, Buck put a lot of consideration into the fact that a growing number of employers are switching to consumer-directed health plans that require a lot more employee interaction and engagement in their own health care.

"It's interesting, even across multiple industries a lot of these employers are seeing some of these same types of issues where again and again employee engagement can be a challenge," says Whitlow, "and moving to mobile makes a lot of sense."

Particularly for employers that have remote workforces or don't have easy access to a computer on the job, she adds.

Laura Walmsley, chief business development officer at Preventure, agrees. She sees smartphone applications as a "terrific bridge" between paper and online communications.

"One of the challenges of the wellness industry as a whole is engaging populations that don't sit in front of a lot of media throughout the day," Walmsley says.

For example, using QR codes on things like posters around the workplace will allow employees who have a cell phone but maybe not computer access to view wellness content they might otherwise miss.

However, Michael Troup, owner of Forsite Benefits in Green Bay, Wisc., says although his company's wellness program, myInertia, is viewable on a smartphone, when wellness moves to an app-based platform he's concerned about access for those employees who don't have a smartphone.

"Right now I see the advances in smartphone apps growing for individual users, but for a population solution I don't see them working in a corporate environment," Troup says.

"We still run into corporations across the country where not 100% of the employees even have email addresses for our program. Obviously, there would be even a greater number of individuals that do not have smartphones. Therefore, I do not believe that you can get good employee engagement with programs that require a smartphone."

Even so, Troup does see the value of technology in overall wellness plan participation and effectiveness. "The technology allows individuals to see immediate results before they see physical results," he says. " ... Technology also offers so much more to the administrator and company in terms of decreasing the time commitment to manage, making things easier to roll-out, increasing engagement, and having a better ability to evaluate return on investment."

Employees can see an immediate ROI when wellness programs - app or not - use an incentive approach, says U.S. Preventive Medicine's Loeppke. Similar to a credit score, a "prevention score" allows users to earn points throughout the year with competitive challenges, training and weight loss programs, etc.

When accessible on a smartphone, "they get to see the fruits of their labor," at any time, says Loeppke. "Too many times it's a cool app for one or two times where we remember to open it and look at it. But this integrates and is wireless updating of these various activities. It's a way to be an ongoing personal health monitor."

It takes multiple, integrated attributes to keep employees going back to the wellness app, adds Tom Abshire, SVP of products, marketing and member engagement at Virgin HealthMiles. "Even the same person will be motivated by different things in different ways," he says. "So our goal is to really help people find the things that are going to motivate them the most on any given day."

Virgin HealthMiles uses a range of strategies to do so, many of which are deployed through the smartphone. Such tactics include incentives based on employee challenges and onsite triggers to help employees remember the app, such as a reminder for a lunch time walk with co-workers.

There are approximately 2,500 employee-created challenges going on at any given time, Abshire adds, with an average of six to seven participants in each. The company offers a Facebook-style social network within each employer's domain for interacting, and about 20% of employer clients even allow interaction with employees among similar employers in a given region.


Giving employers control

Working primarily in the large employer market, Virgin HealthMiles, like other wellness app providers, reports collected data back to employers on a HIPAA-mandated de-identified basis. Of course, with the ability to track more comes higher expectations from employers - and that's the value-add of such apps, says Abshire. For example, an employer that just had 50 people complete a smoking cessation program can monitor six months later how many have gained weight.

"Because we are collecting this data we can provide that kind of cross-program systematic data and actually turn health and wellness from something to outsource to a key business process that they manage," says Abshire.

With Buck's app, employers are happy to have a new way to reach employees and capture their attention. They also appreciate the content management system that allows them the flexibility to edit content themselves without relying on a programmer, much like a Microsoft Word document, says Whitlow. The system also allows them to push messages to specific employee groups, such as wellness events happening at certain office locations.

Preventure's Walmsley says a concern they sometimes hear from employers about wellness programs is the self-report aspect during a competition. Wellness apps that come with a built-in pedometer take care of that, she points out - they even track information not typically available with an average pedometer, such as average speed and distance covered, and send it directly to the wellness portal. "It's improved functionality and improved compliance," she says.

"One of the things that's really unique about [working in] wellness ... is that wellness, instead of being a resource people come to when they need it, our job is to change the lifestyle choices that people make every day," Walmsley adds. "We actually have to create different habits in people every day. Having the convenience of new technologies to allow us to do that is a huge boon to our industry."




The Making of a High-Quality Wellness App

By Bryce Williams, Blue Shield of California

1. It's got to be social. It's got to connect people. Not everyone wants to be a social media maven, but it at least has to have the ability to connect people if they want it.

2. It has to be fun. Wellness can be really hard work, but it doesn't always have to be a chore. If we can make it fun and enjoyable and a little bit of a game we should go ahead and do that.

3. It needs to be simple. So much of wellness and health education is about just bludgeoning people with information and often conflicting information - which is an overload. So let's keep it simple.

4. It's got to be effective. If it doesn't work and people don't get something out of it for the time they're putting into it, all the bells and whistles and the slick user interfaces aren't going to do anything.

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