At Rood & Dax Advanced Insurance Services in Sacramento, Laurie Rood and partner Gayle Dax approach client wellness plans by creating a comprehensive culture that uses both technology and personal interaction to foster a healthier, happier workplace. "Especially nowadays when people aren't willing to pay a lot of money for things, we have set a lot of our clients up with the idea that they are creating a wellness culture in which to operate to keep their employees happy and healthy and wanting to come to work," says Dax.

The firm is not alone in its approach. Over the last decade or so - and especially in the last few years - the wellness industry has seen a shift from standalone, one-dimensional online resources to an integrated model that keeps employees engaged and invested in their own wellbeing through multiple platforms.

Like many wellness providers, Provant Health Solutions offers clients an online portal from which to access and manage the company's services. CEO Heather Provino recalls a time in the mid-'90s when advances in technology began to replace the traditional high-touch approach to wellness. "Companies in droves went to just offering technology solutions for wellness," she says, "but what we quickly discovered was that individuals weren't engaging in technology only. They needed that high-touch interaction still, so technology has really migrated to support overall health action plans for individuals."

Using the Internet as a wellness resource took off through sites like and, which empower users to research their own health conditions. Over the years such sites have added assessment tools as the health industry continues to grow and "switch from a focus on researching health aspects to the level of engaging consumers in providing them action plans so they can have a very clear roadmap of how to improve their health," says Shawn Moore, senior product director with OptumHealth Care Solutions.

Moore describes the OptumHealth process as "taking the consumer through the experience," so rather than just requiring they complete a health assessment and providing the results, the company creates a health action plan detailing the next steps to take, such as scheduling doctor appointments, accessing exercise trackers and using healthy recipes.

As an accountable care organization, Kaiser Permanente enables 3.3 million members to access lab results, email their doctor, refill prescriptions, make appointments and more through Interactions are then integrated into the member's electronic medical record as well as the provider's health and wellness program, explains Ann Sherry, a senior director at Kaiser. "We would never make an offering on that wouldn't link into our health and wellness programs and that wouldn't link back into [the member's] care delivery," she says.


PLATFORM INTEGRATION - LuAnn Heinen, vice president of the National Business Group on Helath, say it's important to "pursue as many channels as possible," when connecting employees with wellness programs. While Heinen works with many large, self-insured employers that swear by onsite clinics and health care personnel, "not everyone has access to that, not everyone prefers that," she says.

The numbers speak for themselves at Provant Health Solutions. Clients that just order technology-based health programs typically have utilization rates below 10%, while those that use the technology in conjunction with other programming see anywhere from 47% to 67% continued usage of the online tool. "When you're using a comprehensive strategy, you're using health professionals who are touching individuals through touch points: telephonically, onsite, face-to-face. And they're promoting the tools on the portal as part of the program and as support tools," says Provino.

For example, a health coach working with a diabetic client can observe as that client logs his glucose levels and can make sure his plan is on track. If they do notice a problem, they're able to intervene earlier than that client's next scheduled appointment.

Aetna offers a growing series of online programs to more than 11 million of the carrier's 18 million members that are accessible through its Simple Steps to a Healthier Life portal, according to Dan Greden, head of eHealth Product Management. A pilot program on meditation and stress management conducted last year with two groups, one onsite and one online, found the online group to be as effective - if not more so - as the onsite group in learning and applying the skills to manage their level of stress, according to Greden. "Done right, we think we can utilize online technology-based interactions to be just as effective as traditional mechanisms whether it's by telephone or in person," he says. "But it has to be very thoughtful about what they're doing online and it has to be integrated with the other interaction points."


SUPPORT NETWORK - AETNA is also in the process of developing online communities for people with similar conditions to interact with one another. "We're finding it more relevant to engage around specific topics that are clinical as opposed to try to steer these very flexible, broad communities," says Greden.

Through OptumHealth's participants can also blog and chat with others in their same situation. The site is tied in with online coaching services, says Moore.

By interacting with a greater degree of anonymity online, Greden says Aetna finds people to be more honest and open about their health care issues. Additionally, online questionnaires like health risk assessments will ask the tougher questions that a nurse on the phone may find are too sensitive to ask in the moment. "People on my team will compare the online interaction in a program to the telephonic and they say to me, 'The online program asks me some tough questions about what really matters to me, what my values are, and what the basis for my motivation is to improve my health that the nurse didn't ask me,'" Greden explains.

At MagnaCare, Joe Berardo, president and CEO, is "amazed" at the level of information people will share online - sometimes it's a little too much. "We will get things about, 'I have this rash ...' Sometimes we recommend that they delete their post. That way they don't end up having something out there that they don't want to have the next time they go on a job interview," he says. "But it's been pretty amazing, the candor."

The regional health care network serving New York and New Jersey recently launched an interactive blog dubbed "The Intercom" where MagnaCare staff and contributors post on a range of topics from cervical cancer to the best kale recipes. The recipe post alone has more than 14,000 "likes" on Facebook. Berardo is thrilled with the high engagement. "That is what I found amazing," he says.

Using the Internet and blogs in particular as a tool to help with engagement and motivation enables true change over time, says NBGH's Heinen. "It's a lifestyle change and there's wonderful support," she says. "I've seen it for weight management through blogging and some employers are supporting blogs."

A popular method of online interaction that's "a big deal right now," says Heinen, is employees participating in a group challenge with individually incentivized goals where members earn points for the group by meeting their own goals. "They love doing that and posting their team results and then the team captain sends out a Tweet, 'Check out who's No.1 this week.' It keeps everybody motivated and engaged," she says.


ALTERNATIVE OUTREACH - It's been about a year since MagnaCare fully embraced a social media presence with the help of a social media management company that runs its Facebook and YouTube pages. The Intercom blog launched after the management company suggested it present a less formal corporate presence to clients. "We thought there was some value to just having an open and a little bit more raw discussion a positive way to communicate," says Berardo.

Berardo also finds value in knowing MagnaCare is represented in all forms of media. "Everybody makes an individual choice on how they want to get their information, people follow blogs, people follow Facebook, people go online. Some watch the news, some read the newspapers and I think we have to be present everywhere," he says.

Both Provino at Provant Health Solutions and NBGH's Heinen agree that employers are joining MagnaCare in embracing a social media presence, but neither is sure that the enthusiasm transfers to the HR world. "We're seeing it from a corporate perspective but not so much from a corporate wellness perspective," says Provino. "The reason for that is it's health information and I think individuals are still extremely skittish about where their health information is located and who has access to it."

While Provant offers a social networking component to their wellness portal, 98% of its clients turn the functionality off, Provino adds. "I think it's just a protection to make sure they don't get into the situation where somebody's information is disclosed. Even if it's voluntary, it could turn into an involuntary or harassment situation and employers just don't want to go there right now."

Even so, wellness provider Wellsource is testing the waters on integrating social networking sites into their services as a support network for clients, says Don Hall, founder and chairman. "We're trying to use the modern medium," he says. "We're also looking forward to using iPhone apps and things where people can track their progress, exercise and things."

OptumHealth is also expanding its smart phone offerings. The OptumizeMe app for Droid, iPhone and Windows Phone 7 launched six months ago and is marketed directly to consumers for now. It enables people to join health challenges and compete and communicate with friends. For example, participants in last month's March of Dimes walks around the country used the program during the walks, according to Moore. OptumHealth plans to have a version directed at employer groups out by the end of the year that will include a desktop component, leader board tracking and incentive and sweepstakes award opportunities.

As for Rood & Dax's effort to create a wellness culture for clients, they are finding a video created by their own staff members to be an excellent outreach. The whole office participated in the approximately five-minute production that shares stats on wellness and shows staff members engaging in healthy activities.

Many clients watched the online video, and one group of around 125 lives that was inspired to sign up for a wellness prgram even created their own video. Says Dax: "It's kind of funny, we periodically tell our clients, 'Hey, you need to get some wellness culture going on around here. Let's get our video.' And then we get back to them. They're interested and they start setting up these committees and letting their employees have fun with it."


Timing and incentivizing wellness programs June may seem a little early to begin planning a wellness program set to start in 2012, but it's actually the best time of year to introduce the concept to clients, say experts. Wellsource recommends its clients provide a leeway of at least three months before open enrollment to get their program up and running. The process includes launching their custom website, acquiring training to run the site, working with wellness consultants to integrate Wellsource's tools into the employer's system, and then spreading the word to employees that the program is coming, according to Heather Tourville, COO and general counsel.

Employers working with Provant Health Solutions typically time the launch of their wellness program to coincide with open enrollment, or just before, so that employees can enter a new plan year already knowing where they stand with their level of care and what incentives they have earned, according to Heather Provino, CEO.

"We are seeing a huge transition to incentive-based programs across the marketplace right now," she says. "Health care reform has certainly played its hand in that, as well as the economy in general and the need for employers to bring employees to the table as partners in their health care affordability agenda."

Aetna continues to see employers integrate online wellness participation into employee premium calculations, says Dan Greden, head of eHealth Product Management. The carrier launched a member health engagement plan this year that builds upon a participant's personal health record and recommends actions to improve their health. As soon as an employee completes an HRA the plan updates to provide recommended actions to the employee.

While Greden does see disincentives from some employers that will increase member contribution to premiums, those same employers will often provide a chance to earn that money back by demonstrating healthy behaviors, he points out. The key, he says, is to structure wellness programs to reward completion of multiple steps in the plan, not just one.

Shawn Moore, senior product director with OptumHealth Care Solutions, looks at incentives as participants becoming loyal to their health. Optum's wellness program has an aspect called Surprise and Delights that occasionally pops up on the screen to keep employees coming back to the site by offering points that can be redeemed for gift cards or merchandise. "Instead of a typical stick-and-carrot play it's more of a loyalty thing and trying to get individuals to be loyal to themselves and their health process," she says.

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