Healthcare expenditure in the U.S. in 2014 is forecasted to be $3.8 trillion. Despite this staggering sum, three in every four Americans will die prematurely from a chronic disease - conditions that are related to lifestyle, habit or circumstance.
The plain fact of the matter is that for over 100 years, the licensed medical establishment has been poorly structured to prevent the incidence of chronic diseases such as diabetes and heart disease. On August 16th, the Center for Medicare & Medicaid Services (CMS) announced that it would pay doctors who treat Medicare patients with chronic diseases a modest fee to monitor their patients in between office visits.
This is a welcome move in the right direction - for over 100 years - the licensed medical establishment has been focused on, and incented to, treat patients for urgent problems. In an ideal world, doctors would be incentivized to prevent chronic disease - and patients would be coached through the challenging process of improving their diet and exercise habits.
In reality, this isn't part of a physician's job description, and patients aren't being informed of their risks, much less instructed how to reduce them. Type 2 diabetes is the most dire example. According to the CDC, of the 29.1 million individuals with Type 2 diabetes in this country, 1 out of 4 doesn't know they have it.
And 90% of the 29.1 million individuals with prediabetes remain completely unaware. These alarming statistics - the latest one: 40% of all Americans are on course to develop Type 2 diabetes - are driving changes to our health care system. But change will be slow. Meanwhile, employers are rising to the occasion by looking for innovative new solutions.
Rand's 2013 Workplace Wellness Programs Study found that half of U.S. employers offer wellness promotion initiatives, and 85% of those employers include programs focused on diabetes. Programs that address diabetes and prediabetes have enormous potential to influence employee health and health saving positively - 87% of current employee health care cost savings are the direct result of disease management programs.
Unfortunately, engagement in these programs is, on average, abysmal, with only 16% of qualified individuals participating, according to another Rand briefing report from earlier this year. That's not surprising, given that the classic disease management program consists of a series of poorly timed and non-empathetic email and/or phone reminders.
A move toward new and innovative offerings is absolutely in order, and the most forward-thinking employers are already thinking in this direction. But for disease management programs to be both appealing and effective, it's necessary to keep a few things in mind.
The Road To Better Health Is Littered With FitBits
The rise in popularity of personal health trackers has led some employers to consider programs that revolve mainly around wearable devices. The novelty of wearables is often enough to entice employees to get involved. But a recent survey by Cambridge, Massachusetts-based Endeavour Partners revealed that one third of people who own wearable fitness devices stop using them after just six months.
Being presented with a steady stream of personalized data may be enough to engage employees for a short period of time, but the novelty soon fizzles - and the Fitbit ends up stuffed in the back of a desk drawer. In order for health trackers to be helpful in managing and preventing disease, they must be integrated into a program that approaches behavior change scientifically and holistically.
Limited Accessibility Will Lead to Limited Participation
People fail to engage with their health because they are busy, tired and stressed. And people who are busy, tired, stressed and dealing with a condition like diabetes or prediabetes have even less time and energy to spare.
In order to increase engagement and adherence amongst this key demographic, programs must be accessible around the clock and work equally well on any device, from a personal computer, to a tablet, to a smartphone. If your goal is to increase participation, you can't expect employees to make special efforts to access a program. You have to bring the program to them.
If An Online Program Isn't Well-Designed, It Won't Stick
Employees are also consumers with high standards when it comes to the look, feel and functionality of their personal tech. They're deciding whether to invest their money in an Xbox One or a PS4, to sign up for Hulu or Netflix, to buy an iPhone or an Android, and all of these options compete for their already limited attention.
To inspire long-term engagement and adherence, disease prevention and management programs that use web and/or mobile platforms should aim to live up to these standards. A single bad experience with a confusing or unappealing interface can mean sudden death for engagement. On the other hand, a surprisingly well-designed and seamless experience can result in unparalleled involvement.
If It Isn't Based On Science, It's Unlikely to Get Results
Authors of a recent study published in the Journal of Medical Internet Research analyzed more than 2,000 health and fitness apps, and concluded that the majority failed to teach people the skills necessary to change behaviors. Innovative disease prevention and management programs should be both evidence-based and clinically proven.
When they are, they work. A clinical trial recently published in The Diabetes Educator showed that the online-based diabetes prevention program PreventNow.com, which integrates established behavioral science and one-on-one health coaching with all the innovation of wireless health trackers, social networks, and multi-platform accessibility, was found to be even more effective at reducing the risk factors for Type 2 diabetes than in-person programs designed by the CDC.
The upshot: When done right, innovative disease prevention and management programs can be the solution employers need to stem the growing epidemic of chronic illness amongst their workforce. And the best of these programs will enable meaningful behavior change that is sustainable for a lifetime.
About the Author
Mike Payne is Chief Commercial Officer and Head, Medical Affairs of Omada Health. His company, Omada Health is pioneering a new class of medicine called digital therapeutics that drives positive health outcomes through a combination of immersive digital experiences tied to real, clinical outcomes.
The company's flagship product, Prevent, is the first-ever online diabetes prevention program for employees and the general public, and is based on the landmark Diabetes Prevention Program (DPP) clinical trial.
