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© RedBrick Health, 2015. Not for unauthorized distribution.

Michigan Wellness Council

September, 2015

Does Wellness Work? Don’t Believe Everything You Think!!

2

A (very) little bit about us

© RedBrick Health, 2015. Not for unauthorized distribution. 3

RedBrick Health

Our Purpose

Help people be healthy

Our Passion

• Consumer ownership of health

• Creating real engagement

• Designing for behavior

• Doing what works (vs. what’s conventional)

CONSUMER

ENGAGEMENT

TECHNOLOGY

PLATFORM BEHAVIOR

SCIENCE

DATA INSIGHTS


What’s everyone talking about?

personalized

evidence-based engagement

wellbeing accountability

fle

xib

le

incentive management mobile

SOCIAL consumerism

keep it simple

gamification exchange strategy

ROI

OPEN PLATFORM

price transparency

wearables

scalable

closing care gaps

BEHAVIOR CHANGE fre

sh

PRODUCTIVITY

INTEGRATION EXCISE

TAX

recruiting/retaining talent

digital coaching

reasonable alternatives

treatment decision support

population health

management fun


• Why do we think the way we do?

• Why do we behave the way we do?

• Does “wellness” actually work?

• What about incentives?

• How can we tap intrinsic motivation, too?

• Do outcomes-based designs drive outcomes?

Some questions...

6

Why do we think the way we do?


" We make too many

wrong mistakes" famous philosopher and baseball

star Yogi Berra

Why do we think the way we do?


Kida’s six pack of broken thinking COMMON MISTAKES

1. We prefer stories to statistics

2. We seek to confirm

3. We rarely appreciate the role of chance and

coincidence in life

4. We can misperceive our world

5. We oversimplify

6. We have faulty memories

Source: Adapted from: Thomas Kida, “Don’t Believe Everything You Think”


Kida’s six pack of broken thinking

1. We prefer stories to statistics • The evidence tells the real story despite our natural

tendencies to hold onto beliefs

– Smoking isn’t bad for your health- I’ve got an uncle who

smoked and lived to be 100

– Listening to Mozart’s music promotes more intelligent

children

– Lots of anecdotes don’t add up to evidence




2. We seek to confirm • We look for evidence that confirms our beliefs and ignore

contradictory evidence

– Politicians we don’t like are crooked, ones we like aren’t

– Social stereotypes, racial profiling

– Astrologers predictions

• Sugar induced hyperactivity studies: – One study showed that 5 out of 6 kids who consumed sugar were

hyperactive. Creates a belief.

After further research it was discovered that 5 out of 6 kids who

did not eat sugar were also hyperactive. Still a common belief.




3. We rarely appreciate the role of chance and

coincidence in life • Two things may be true and occur together but are not

related

• Sports figures: lucky pennies, lucky socks

• Guy wins $100 in the lottery after reading the serial number

on the $10 bill he used to buy the ticket. He never wins

again, but plays every day

• Million to one odds happen 8 times a day in New York




4. We can misperceive our world • Fact: Referees call more penalties on teams wearing black

than any other color.

Why? Black is associated with evil.

• UFO sightings that are airplanes and clouds




5. We oversimplify: We use shortcuts when thinking,

this saves us time and simplifies life • We ignore base rates or don’t take the entire population into

account

• We disregard regression to the mean

• We ignore sample size

• We disregard the “conjunction fallacy”

• We stereotype & framing

• We use the “availability heuristic”

• We use an “anchoring and adjustment” approach




6. We have faulty memories • Our memories are not exact memories of specific events;

they are a mixture of what we wanted, what happened and

our expectations of the event.

• Inaccurate eye witness stories

• Salem witch trials: Mass hysteria occurs when large

groups of people claim to experience things that didn’t

happen



"You are what you think…

geez, that's frightening"

famous sociologist and comedian Lily Tomlin

Additional words of wisdom!

16

Why do we do what we do?


“Hard work pays off

in the future…

laziness pays

off now.”

famous philosopher &

comedian Steven Wright

Why do we do what we do?


What moves us?

Notes:

Adapted from: BJ Fogg Behavior Design Boot Camp, October 2011

Belonging Acceptance Rejection

Anticipation Hope Fear

Pleasure Pain Sensation


7 things to keep in mind

7) There is no “neutral” choice

6) Intrinsic motivation beats extrinsic

5) Fear of loss trumps possibility of gain

4) We over-estimate chances of winning

3) Status quo bias: inertia rules

2) We discount long-term benefits

1) Humans are not “econs”

What about incentives?

Notes:

Adapted from: Nudge, Thaler & Sunstein, 2008, Drive, Pink,

2009

Become a

Choice Architect

• Recognize the power of

the default

• Structure complexity,

limit options

• Map to the “known”

• Give frequent feedback

• Beware of unintended

consequence!


© Randy Glasbergen

www.glasbergen.com

“I decided to start smoking because my employer

is giving a bonus to everyone who can quit!”

Beware of unintended consequences…


© Randy Glasbergen

www.glasbergen.com

How to tap existing motivation?

Look and feel better

✔Boost my energy

Save time getting healthier

Set a healthy family example

Keep my numbers in check

Z


Choice architecture


© Randy Glasbergen

www.glasbergen.com

How to “get small?” Duration, frequency or intensity

Variation from routine

Deviation from social norms

Effort (physical or mental)

Money

Time

Z


Creating behavior triggers


Creating feedback loops

26

Does this stuff actually work?


What we’ve learned

1. Personal accountability matters

2. Choice drives success

3. Doing anything is much better than doing

nothing

4. Doing something more specific is better than

less specific

5. Doing more is better than less

Source: RedBrick Health Outcomes original research, 2015


Personal Accountability Matters

Effect of Next Steps Consult

Notes

Reflects RedBrick book-of business eligible consumers as of 7/18/2014.

At 30 days without NSC call n=381,019; with NSC call n=38,741.

At 180 days without NSC call n=356,926; with NSC call n=17,260.

4%

22% 19% 17%

34%

50%

PhoneCoaching

OnlinePrograms

ActivityTracking

Program Enrollment at 30 Days

Without NSC Call With NSC Call

3% 4% 12%

16% 14%

38%

PhoneCoaching

OnlinePrograms

ActivityTracking

Program Enrollment at 180 Days

Without NSC Call With NSC Call


You can’t buy better health… but rewards prime the pump

49%

Earn

incentive Improve

health habits Curious More

Convenient

Other

Notes:

Based on an analysis of 2,610 survey respondents, August 2013.

37%

9% 3% 2%


Outcomes are better for engaged consumers!

Biometric outcomes: weight

Source:

Cohort analysis of 84,400 repeat health screening participants 2012-2014. All differences

significant at p<.001. Clinically meaningful weight loss defined as a loss of > 5% of initial body

weight within one year.

Started AnyJourney

Started WeightJourney

Completed AnyJourney

CompletedWeight Journey

42%

37%

27%

23%

Obese participants (30+ BMI) were more likely to achieve clinically

meaningful weight loss (5% or more)



Biometric outcomes: blood pressure

Source:

Cohort analysis of 84,400 repeat health screening participants 2012–2014. Percent reflects

Increased likelihood of reducing blood pressure from between 120–140/80–90 to less than 120/80.

All differences significant at p<.001.

60% of those with high blood pressure had normal BP in year 2.

Strongly related to participating in a health screen.

Participants with pre-hypertension were more likely to reduce their blood pressure.

Started Any Journey Completed Any Journey

18%

14%


Started AnyJourney


Started PhysicalActivity Journey

CompletedPhysical Activity

Journey


Behavioral outcomes: get active

Source:

Cohort analysis of 84,400 repeat health assessment participants 2012–2014. Percent reflects

increased likelihood of increasing physical activity by 60 minutes or more per week. All differences

significant at p<.001.

Journeys participants were more likely to improve physical activity.

21%

9%

20%

8%


Started AnyJourney


Started NutritionJourney

CompletedNutrition Journey


Behavioral outcomes: eat well

Source:

Cohort analysis of 84,400 repeat health assessment participants 2012–2014. Percent reflects

increased likelihood of improving fruits and vegetables intake by 1 or more servings per day. All

differences significant at p<.001.

Journeys participants were more likely to improve nutrition.

16%

8%

12%

6%



RedBrick program effectiveness

1. >=5% weight loss; baseline BMI >= 30

2. >=10% reduction in non-HDL cholesterol; baseline non-HDL-C >=160 mg/dL

3. follow-up BP<120/80; baseline BP between 120/80 and 140/90

4. Increase fruit and vegetable consumption >= 1 serving/day; baseline <5 servings per day

5. Increase minutes of moderate or vigorous activity >=60 min./week

6. Improve stress coping at least 1 category

* Finding not statistically significant

Phone Coaching Relative Likelihood of Achieving Clinically

Meaningful Risk Reduction**

Metric

Participation Completion

Any Focus

Specific

Focus Any Focus

Specific

Focus

BMI1 20% 16% 29% 26%

Non-HDL cholesterol2 9% 32% 12% 38%

Blood Pressure3 NS* NS* NS* NS*

Nutrition4 11% 15% 13% 18%

Physical Activity5 9% 19% 10% 20%

Stress6 9% 60% 10% 61%

** Compared to those who engaged only in their usual healthy

activities but not in RedBrick programs. Study includes 182K

Health Assessment and 84K Screening participants.

35

Does reward size matter?


Comparison of results by size

9%

27% 28%

59%

69%

0%

10%

20%

30%

40%

50%

60%

70%

80%

NoIncentive

DrawingEntries

$1-$50 $51-$100 Over$100

Health Assessment

6%

29% 28%

52%

0%

10%

20%

30%

40%

50%

60%

No Incentive DrawingEntries

$1-$250 Over $250

Overall Unique Participation

Notes

Analysis of participation by reward design conducted on over 700,000 adults eligible to participate during 2013.

! !

37

What about consumer choice vs. traditional stratification? Or, can we put the person back in the personalization?


A Typical Program Design…

Risk Identification/Stratification

High Risk/Chronic Phone Coaching

Lifestyle Management

Disease Management

Moderate/Low Risk Online Programs

Low Risk Trackers


Original Research

Impact of choice

18%

33% 40%

20%

34% 41%

20%

31%

41%

≥5% Weight Loss Categorical Reduction inBlood Pressure

≥10% Reduction in non-HDL Cholesterol

When consumers choose, the modalities are similarly effective

Activity Tracking RedBrick Journeys RedBrick Phone Coaching

Notes

Repeat health screening participants. Activity tracking n=14,643; RedBrick Journeys n=23,435; RedBrick phone coaching n=10,335.

Baseline measurements: Weight loss BMI ≥30; blood pressure ≥120/80; cholesterol non-HDL Cholesterol ≥160 mg/dL.


80% of coaching

participants choose

to start here

The result

Nearly 3x more condition

relevant coaching engagement

More than 4x increase in

total coaching engagement

Notes

RedBrick Lifestyle Management topics include: Healthy Pregnancy, Healthy Back, Hyperlipidemia, Hypertension, Nutrition

Management, Physical Activity, Stress Management, Tobacco Cessation, Weight Management.

Diabetes

COPD

CHF

CAD

Asthma

Lifestyle

Risks

Original Research

Impact of choice

Evidence-based

whole-person

coaching model

What about the choice of “lifestyle” vs. “disease management” coaching?

41

Do outcome-based designs drive better outcomes?


Comparison of results by design

Notes

Analysis of results by reward design conducted 482,035 adults eligible to participate during 2013.

Program Eligible

by Reward Models

n=482,035 (86 incentive programs)

✔

✔

✗

Size of the reward?

Level of engagement?

Rewarding the outcome?

What’s Actually Driving the

Outcomes*?

* Clinically meaningful and statistically significant improvement in

BMI, Blood Pressure, or Non-HDL Cholesterol. (We also looked

at improvement in physical activity, nutrition and stress.)

No incentive 27%

Participation Model 33%

Partial Outcomes

Model 26%

Outcomes Only Model

14%

43

What’s the take away?


Original Research

Summing it up • Choice-based models produces stronger engagement

– When consumers chose, modalities and outcomes are

equally effective

• Rewards can drive engagement, but engagement drives outcomes

– “A little human help” can be a cost effective alternative

• Outcomes-based rewards don’t produce better outcomes and may

reduce overall engagement

– Figure out what’s most engaging with your population


"Keeping an open mind is a

virtue, but not so open that your

brains fall out."

famous thinker Bertrand Russell

In Conclusion:


Thank you! Dr. Jeff Dobro [email protected]

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