Engaging Consumers in Health and Wellness

Earlier this week, I had the privilege of presenting at the North Carolina Association for Healthcare Quality (NCAHQ) Annual Conference in Durham. I have been a member of NCAHQ since 2004 and I served on the Board of Directors from 2011-2018. It was fun to attend the conference as a member as well as one of the invited speakers.

As many of you know, my education and training are rooted in health education. However, I spent most of my career working in healthcare quality improvement before returning to my health and wellness roots about five years ago when I became a health coach.  I have sometimes struggled to figure out how to meld the two worlds I’ve lived in professionally for the past 20 years, but I think I managed to do so with my presentation topic: Innovative Ways to Engage Consumers in Their Health and Wellness. I thought I would share some of the highlights from my presentation.

Health 2.0: Consumer-Driven Health Market

My presentation began by making the business case for the rise in consumerism in healthcare. As just about everyone knows, the US spends more money on healthcare (as a percentage of the gross domestic product or GDP) than most developed nations YET we have some of the worst health outcomes, including life expectancy. In addition, about 80% of the spending in healthcare is tied to the treatment of chronic conditions that are rooted in lifestyle choices. You know the list: heart disease, stroke, Type 2 diabetes and of course, obesity. These conditions are the most common and costly – but also the most preventable – of all health conditions.

With the rise of high deductible healthcare plans, which many employers are now turning to as a way to help reduce healthcare costs, consumers are now feeling the pinch in their own pockets. A physician office visit that may have incurred just a $25 copay in the past may now cost upwards of $100. This shift in the health insurance industry has been a wake-up call for many consumers to take a more active role in managing their overall health and wellbeing. We are also seeing the rise of “lifestyle medicine” – the use of evidence-based lifestyle approaches (e.g., a healthy diet, regular physical activity, adequate sleep, etc.) to prevent, treat and in some cases reverse the progression of the chronic conditions noted above. Healthcare is shifting (albeit much slower than many of us would like) from a sick-care model to one with a greater emphasis on promoting health and wellness through preventive services – with individuals taking a more proactive role in their health and wellness decisions.

Consumer Engagement Strategies

I prefaced my presentation by noting that my own passion for health and wellness grew out of my experience being overweight in my youth. It wasn’t until a good friend encouraged me to play sports in high school that I lost weight, gained confidence and realized that my behavior choices could directly impact my health – positively or negatively. This epiphany turned into a desire to help others on their own health and wellness journey. However, I also shared one of the first (and hardest) lessons I learned from my early days as a health educator – that not everyone is intrinsically motivated to make healthy choices or take care of themselves. Sometimes it takes a little extra incentive to get them engaged in the behaviors we know are linked to better health outcomes. I chose to share some of the more innovative strategies being used to help engage consumers in healthy lifestyle behaviors:

  1. Wearable Technology: A blanket term for electronics that can be worn on the body either as an accessory or as part of the material used in clothing. The most common format is the ubiquitous fitness tracker, such as a Fitbit or Apple Watch. However, there are some new products on the market including the Spree Smartcap and the Hexoskin Smart Shirt. The major selling feature of all of these items is the ability to connect to the internet, enabling the exchange of data between the device/product and a network. This has resulted in the user having access to a whole range of information about their health, such as steps taken, calories burned, heart rate, and sleep, at the touch of a button.

 

  1. Gamification: Essentially, the application of gaming elements and digital game design techniques to everyday problems including business dilemmas, social challenges or lifestyle behaviors. The idea is that gamified services tap into our natural desires for competition, achievement and status – and of course, the desire to have fun! One of the more common formats is smartphone apps and I chose to highlight a few including Plant Nanny (to help increase water intake), mySugr (to help diabetics manage blood sugar levels), and Stop, Breathe and Think (to support one’s meditation practice). All of these apps strike a balance between information and entertainment, but most importantly, are designed to help the user achieve sustainable change around the desired health behavior.

 

  1. Wellness Incentive Programs: Many employers and health insurance companies have been offering wellness programs for a long time so the idea itself may not be that innovative, but what has evolved are the types of incentives offered to individuals. In the past, employees or customers were often rewarded with small, health and wellness-related products such as water bottles, sweat towels or exercise bands. Then, many programs shifted to rewarding participants with gift cards to their favorite retailers. Today, we are seeing the rise of benefits-based incentives, where achieving a certain level of points for engaging in wellness activities or programs translates into a reduction in health insurance premiums and/or an employer contribution to Health Savings Accounts (HSA). Although these benefits-based incentives are considerably more expensive to implement, studies indicate that they do increase employee engagement in wellness programs.

Helping Individuals Find Their “Why”

I was the final speaker at the two-day conference and in years past, the final presentation has traditionally served as a way to end the conference on a positive note and provide attendees with some inspiration as they return to the workplace. Knowing how hard healthcare quality and safety professionals work every day, I wanted to give them a chance to focus on their own health and wellbeing. Thus, I dedicated the last 15 minutes or so of my presentation to lead attendees through the vision and values exercise I use with my coaching clients. Although we did not have time to take a deep dive into this exercise, I wanted to at least get them started thinking about their own vision of optimal health and wellbeing. Oftentimes, healthcare professionals tend to neglect their own health as they are so focused on taking care of others. This was a gentle reminder of the need to take care of themselves first so that they can continue to take care of others.


If you work in healthcare in North Carolina and are not already a member of NCAHQ, I encourage you to visit their website to learn more about the association and the work of its members to promote excellence, professionalism and continuous improvement in healthcare quality across the state.

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Know your numbers – but which ones?

It’s that time of year when many employers are strongly encouraging their employees to complete their biometric screening, typically as part of an employee wellness incentive program. According to the CDC, a biometric health screening is defined as “the measurement of physical characteristics such as height, weight, body mass index, blood pressure, blood cholesterol, [and] blood glucose…that can be taken at the work site and used as part of a workplace health assessment to benchmark and evaluate changes in employee health status over time.” Many organizations use this screening as a way to increase benefit offerings, improve employee health, and decrease health plan costs at the same time. Given the amount and variety of measurements involved in such screenings, making sense of the numbers can be challenging for many people.

I recently came across an article in the Washington Post written by a registered dietitian, who surveyed 20 experts in her field for their suggestions of which numbers are the most important when it comes to monitoring health. Interestingly, many of the numbers they believed to be most important are not even part of the usual biometric screening. For example, the first two recommendations focused on daily fruit, vegetable and fiber intake:

  • When it comes to a healthy diet, a simple method to use is the plate model, with appropriate proportions of fruits, vegetables, proteins, and grains. The rule of thumb is to fill half your plate with mostly vegetables and some fruit, which may be easier than trying to track how many servings of each you’ve eaten. Using this plate method can also help you get the recommended daily amount of fiber, which is 25-35 grams. Fiber is important for regularity, managing cholesterol and blood sugar levels, and prevention of certain cancers including colorectal cancer. It is also helpful in weight management as it keeps you feeling full for longer. Fiber-rich foods include most vegetables (the darker the color, the better), fruits, beans, nuts/seeds and whole grains.

The article did reference two of the typical biometric tests as being important for health management: fasting blood glucose (sugar) level and blood pressure:

  • The fasting blood glucose test is used to check for Type 2 diabetes and the goal is for it to be less than 100 mg/dL. These days, it seems more and more people are diagnosed with “pre-diabetes,” which corresponds to a blood sugar level of 100-125 mg/dL. The good news is that you can often reverse the effects of Type 2 diabetes (and pre-diabetes) through eating a healthy diet and exercising regularly. Therefore, it’s important to conduct this test at least annually to monitor your blood sugar level so you’ll be able to make necessary lifestyle changes to prevent or reverse a diagnosis of diabetes.

 

  • High blood pressure is commonly referred to as the silent killer because it often has no clear symptoms. However, if untreated, high blood pressure can lead to a heart attack or stroke. Therefore, it’s important to monitor your blood pressure regularly so you can seek treatment if necessary. This measurement is more important than ever as new guidelines from the American Heart Association lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention. Previously, a measurement of 140/90 or greater was considered high. Now, the threshold has been lowered to 130-139/80-89 and even 121-129/<80 is considered “elevated” and an early warning that blood pressure should be lowered through non-medication approaches (primarily diet modification and exercise).

 

The author also addressed some measurements that she and her colleagues believe don’t matter as much when it comes to monitoring health. I agreed with all of them, but the one I want to address is body mass index or BMI, as there has been lively debate for some time now as to whether it is an accurate measure of health, particularly of obesity. As the author notes, BMI is a tool used to classify people into categories of normal weight, overweight or obese depending on height and weight. Individuals with BMI results in the latter two categories are often encouraged to lose weight by their healthcare provider and many are incentivized to do so through workplace wellness programs. However, BMI does not consider factors such as age, gender and bone structure, nor can it distinguish between muscle and fat. Thus, you can have a healthy, athletic person who exercises regularly but has a high BMI due to muscle mass. Or conversely, you can have a person with a normal BMI who does not eat well or exercise at all and is generally unhealthy. Going by BMI only, the athlete would be considered the obese or unhealthy one.

Scientists have recognized that what really matters is not body weight but body fat, and thus given the limitations of BMI, they now recommend a different measure for body fat/obesity: waist circumference. Measuring your waist to learn if you have abdominal obesity and excess visceral fat (fat surrounding your internal organs) is important as excessive fat inside the abdomen is a major contributor to cardiovascular disease. You have a higher risk of developing obesity-related conditions if you are:

  • A man whose waist circumference is more than 40 inches
  • A non-pregnant woman whose waist circumference is more than 35 inches

The one drawback to waist measurement is that it is more prone to errors than measuring height and weight. Click here to learn the proper way to measure waist circumference. It may also help to have a family member or a healthcare professional measure it for you, to be as accurate as possible.

There are numerous ways to measure and monitor your health and wellbeing. It’s important to look at a variety of screening test results to understand the complete picture of your health, but it’s also important not to get hung up on measurements that may not be all that accurate. I encourage you to discuss the options with your healthcare provider at your next physical or checkup so that together you can determine the best measures of your health.