Scorecard Quarterly

Engagement Methods

by Steven P. Noeldner, Ph.D., Partner, Mercer

The term “engagement” is widely used in employee health management; however, there are varying definitions of this term. While participation rates are sometimes used as a measure of employee engagement in health management programs, most experts agree that engagement involves much more than enrolling in programs and activities; it implies that individuals participate in meaningful ways that ultimately lead to behavior change and health maintenance or improvement.

To engage individuals in health-promoting activities, you must both educate them about the programs and encourage them to enroll and participate. The HERO Scorecard outlines best practices for employee engagement in two areas: communication and incentives.

Communication

The importance of effective communication for employee health management program success is often underestimated. For many organizations, communication begins and ends with a letter or newsletter article announcing the start of a new program. However, about two-fifths of respondents (43 percent) have an annual or multi-year communication plan and—not coincidentally—these organizations also reported significantly higher participation rates for the health risk assessment (54 percent) than those with no communication plan (26 percent). Pre-launch communication and regular communication with stakeholders were also associated with high health risk assessment participation rates (54 percent and 57 percent, respectively).

Because disease management and lifestyle management are typically targeted to individuals in need of these programs, it’s important to provide detailed information that not only informs, but also compels people to accept the invitation to participate. Higher-than-average participation rates were associated with respondents who received communications focused on purpose, components, value and deadlines for these programs. 

Many organizations recognize that their communication efforts are not as effective as they could be, with only 9 percent of respondents saying their communication program was “very effective” at promoting employee engagement, while 44 percent said their communication efforts were “not very effective” or “not at all effective.” Either way, most organizations likely have an opportunity to improve their communication efforts by adopting best practices.

Incentives

The use of incentives to encourage participation and engagement is a widely used best practice. Respondents are most likely to provide an incentive to complete an HRA (85 percent) or to participate in a lifestyle management program (61 percent). However, just 27 percent of employers offering disease or condition management programs provide an incentive to participate. Because these programs are often provided through the health plan, organizations are less likely to actively promote them through communication initiatives and incentives, and instead rely on the health plan to engage members.

Health Risk Assessment 

While cash or gift cards are still the most common incentive used to boost health risk assessment completion (40 percent), many employers are now tying completion of the assessment to lower health plan costs, most often a reduction in the premium (30 percent). A few provide either lower copays (1 percent) or lower deductibles (3 percent).  

Contributions to health spending accounts (HSA, FSA, or health reimbursement account) were offered by 16 percent of organizations. The average value of incentives (across all types) was $214. For employers in this sample, higher incentives are linked to higher participation rates. Among respondents providing incentives valued at $75 or less, the participation rate was 39 percent. This increased to 64 percent among respondents offering incentives valued at $200 or more. While the great majority of incentives were considered rewards or positive incentives, 4 percent of respondents said that participation in the health assessment was required to enroll in the health plan, which could be interpreted as a penalty for non-compliance.

Disease/Chronic Condition Management

Only 27 percent of responding organizations provided incentives for participation in disease management programs. Of those that did, 11 percent offered cash or a gift card, 5 percent offered lower health plan costs, and 5 percent offered contributions to health spending accounts. The average value of incentives for disease management participation was $141.  Not enough data was available to evaluate the relationship between the value of incentives and their association with participation rates.

Lifestyle Management / Behavior Modification 

As mentioned previously, 61 percent of responding organizations offered some type of incentive to encourage participation in lifestyle management programs. The average value of the incentive was $162. Cash or a gift card was the most prevalent form of incentive (32 percent), followed by raffles (22 percent), token non-cash rewards (16 percent), lower health plan costs (15 percent), intra-company competitions (12 percent), and contributions to health spending accounts (9 percent). For those organizations that reported the value of their incentives as under $50, the average participation rate was 49 percent; among those offering incentives valued at $150 or higher, it was somewhat higher, at 57 percent.

Engagement Best Practices Related to Outcomes

One valuable application of the HERO Scorecard database is to compare the use of employee health management best practices to outcomes. While the Outcomes section uses a mix of quantitative and qualitative measures, it provides insight into how the responding organizations perceive their program outcomes. The comparison of scores for the Engagement Methods section to reported outcomes suggests that organizations that employed more best practices achieved higher levels of participation, greater risk reduction, and more positive medical trend cost experience than those organizations that employed fewer best practices. For example, a quarter of high-scoring respondents (25 percent) reported that their employee health management program has had a substantial positive impact on medical trend, compared to just 11 percent of respondents with average scores.

While the Engagement Methods section of the Scorecard focuses on communication and incentives, a broader view of best practices for EHM suggests that other program elements also contribute to optimal engagement in programs, including leadership support and culture of health, which are covered in other sections of the Scorecard. It’s important to remember that none of these elements stand in isolation from the others. Research evidence suggests that participation, program impact, and financial outcomes are subject to the effectiveness of most or all of the elements that contribute to engagement. For example, an incentive of the same type and value offered by an organization with an excellent communication plan and execution is likely to get better program participation and results than one that does moderately well at communicating the incentive and the employee health management program.

It is encouraging that scores for the Engagement Methods section are directionally associated with participation rates, health risk impact and self-reported financial outcomes. This supports the value of using the Scorecard to guide the development of successful employee health management programs.

About the Author
Steven P. Noeldner, Ph.D.
Partner & Sr. Consultant in the Total Health Management specialty practice of Mercer