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Health Benefits


OPINION: IMPROVE EMPLOYEE HEALTH USING BEHAVIORAL ECONOMICS

Nudging workers to care more about their health boosts retention and helps
contain benefit claims costs.
Dr. Joseph Sanford and Dr. Kevin SextonFebruary 3, 2022
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Photo: EvgeniyShkolenko


THE CFO BRIEFCASE

01


2022 REGULATORY OUTLOOK: A YEAR OF BIG DEVELOPMENTS?

02


2022 OUTLOOK: 4 CHARTS TO WATCH

03


2022 M&A OUTLOOK: DEAL MARKET EXPECTED TO CONTINUE HOT PACE

04


2022 INTEREST RATES OUTLOOK: FED TIGHTENING IS NOT RISK-FREE

05


2022 OUTLOOK: CFOS’ 4 REALMS OF RISK

Prioritizing employee health and wellness is critical to recruiting and
retaining the best talent. Healthy employees tend to be more productive and
express more job satisfaction, according to the U.S. Centers for Disease Control
and Prevention. But what can companies do to improve the health of workers?
Defining the specific health needs of employees and taking a hard look at the
organization’s wellness program is a good start. Clinical informatics and
behavioral economics can help an organization make those personalized decisions.

Clinical informatics is a newly recognized medical specialty that uses
technology and data science to create systems that improve health outcomes,
patient care, and clinician-patient relationships. 

Behavioral economics combines aspects of psychology and economic modeling to
evaluate human behavior and explain why people often do not make the best
decisions — even when they have all the information and tools within reach.
Behavioral economic innovations strive to make choices easy, attractive, social,
and timely. 

Combining the two allows scientific methods of influencing decision-making to be
adapted to the delivery of health and wellness initiatives.


CHOICES, NORMS, AND NUDGES

Companies can use techniques such as choice architecture, defaulting, social
norming, and nudges (all defined below) to select wellness programs, roll them
out to employees, and iterate toward mutually beneficial outcomes. That is best
exemplified in an unexpected industry: video games. 

Good game design teaches users intuitively through things like optimal friction
and defaulting to encourage behaviors. For instance, the original “Super Mario
Brothers” game used defaulting by having Mario always face the right of the
screen, telling players that’s where they should go. It also had behavioral
prompts: Mario could move backward only so far before the left side of the
screen blocked him, but he could jump smoothly and far to the right side of the
screen at will.

--------------------------------------------------------------------------------

 * Choice architecture — Designing ways to present choices to consumers and the
   impact of that presentation on consumer decision-making.
 * Defaulting — Setting a desired value or option to be automatically selected
   if the user does not specify a substitute. For example, people with driver’s
   licenses having to opt out of organ donation programs instead of opt in.
 * Social Norming — Modifying personal behavior based on how we observe our
   peers behaving in similar situations. The Social Norms Theory posits that our
   behavior is influenced by misperceptions of how our peers think and act.
 * Nudges— Influencing the behavior and decision-making of groups or individuals
   through positive reinforcement and indirect suggestions. An example of a
   nudge is providing people with smaller plates to get them to eat less.

--------------------------------------------------------------------------------

Similarly, gamification is used to design online portals that motivate people to
take certain actions. A system can deliberately nudge to encourage employee
participation and make preferred actions the easiest for employees to choose by
assigning default choices or adjusting how hard or easy a process is without
limiting a person’s autonomy. Social norming has become particularly prevalent
to drive engagement. Presenting individual performance metrics next to an
average across peers has proven to be a motivating strategy to get people to
act. Another method in online portal design is to send push notifications when a
user’s friends are online or when large events (like employee wellness webinars)
happen.

Research shows that employers can incorporate these techniques into their
wellness programs to encourage healthy behaviors. A 2019 report in the Journal
of the American Medical Association showed that employees in a wellness program
are more likely to report healthy behaviors like exercise and active weight
management or dieting. Research by Katherine Milkman and others on three groups
of Google employees with different exercise arrangements showed that flexible
incentives work better than incentives that encourage a more rigid behavior or
activity. In one study, paying participants for each day they visited the gym
regardless of what time of day they went generated more gym visits than paying
participants to go during a daily two-hour window.

A full-featured wellness program typically includes a user-friendly online
portal, annual wellness assessment through a survey, wellness visits to medical
providers, a biometric component with lab tests, and ongoing engagement with
individual employees. Each component should be annually assessed for
effectiveness and, in the case of testing or intervention, for adherence to
best-practice guidelines. Encouraging wellness visits can help stabilize
variations in health care and decrease the cost of stop-loss insurance
(protection against catastrophic or unpredictable losses) for self-funded health
plans. 

For example, age-appropriate screenings for common cancers can help catch
early-stage cancers, when treatment leads to better outcomes at a far lower
expense than late-stage diagnoses. People often dislike undergoing screenings,
especially when scheduling preventive visits conflicts with more urgent matters.
That is particularly true if a company does not effectively endorse medical
time-off for non-urgent visits. By allowing employees to schedule time for a
preventive care during the work day, managers can remove barriers to action and
promote behaviors that focus on safety and well-being. New approaches to
wellness that incorporate the tools mentioned above may require a shift in many
companies’ cultures.


ANALYZING CLAIMS

In a self-funded insurance program, the employer takes on most or all of the
cost of benefit claims. By collaborating with an employee benefits consultant to
implement a self-funded plan, employers can isolate key cost drivers. With
detailed claims data, it is possible to manage emerging health risks in a given
population. In addition, the data can inform the design of health and wellness
strategies and measure effectiveness over time.

Claims data analysis enables employers to review more claims more consistently
in less time with a logical, definable, and highly reproducible process. That
allows employers to have quantitative conversations with third-party
administrators and other vendors. These discussions may impact what insurance
covers, how reimbursements occur, and which steps are required for payment
approvals.

To be successful self-funded employer wellness programs should be highly
customized to each individual. Providing a mix of behavioral economics
incentives and clinical informatics-based data analysis helps employees achieve
personal wellness goals while ensuring participation in routine preventive
health care that lowers costs for employers.

***

Dr. Joseph Sanford and Dr. Kevin Sexton lead Datafy and partner on Medical
Claims Analytics with Stephens Insurance.

 



employee benefits


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THE 7 HABITS OF HIGHLY EFFECTIVE CFOS: TECHNICAL AND BEHAVIORAL SKILLS TO LEAD
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