BHCG Monitor: Focus on Health Care Benefits

Return to the BHCG Monitor


Moving Beyond Words and Dollars – Boosting Employee Health and Wellness Engagement

Many recent surveys show a majority of employers, in an earnest effort to reduce health care costs, are fully invested in a variety of strategies to engage employees and their dependents in their own health and health care decisions. These include wellness programs, disease and case management, decision support resources and incentive programs to reward desirable behaviors and lifestyles.

Yet employees still aren’t engaging with these tactics as hoped, or as promised by vendors. A recent Gallup poll reports only 26 percent of employees surveyed participated in wellness programs, although a majority of them (68 percent) had access to a program through their employers.

However, there are real incentives for both employees and employers to continue down the wellness path. For example, a Rand Corp. study found wellness programs were able to reduce costs, on average, by $30 per member per month. What then are the obstacles to active participation in these programs? And what can be done to boost engagement to a level that will bring about change?

Consider psychology

There is no “one size fits all” solution for engaging employees. A number of employers offer financial rewards to employees who participate in health and wellness activities. Economic incentives can be a way to grab employee attention and motivate them to take the first step toward initial behavior change. But it has been proven a higher level of motivation is needed for people to make lasting lifestyle changes than what can be achieved through short-term financial incentives.

You may be of the opinion that the resulting economic and health benefits should be the ultimate motivation for more informed, healthier behaviors, but that is not always the case. The reason is simple psychology.

Let’s take the example of biometric screening. Shouldn’t employees, once they learn about significant areas for improvement in their health, be motivated to take action? The answer is usually no. Changing behavior requires more than just having information – psychology plays a key role in our decisions to make behavioral changes and to act upon decisions. Many other factors come into play to impact our actions.

Readiness for change

Not all employees are at the same stage of readiness when it comes to their willingness to change. Each must be treated differently in order to impact their behaviors. The Stages of Change cognitive-behavioral model developed in 1979 is based, in part, on the theory that people will ignore or dismiss information on how to change if they are not ready or willing to change. The model recognizes five different stages of change as a framework for explaining how behavioral change occurs – and the process is not linear, people can move in and out of these stages in no particular order.

Here’s where employee coaching can play a significant role when areas of improvement or chronic conditions are discovered through health assessments and biometric screening. Successful coaching starts with an honest discussion with the individual as to what their personal stage of change might be – before recommending behavior modification programs. This suggests that employers would do well to include coaching as an integral part of any screening or health assessment activity and to make certain vendors include a readiness for change component in their programs.

The case for comprehensive programs

A recent research brief from the Rand Corp. found that “while incentives increase employee uptake among programs with limited services, offering a comprehensive program is almost as effective.” The researchers considered “comprehensive” programs to be those that included a broad range of health-screening, lifestyle-improvement and disease management services. “Limited” wellness initiatives were defined as being limited to one or more of the components listed above.

The study reported that employers offering rewards of more than $100 for “limited services” programs experienced participation rates of 51 percent (compared with 36 percent for those with smaller rewards). However, they also found employers offering comprehensive programs reported participation rates of 59 percent – and concluded participation in these programs was less sensitive to the types of incentives provided.

What are the implications of this research for employers? It might make sense for employers to redirect resources away from increased incentives to adding a greater range of health and wellness services. “While incentives seem to be effective at increasing program uptake, they are not a panacea,” the researchers stated. “Offering a rich, well-designed program is almost as effective at boosting employee participation rates as incentivizing employees to join more limited ones.”

Engage influencers

Employers across the country report success in incorporating employee wellness advocates to boost participation and interest in health and wellness programs and activities. This should come as no surprise. Commercial marketers have long recognized the importance of social networks – friends, family and support networks – as critical target audiences, since they have tremendous influence on decision-making. When a marketer discovers how to engage these influencers they hold a powerful tool.

A recent study revealed that “recommendations from others” and even “consumer opinions posted online” held significantly more weight with consumers than TV, radio, print and online advertising on the trust scale. Word of mouth marketing can change perception and be used quite effectively to promote health tools and programs. A workplace wellness challenge that uses word of mouth marketing through engaged influencers can turn tepid interest into robust awareness and participation to create a company-wide cultural event.

When employers enlist other employees as trusted advisors to help develop and deliver materials, it can serve to increase the level of trust experienced in a company’s culture and in the sources of information provided. Employee advocates can also be used as role models to demonstrate desired behaviors and stimulate word of mouth to create a work environment “buzz.”

Utilizing employee advocates can also help employers crack the tough nut of reaching different generational and cultural groups through targeted messaging. Although most of us understand the benefits of targeted marketing, the logistics and know-how of developing such programs are often elusive. Employee advocates can serve as strategic focus groups when crafting messaging and engagement ideas. When recruiting influencers, employers should make certain to include diversity in their list of criteria to effectively reach target audiences.

It is also important to note that the home environment is just as critical as the work environment – if not more – in supporting behavioral change. Engaging spouses, children and extended families is always a good call to be certain all influencing bases are covered. Communications, education, empowerment and rewards should be directed toward these vital influencers as well.

In conclusion

Employers are beginning to recognize that communication and monetary incentives alone do not guarantee success. Wellness initiatives succeed only if they inspire real and lasting behavior changes in employees and dependents.

Incorporating coaching that considers individuals’ readiness for change, developing comprehensive health and wellness programs and effectively using employee influencers all represent proven tactics to boost engagement. Engagement is the missing element that connects education to action, moving people beyond mere awareness. And as we all know, engagement is what drives improved outcomes, employee satisfaction – and ultimately, lower health costs.



Barry Hall, FSA, MAAA. Engaging Consumers in Changing Health Behavior. White paper, Buck Consultants, 2015.

Forrester Research. What's the Buzz on Word-of-Mouth Marketing? Forrester Research, 2013.

Otto, Nick. "Boosting Employee Wellness Engagement Will Require New Incentives." Employee Benefit Adviser, June 23, 2015.

Prochaska, J. O. Systems of Psychotherapy: A Transtheoretical Analysis. Homewood, IL: Dorsey Press, 1979.

Stephen Miller, CEBS. "HR Topics & Strategy." Society for Human Resource Management. May 21, 2015. (accessed November 2015).



Back to top


Find us on: LinkedIn | Facebook | Twitter

BHCG Monitor: Focus on Health Care Benefits - April 2012