The letter in the Journal of Occupational and Environmental Medicine discusses how women comprise nearly half the workforce and have unique needs when it comes to health behaviors, access to preventive services and effective incentives. There is also a “trickle down” effect because women make the majority of health care decisions for their families. Improving the health literacy and health behaviors of female employees can make a positive impact on the health and medical care costs of not only the employees, but their families too.

Read my article from this week at Women of HR for tips about how working women can incorporate more wellness into their daily lives. To the extent employers can help facilitate these wellness strategies by removing structural barriers like providing a fitness facility or offering on-site flu vaccinations, they can help female employees achieve better health. I would enjoy hearing from employers about ways they meet the wellness needs of female employees.

Health literacy is accessing, understanding and using information to make health decisions and is an important health communication goal. Healthy People 2020 includes health literacy as part of its health communication focus and JAMA offers an overview of the topic and tips on improving health literacy in this week’s issue.

For more about health communication, including health literacy, read my blog post from last week at the Chicago Health Technology site. I discussed the topic in the context of both consumers and providers.

Companies like Keas have tried and failed (fortunately for them, Keas is finding success with a new gamification approach). They aren’t the only company whose attempted to be the “Mint.com” of health care – if I only had a dollar for each time an entrepreneur has mentioned this aspiration, I’d need Mint.com just so I could manage all my earnings! Watching this strategy unfold, I ask myself “Are we trying to do too much, too soon?”

I believe relevance and showing progress are both key ingredients to motivating behavior change.  Collecting data enables tailored content and interventions. People see their progress through data feedback. Ideally this is immediate– real-time if possible– and relevant to them. We know it’s relevant if it connects with their values. Thomas Goetz of Wired magazine gave an interesting TEDTalk on using personalized data to create simplified, relevant messages.

Up-and-coming services and apps like Foursquare and RunKeeper collect and feed back user data for specific goals. They are focused on specific behaviors, in these cases, visiting places and runs. We can observe these projects and learn from their successes and failures. Just like a person can’t realistically change his own diet overnight, we as an industry can’t change our population’s health and wellness overnight. So, let’s see what works as we tackle different behaviors using different data-driven tools. At some point, I think we will achieve the Holy Grail of healthcare– managing and using our personalized data all in one place– but only after successive industry-wide iterations.

Today, I wrote about wellness technologies for self-insured employers on the Chicago Health Technology blog. Take a look!

Please visit my blog entry at the Chicago Health Technology Organization’s website to learn more about the conference and Chicago area speakers. I will be presenting Data-driven Health Behavior Change and mHealth on Thursday morning. Looks to be an interesting event!

Nexium

I peer-reviewed an article for an open source journal, BMC Public Health, that showed traditional measures of socioeconomic status (SES) may underplay social disparities in smoking prevalence. Not surprisingly, the authors found that increasing smoking prevalence was correlated with increasing deprivation. The consumer segmentation tool linked smoking to non-traditional SES factors such as access to a car, single-parent vs. married households and TV viewing behavior.

This study is a good example of linking the increasing amounts of collected consumer data with health data to gain insights about the health behaviors of individuals.

A study published in Obesity found that low-cost weight management programs can be effective. The article, written by researchers from the University of Colorado Anschutz Medical Campus, reported the outcomes from the nonprofit Take Off Pounds Sensibly (TOPS) program. They found that participants lost five to seven percent of their body weight and maintained the loss. At $90 annually, TOPS is significantly less expensive than other commercial weight loss programs that cost hundreds and even thousands of dollars (when food prices are included) per year.

This is great news for small to midsized companies with limited resources. Offering a weight loss program provided by nonprofits such as TOPS or Overeater’s Anonymous can be a positive step toward achieving a healthier workforce. In a study I published in 2007 with researchers at the University of Washington, we found that a comprehensive weight management program can improve both health and cost outcomes. A difference in that program, used by Fortune 500 companies, than the one here, was its $6000 annual price tag per participant. While that program had effective components such as physician monitoring and behavioral counseling, its degree of intensity and cost is likely too great for small to midsized companies with a low budget for wellness. For these employers, supporting a membership into a program like TOPS may be the best use of their limited health promotion dollars.

The study analyzed over 44,000 individuals and found that health screenings for conditions like cancer and high cholestrol increased when insurance deductibles were waived. This large study is a great start in developing a more solid evidence base for preventive benefits utilization strategies.

In the news article, I emphasize the importance of effectively communicating the waived deductible policy to the member population. A lack of awareness of the policy could be an explanation for why there was only a modest increase in utilization. This should also go hand-in-hand with educating members about the importance of obtaining clinical preventive services. The member is weighing the costs and benefits of taking the time and effort to receive the screening; as health educators we need to show these services are worth getting.

So where do these savings come from exactly?  Decreasing absenteeism (physically not going to work) and presenteeism (being at work but not being that productive due to illness, etc.). Less illness, improved attitudes and better morale all contribute to a more productive workforce.

How does a company measure productivity? There are several ways including traditional measures such as sick leave and disability to newer measures like self-reported surveys (e.g., WPAI, WLQ).

How can an employer improve productivity?

1) Focus on the major disease causes of productivity impairment– these include common diseases (e.g., hypertension, diabetes) and relatively inexpensive diseases (e.g., migraine, depression)– through health promotion and preventive services.

2) Implement a targeted program that zeros in on one or two productivity suspects such as back pain or depression, depending on the specific population’s needs.

3) Measure using multiple methods pre-, during, and post-program.

There is huge potential with personal devices for lowering costs and helping the patient take control of his/her own health. It’s great to see technology companies developing low-cost alternatives. All too often, the pharmaceutical and medical device industries push more expensive drugs and equipment that are no better, and sometimes less safe, than existing solutions. My PhD dissertation committee chair, Dr. Donald Patrick, co-wrote a comprehensive book on this: Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises. It points out that newer isn’t always better when it comes to medical care. 

I think we will reverse the trend of blindly accepting the newest, most expensive care if not just because we want to but have to in order to control health care costs. Comparative effectiveness studies, drug and device regulations, and low-cost technologies as described in the NY Times article will help society achieve better, high-value care.