Larry Chapman’s Blog

Results-Driven Worksite Wellness

Do you AMSO? “O” is for opportunity to practice behaviors


When was the last time you had someone from IT help you solve a particularly annoying software problem? For me it was yesterday. Well, as you listened to the solution and if you didn’t write down the instructions or practice the fix several times, what is likely to happen the next time you run into that same problem? It won’t be pretty. I am sure you too have learned that the key to using new technology is taking the opportunity to practice.

Unfortunately much of life follows this pattern and wellness skills aren’t an exception. In the language of AMSO, the “O” represents “Opportunity to practice the new wellness behavior.” If our workplace wellness programs are not giving people clear opportunities to practice new healthy behaviors and refine skills then they are not likely to adopt these new behaviors and actually change their long term health behavior. And remember: no behavior change –> no health improvement –> no economic/measurable impact –> in no time you have no program!

Practicing skills gives allows us to do something enough so that it begins to feel familiar and natural. In the process of getting familiar we learn how to overcome little things that will otherwise grow into real resistance to performing the new healthy behavior. Unfamiliarity is often an enemy of behavior change because it can create uncertainty, fear or increase the perceived personal “cost” associated with overcoming that which is unfamiliar.

An opportunity to practice gives us an entry point to a new skill like healthy meal planning, adding a walk to our daily routine, or core strength exercises that prevent back pain. Opportunity can depend entirely on individual action or it can harness the social power of having others involved. It can also include feedback loops such as recording or tracking a behavior or using wearable tools like a Fitbit.

How many opportunities to practice are necessary? There isn’t hard science on this but the more the better! People will self-select into these opportunities but we want to provide enough options so that no one fails to change for lack of opportunities to practice. Also many wellness behaviors are carried out once every year or three, such as a preventive screening. In the case of episodic behaviors we probably want to make sure we have reminder systems in place.

The critical thing for us to remember about AMSO is that the opportunity to practice needs to be repeated often enough to lead to the formation of a habit. Habits are really the result of our consistent intention multiplied by the number of opportunities to practice. Habits are powerful and need to be cultivated and re-cultivated over time. We are actually trying to build a whole constellation of healthy habits in the individuals we seek to serve with our wellness programs.

Here ways that our wellness programs can provide the opportunities for practicing a new health behavior:

  • Tip #1 – Embed the practice experience into the program activity: Regardless of the type of wellness program activity always include a practice session (or sessions!) into the activity. If it’s an educational session like a lunch and learn have part of the time dedicated to actually doing or practicing the specific activity to the maximum extent possible. Demo everything always including websites, YouTube videos, wellness coaching calls, health advice lines, stretches, specific exercises, stress reduction strategies, and testing.
  • Tip #2 – Emphasize explicitly the formation of habits in all programs: Make explicit the discussion about tips for forming healthy habits. Talk about relapse prevention and behavior modification to help participants form consistent habits. The overriding concern of the wellness program should be habit formation not just the one time performance of a specific health behavior. Provide tools for participants that are intended to help them form those long term habits.
  • Tip #3 – Plan follow-up sessions that emphasize practice opportunities: For each formal wellness program activity provide a follow-up practice session where it makes sense. Using experiential learning to its maximum extent always plan a week later session or month later session and label them “follow-up practice session”. Give people an opportunity to reconnect with the skills.
  • Tip #4 – Actively link people who want to practice the same new behavior: Create or utilize social networking technology to help aggregate people who are working on the same health behavior change so that they can practice the new behavior together.   This method works well with walking, group exercise, fitness facility use, nutritional learning experiences like grocery store walk-throughs, healthy pot-lucks, watching LMS modules together with discussion afterward, healthy vacation options, stress reduction technique practice, humorous movies, chair massage, and many others.
  • Tip #5 – Orient wellness coaching to focus on practicing the new behavior: Have wellness coaches focus on helping the individual structure practice sessions for the behaviors they are working on. They should formulate personal wellness objectives that emphasize practice. Look for ways to suggest practice opportunities that can be piggy-backed into the person’s average day. If the wellness coach is asking consistently about practice experience of the individual it is likely to have a stronger behavior change impact on the individual.
  • Tip #6 –Use criteria in wellness incentive programs to emphasize practice: We believe that a long term wellness incentive program linked to $600 to $1,200 of reduced health plan contribution levels tied to a variety of wellness criteria is a necessary end game strategy for all Results-Driven Wellness programs. These incentive criteria can be crafted to encourage practice of healthy behaviors. The criteria can also be constructed to provide formal opportunities for practicing specific behaviors. The individual criteria can have alternative ways of being met and can include practice considerations.
  • Tip #7 – Use annual wellness incentive programs to draw people back to selected wellness practices: The core long term wellness incentive program can also be used to call individuals back into wellness behaviors and to practice sessions. This overall process is what we call an annual opportunity to “get on the Wellness bus.” This calls people back to practice opportunities.
  • Tip #8 – Start acknowledging people who have formed a new healthy habit: Just as many wellness programs do write-ups about people who have accomplished a significant wellness event, such as hiking through the Himalayas you can also do write-ups of people who have successfully developed a new wellness habit. If you set the definition of a “habit” as a full six months of a minimum level of behavior change then you can acknowledge those individuals and give an impetus for people developing a new habit.

This focus on structuring opportunities to practice the new skills and new behaviors needs to be intentionally built into every aspect of your program. At the same time you need to constantly work to bring new ways to help people change by helping them practice the new behavioral skills and develop those healthy habits.

Next time we’ll look at the new initiative of the Health Promotion Advocates to bring wellness and health promotion to every American.

Don’t forget, strategies for using AMSO are a key area of emphasis in each level of certification in the WellCert Program!

WellCert Grads: Check out our new WellCert Membership and be sure to sign up for your FREE TRIAL!

Do you AMSO? Part 3: “S” is for Skills

coach-skills-huddleTrue confessions: I grew up in Southern California with lots of opportunity to surf, but was a pretty lousy surfer. I could never get the fine balance skill between being too far forward “pearling” the board and being too far back and missing the wave. I lacked the key skill that would have helped me be in the right place on the board at the right time and place in the wave.

Unfortunately, I didn’t get the help I needed to develop the skill I was missing. That’s a real regret of mine. As a result I did become a pretty competitive body surfer and body boarder, but I still regret that I didn’t get the help I needed to be the surfer I wanted to be.

The “S” in AMSO is for skill acquisition–acquiring skills that support the new healthy behaviors participants want to take on. To bring the “S” in AMSO, your wellness program has to have various methods that help people acquire the new skills they need to become a regular exerciser, eat more healthily, reduce tobacco use, reduce heart disease risks, maintain a healthy body weight, handle stress more effectively and many more specific healthy behaviors.

The desired new healthy behaviors participants are motivated to adopt always require the acquisition of new skills for the individual making the change! The skills are complex and need to reflect individual differences and circumstances.

If your wellness program is not helping people get those new skills across the full range of prevention targets your program is addressing, then it is not likely to be effective at helping people change their short term, let alone long term health behavior.

No participation-> no skill acquisition; no skill acquisition -> no behavior change; no behavior change -> no health improvement; no health improvement -> no economic return. None of the above –> no program and no worksite wellness career!

But remember, acquiring a new skill is not rocket science, we learn new skills all the time, but we do need to thoughtfully build in to our wellness programs many ways and options for learning those new skills. Skills are fundamentally about how we do something.

Some of us need more help than others at picking up what the new skill is and how we actually should go about doing something. Some of us can simply be told how to do something and we will figure it out. But others of us need to see someone doing the new skill in order to grasp it and yet others need to have a coach giving them personal feedback on how we are doing with the new skill.

Here are the major ways that our wellness programs usually impart the skills associated with a new health behavior.

Method #1 – Provide written information on demand: In newsletters, informational brochures, websites and FAQs that address how to do what you need to do to change that unhealthy behavior into a healthy behavior. We are talking about things like: how to quit smoking, how to use a fitness facility, how to eat healthy on the road, how to lose weight, how to manage your personal stress, how to moderate your alcohol consumption, how to seek advice for common self-limiting medical symptoms, how to select a PCP, how to build your personal resilience and literally hundreds of other “how-to’s”. However, the information provided has to be intentionally skill oriented and organized in easy to follow step-by-step sequence.

Method #2 – Provide video and learning modules: Why is YouTube so popular? Among other things because It gives people clear visual examples of how to do something. Helpful YouTube videos can be made available that cover key health behavior skills and more formal Learning Management Systems (LMS) can be used in the same way to emphasis the acquisition of key skills for specific health behavior changes. Those under 40 years of age are beginning to see video as THE main way they want information.

Method #3 – Provide experiential learning opportunities: Experiential learning is powerful and effective if done correctly. Tasting a healthy salad after seeing how it is made can help someone acquire that new skill. Having them make the salad themselves is another great experimental skill-building technique. Going through a cafeteria line with a nutrition coach giving feedback about your choices would be another example of experiential learning. Taking someone through the set-up process for a Fitbit wearable would be another example. Using a fitness facility for the first time with a buddy that has used one for years and coaches you would be another example. Navigating a restaurant menu with a wellness coach would be an example of experiential learning at its most practical. Lots of ways experiential learning can be woven into the fabric of your employee wellness program!

Method #4 – Provide telephonic coaching help: Using telephonic coaching is a typical intervention that wellness programs use to help participants acquire the necessary skills to prepare for or begin a healthy behavior. Trained and/or certified wellness coaches can provide skill building expertise to employees. The coaching help can be one time or multiple times over a year period and it can be combined with supplemental learning techniques such as biblio-therapy, support groups, health advice line use, website use and other methods. If we know how our participants likes to learn we can augment the coaching process and make it even more powerful.

Method #5 – Provide face-to-face coaching help: In many situations it is possible to use wellness coaches in the work environment on a regular basis. This process can be made available to specific work groups or for specific health behaviors and can become a regular part of the work environment. The wellness coach can help participants individually scope out and prepare for a behavior change and problem solve to help reduce recidivism. The process of knowing that you will be facing your coach soon is also likely to help support your change process.

Method #6 – Provide wellness mentors: By intentionally linking those employees of the same gender that have already successfully made a specific health behavior change with those who are just starting out with a similar change you can set up an opportunity for key skills to be acquired. Mentors are not trained wellness coaches, but can be trained and alerted to focus on the how-to issues reinforcing what skills their mentee needs to acquire.

This focus on skill building and skill acquisition in all these methods need to be strongly and clearly aligned and we need at the same time to constantly work to bring improvements to our efforts to help people change by helping them acquire new behavioral skills.

Next week we’ll look at the “O” in AMSO- a powerful framework for making sure your wellness program is producing results!

Don’t forget, strategies for using AMSO are a key area of emphasis in each level of certification in the WellCert Program!

Do you AMSO? Part 2 – “M” is for Motivation


Think about the last time you found yourself shopping for clothes. Looking over the multi-colored business shirts at Joseph A. Banks last week, though I needed a shirt, I wasn’t feeling that motivated to jump in and buy. Sensing my interest in the shirts, the saleswoman informed me about their current deal: three shirts for the price of two! So like magic I went from thinking I needed maybe one shirt to walking out with three!

Don’t you feel bombarded by deals, special incentives, and promotions? If the multi-trillion dollar retail marketplace uses these tricks to take latent intrinsic motivation all the way to a sale, why should we be surprised that we need incentives to trigger action in wellness?

The “M” in AMSO stands for Motivation. I was motivated by the deal to buy 3 shirts instead of 1. The tried and tested AMSO framework holds that effective wellness programs need to have multiple strategies for enhancing the intrinsic motivation for wellness that already exists in participants. In my experience about 20% of most populations are already intrinsically motivated to engage in wellness even before a wellness program is offered. The problem is that the other 80% usually aren’t motivated strongly enough to participate in a wellness program and often tend to ignore it, making the wellness program run the risk of looking (and being) unsuccessful.

Now some wellness advocates believe that if they can just talk to those in the 80% group they will eventually become intrinsically motivated to participate in wellness programs. However, I see absolutely no evidence in the scientific literature that anyone has ever sustained high short or long term wellness program participation by simply talking with people—more information doesn’t create motivation out of thin air. I believe that it takes an attractive “deal” to get more of those 80%’ers to engage.

The “deal” can be so many things–this is where you need to think out of the box.  It could be a sense of belonging, an opportunity to contribute, greater disposable income, a sense of achievement, fun, more time off, lower health plan costs, or dozens of other pay values. All of these types of “deals” represent extrinsic sources of motivation that are intended to augment the intrinsic motivation that innately exists in virtually all populations.

Once you have the 80%’ers participating you have an opportunity to work on converting the extrinsic sources of motivation to intrinsic motivation. Intrinsic motivation is absolutely what creates sustained change, but we need folks to get on the wellness bus in order to have a bite at that apple (more about that in another series of posts).

What kinds of strategies should you consider using to help reach the 80%’ers? Here’s what I recommend:

Step #1 – First, spend time learning about the 80%’ers. Find out what they think about wellness, what it means to them, and what do they know about why wellness makes sense for them. Typically this can be done through an interest surveys, focus groups, interviews, online chat rooms and open forums.

Step #2 – Next, ask about why they don’t find wellness very interesting or important. In your discussions with individuals and small groups ask about why they don’t see wellness as important. Use questions like: “What would it take for you to actively participate? What’s holding you back?”; “What do you see as the main barriers to taking better care of your health?”; “How important is your own well-being to you?”; “What kind of a “deal” would help you participate?”

Step #3 – Probe about what it would take for them to participate and authentically engage. When discussing wellness ask them questions like: “If you could feel better would you want to participate?” or “If you could pay less for your health plan would you be willing to participate?” Use ‘what if’ questions like: “What if you were part of a team? Would that appeal to you?” You want to get under how your 80%’ers feel about the following possible extrinsic reasons for participating in a wellness program:

  • Feeling and looking better
  • Receiving a sizable financial reward
  • Avoiding a significant financial penalty
  • Receiving more time-off from work
  • Getting a desirable material goods
  • Receiving a special privilege at work
  • Being recognized for an accomplishment
  • Being part of a team in a group competition
  • Being able to exercise some control and ownership over the program
  • Having access to wellness made easier
  • Having a personal role in feedback
  • Having something new to experience
  • Having an opportunity to gamble or win something
  • Having an opportunity to belong to a group
  • Having an opportunity to experience humor
  • Help in meeting a personal challenge
  • Enjoying fun and lightness
  • An opportunity to develop self-mastery
  • Experiencing a sense of acceptance or approval
  • Experiencing comfort
  • Having an ability to contribute to something bigger than yourself
  • Experiencing a creative outlet
  • Opportunity to be a good exemplar to others
  • Opportunity for high visibility or attention
  • Opportunity to avoid personal discomfort
  • Opportunity to meet and mix with managers

Step #4 – Combine 3 or 4 of the most popular extrinsic reasons into a long term incentive program. Select the extrinsic reasons of your 80%’ers that seem to be the most often mentioned into a reoccurring core incentive design. My experience is that a $100 a month lower health plan premium for several wellness achievements is one of the single most effective extrinsic reasons for participation in a worksite wellness program.

Step #5 – Look for ways to build as many of the other extrinsic reasons for participation into your program as possible. In addition to a formal incentive program I recommend that you look for creative ways to address several more of the most popular reasons cited by your 80%’ers associated with participation. Look to combine other popular “pay values” into other program interventions or short term incentives.

Step #6 – Communicate about all the extrinsic reasons with your entire population. Once you have selected your 3 or 4 core extrinsic reasons for participating and the other extrinsic reasons you select, keep communicating about them to your entire population. If employees and their spouses don’t know about the extrinsic reasons for participating in their wellness program then they are not likely to participate.

Step #7 – Create programs that convert extrinsic motivation to intrinsic motivation. This is a big topic In another series of posts I’ll be sharing about programming strategies for helping convert the extrinsic sources of motivation into intrinsic motivation.Step #8 – Rinse and repeat: cycle back around to fine tune your approach. Take the time each year to examine your “deals” or extrinsic reasons for participation and consider new or modified “deals” or pay values. Keep your novelty draw high with new challenges and new learnings.

Next time we’ll look at the “S” in AMSO a powerful framework for making sure your wellness program is producing results!

Don’t forget, strategies for using AMSO is a key area of emphasis in each level of certification in the WellCert Program!

Do you AMSO? Part 1 – “A” is for Awareness

When was the last time you decided to buy a car? Just as soon as you decide on a make and model you want, you start to see your heartthrob vehicle everywhere you look. Amazing huh! Not really! You just turned on your Reticular Activating System, among other things, that mediates what grabs your attention. Your brain is helping you find the object of your desire. Until we amped up our awareness of that car, our brains just dumped that stimulus out of our heads like so much random noise.

Our wellness programs exist to get participants’ brains to seek out healthy behaviors. My recent four-part series on the HRA reflected on how to use HRAs as awareness drivers. Awareness is our starting point and is critical in behavior change! We want the HRA, among other program interventions, to help each individual become aware of health and wellness issues that are relevant to their own present and future health and well-being.

Michael O’Donnell, one of the most prolific and influential leaders in the field of health promotion (AKA Wellness) developed an analytic framework that helps us determine whether a wellness program will actually work—whether it will change the long-term behavior and improve the health of a population. He came up with the acronym “AMSO” to help us remember all four of the key parts of programs that create lasting behavior change.

O’Donnell’s evidence-based finding is that for a wellness program to change behavior, it must do four things. The first requirement is, you guessed it, AWARENESS of health issues for each individual in your population. This Awareness isn’t just a general idea like “we should eat our vegetables.” While general messages are fine, the Awareness here is really about the specific health issues relevant each individual. HRAs are one of the most useful tools for raising awareness of individual own health and wellness issues thus our connection of AMSO to my recent series on HRAs.

To fully realize the awareness potential of the HRA we need to:

  • Have everyone complete an HRA each year.
  • Provide useful and changing information and feedback from the HRA each year.
  • Communicate clearly the consequences of current health choices.
  • Provide easy to understand relevant insights about how they can improve their health present and future.
  • Provide easy to access follow-up interventions in health behavior areas of interest.

We also need to include other ways of raising awareness of health issues for the individual besides the HRA. These other interventions may include: eHealth portals, access to wellness coaches, wellness newsletters, self-help groups, online learning modules and wellness mentor programs. The intentional linking of these potential interventions to maximize awareness in each individual is one of those areas of “art” for the health promotion and wellness practitioner.Next week we’ll look at the “M” in AMSO- a powerful framework for creating effective wellness programing.Don’t forget, strategies for using AMSO is a key area of emphasis in each level of our WellCert worksite wellness certification.

HRA as MVP Part 4 – Game plan for dealing with HRA vendors


I hope you are starting to raise your expectations on what you can achieve with your HRA. Inevitably, making changes often means working with your vendor (or getting a new one).

Now let’s think about pens. If you’re like me, you have a drawer somewhere with a bunch of old pens—many of them I got for free at some long forgotten conference or event. There are also many from vendors. Now I don’t want to malign vendor tchotchkes, but let’s be honest, free pens from vendors aren’t usually going to be the best pens—the ones that you look forward to writing notes with in the important meeting. Free isn’t usually synonymous with “the best”.

There seems to be a growing trend of the “gift with purchase” HRA. You get the HRA with the purchase of other services, or by working with a specific health plan, etc. While “free” is always pretty tempting, there are many times when a free HRA is no bargain, especially if it’s poorly designed and can only realize poor utilization. Often, free HRAs don’t have many of the features I described in past posts that drive a WOW. Especially features that provide instant value to your employees. HRAs aren’t all created equal.

Give your HRA check-up from the neck-up

Before you go through the headache of changing vendors, you need to find out if your current HRA vendor can change an improve your HRA. The best vendors will be willing to work with you—from salespeople to account management and technical staff. They should want the same things you do: an HRA that drives results by engaging employees in healthy lifestyle choices.

To give your current HRA vendor a chance to get on board, here’s what I would do if I were you:


Step #1 – Collect some employee feedback on your current HRA. Ask employees right after they complete the HRA and have access to their personal report, the following 4 questions:

  • Q#1: How would you rate your experience with our current HRA on a 1 – 7 scale with “7” being “excellent” and “1” representing “poor.” (Average their scores)
  • Q#2: Does our current HRA provide you with new insights about your health and wellness each time you complete it? (Yes or No) or (Always, Often, Seldom, Never)
  • Q#3: Has the HRA helped you change a health behavior? (Yes or No) or (Always, Often, Seldom, Never)
  • Q#4: Would you recommend that your friends complete this HRA? (Yes or No)

Step #2 – Sit down with your HRA vendor and share your findings. Summarize the answers to the four questions with your vendor. Lay out your findings and describe how you got them. Ask if other clients have done anything like this and what did they find. Ask if this is what they expect employees to be experiencing when they complete their HRA. Do they want to produce a “wow” experience for users?

Step #3 – If the survey shows poor results, tell them this situation is not acceptable –you need to have an HRA that does better. If your numbers are as low as I think they will be then be candid with them and tell them that you are going to have to make a change unless they can improve the HRA experience for your employees in a significant way.

Step #4 – Set a date for your vendor to give you their plan for improving the HRA. Make sure you give them enough, but not too much time, to come up with a remedial plan for addressing the needed improvements. I have found that it is necessary for the vendor to actually believe that you will really dump them if they don’t fix the problem. Make sure you give yourself enough time to review the plan in depth.

Step #5 – Determine if their plan for improvements is acceptable. Consider how soon the vendor will be able to make the necessary improvements as well as if the proposed changes will fully address the current defects. Will you have to wait one, two or three HRA cycles before the improvements come on line? Will the improvements produce a “wow” HRA experience?

Step #6 – Keep your current vendor or get a new one! Based on steps #1 -#5 decide to either keep your current vendor and work with them or go get a new one. Make sure you are actually accomplishing the improvements that will make the HRA a “wow” experience for your employees and spouses.

Step #7 – Get the same kind of employee feedback on the new HRA. Use the same survey questions to evaluate the new HRA among a small pilot group. Compare the results with the previous 4 question survey results. Determine if the new HRA is performing at an acceptable level.

Don’t forget that the HRA should be one of your wellness program’s most valuable players and its full potential takes consistent effort to realize!Next week we’ll look at how HRAs connect to the “A” function of “AMSO”- a powerful framework for making sure your wellness program is producing results!

Don’t forget, strategies for effective use of HRAs are one of the key skills we teach in our Level 1 WellCert worksite wellness certification program and we have a new set of “Virtual” trainings coming!

HRA as MVP Part 3 – How to get more people completing an HRA


I have been involved with organizations where less than 10% of employees completed an HRA and others where as high as almost 100%. If you believe that an HRA helps people change for the better then we definitely want to be over on the high end of participation.

Maybe we should get Congress to pass a law that makes an HRA part of our tax return? On second thought, the association may not be to our advantage.

In all seriousness, we need to get as many people as possible completing an HRA each year. It is definitely harder for all of us to ignore some of those common health behaviors if we are faced with them as part of a regular process.

As wellness people we definitely want as many people as possible filling out an HRA each year particularly if we can make it a wow experience for them! This means you have to have a well-designed “campaign approach” to completion of the HRA each year- often taking particular advantage of open enrollment periods and benefit linkages.

Here’s some additional strategies you can use to get those HRA completion rates as high as possible.

Strategy #1 message your population frequently about the importance of the HRA as a tool for health improvement. The basic messages should be that the HRA is a useful and important tool for health improvement and that it is important to your organization. Communicate the importance of the HRA!

Strategy #2 publically plot out the completion rates during the HRA completion period. This strategy uses a “United Way” like approach with the thermometer graphic. Feed the completion rates back to the entire work force with a stated goal such as 90%. Visually challenge the population to complete their HRA!

Strategy #3 link completion of the HRA to a health management process including preventive screening. If the HRA is completed as part of a health assessment and the data is brought together to strengthen its utility to the individual you will frequently get higher completion rates. This can also be linked to a graphic showing the status. Position the HRA as part of a more comprehensive testing process!

Strategy #4 require completion of the HRA in order to participate in a significant premium reduction incentive. For example, waive a $100 a month health plan contribution for meeting several wellness criteria and have the completion of the HRA as a requirement for participating in the premium reduction. Use the HRA as a “ticket” into a premium reduction based wellness incentive!

Strategy #5 require completion of the HRA in order to continue health plan coverage. Use an annual application process for continuation of health plan coverage that requires completion of an imbedded HRA. Require completion of the HRA to continue health plan coverage!

Strategy #6 require completion of the HRA as part of the application to access a Section 125 Cafeteria Plan. Employers are free to require completion of an application for access to flexible benefit choices as part of open enrollment. Instead of limiting it just to the health plan this strategy links it to access to all flexible benefit choices. This way even those who waive their health plan coverage will need to complete the HRA. Link the HRA to access to cafeteria or flexible benefits!

Strategy #7 link completion of the HRA to a reward of one, two or three additional Paid-Time-Off (PTO) days. Calculate the total number of annual PTO days so that these “Well Days” are included in your overall standard. If the employee completes the annual HRA they receive the additional PTO days. Reward HRA completion with additional PTO days!

Next week we’ll look at how to get your HRA vendor to make needed improvements…..or how to get a new vendor!

Don’t forget, strategies for effective use of HRAs are one of the key skills we teach in our Level 1 WellCert worksite wellness certification program!


HRA as MVP Part 2 – HRA as intervention


Yes, I am going to start this post making you think about what happens when you do your taxes. Ok, maybe not a great way to start your day—sorry about that!

Stick with me on this. When you do your taxes, the act of just preparing the necessary information and filling out form after form causes you to think more deeply about your financial health than you had for the last few months—maybe than you had all year! The act of doing your taxes probably had you considering things you hadn’t thought about since the prior year: How much should I give to charity? Do I have the right mortgage? Should I re-think my investment strategy? Kind of a check-up for your pocket book.

If you are like me, you might actually consider changing your financial behavior after this annual act of torture. You might actually even start some healthy behaviors—at least for a month or two after this ordeal. You can bet that the IRS isn’t thinking about maximizing our behavior change—or making the most of this opportunity, but these behavioral effects happen anyway!

I would argue that simply filling out the HRA has a measurable impact on health behaviors—even if the HRA is poorly designed or executed. That said, there is so much you can do to maximize the impact of this natural check-up moment.

Here are some powerful ideas we recommend in the WellCert program to make the HRA process for each individual a more powerful behavioral change intervention.


Idea #1 – make the HRA an annual process with a strong reason for employees and their spouses to fill it out. If I could I would make completion of an annual HRA a requirement for every one that is covered by a health plan! You as a health care consumer get health plan coverage at a fraction of its real cost and your responsibility is to give us 15 minutes of your time each year to fill out your HRA. Make the HRA an annual process for everyone!


Idea #2 – provide historical comparisons from previous HRAs. Each person completing an HRA should see their summary data (like their Overall Wellness Scores) at least from the last three times they completed the HRA. Actually it would be even better if they saw their scores for the entire history of their completion of an HRA! Think about it like providing a “highlight reel” of the pattern of their past responses!


Idea #3 – provide a personal or online discussion or interpretation of what the HRA report is saying. We used to do group interpretation sessions where people could get their questions answered. These also would deal with helping the person develop a couple personal wellness goals or objectives. Using current technology we can now provide an online learning module that can help accomplish what we used to do in these group sessions. Offer an interpretation session that helps them identify 1 or 2 personalized next steps!


Idea #4 – make sure their personal health reports from the HRA provide fresh insights about their health. If each year’s report from the HRA is the same how can it provide much value to people? We need to put much more pressure on our HRA vendors to improve the utility of HRA reports. It’s not a technical limitation – it’s a design limitation! Assure that new and fresh insights come out of every HRA experience!


Idea #5 – require a face-to-face or telephonic discussion of each person’s HRA results with a certified wellness coach. Using a series of questions the coach can help the individual better understand the HRA results and can assist them with making small improvements in their health behavior. Discuss the report and mutually plan small improvements!


Idea #6 – provide a meaningful incentive reward for health and wellness improvements. Paying a $1,000 a year less for health plan coverage would be an example of a meaningful reward attached to several small changes or improvements in health behavior. Achievement, improvements or straight participation could all qualify. BTW: The employer doesn’t have to provide the $1,000 – it can be funded by restructuring the employee’s health plan premium contribution. Reward wellness behaviors and outcomes in a real way!


Next week we’ll look at how to boost completion rates.


Don’t forget, strategies for effective use of HRAs are one of the key skills we teach in our Level 1 WellCert worksite wellness certification program!



Part 1 – How to make your HRA a WOW experience


flickr – He doesn’t like your HRA either


I hope you had a great holiday season! Always nice to regroup, be with family and refresh! Right before the holidays I wrote about a new study on the effects of a Health Risk Assessment (HRA) in a health plan setting that was just published in JOEM. Several commenters questioned the magnitude of results reported in the peer review article and we continue to dialogue on the interpretations and implications of the article.


However, my bottom-line point is that I believe that the average HRA out there is designed and used in a way that produces very little positive effect on program participants, even though researchers like Sieck and Dembe continue to provide alluring snapshots of its potential.


Michael Hyatt, in his landmark book, “Platform: Get Noticed in a Noisy World” unequivocally states that in order to be taken seriously now days we need to strive to give our audience a “wow” experience. In other words….taking your wellness program’s HRA needs to be a “wow” experience for every participant!


Getting to “wow” means making the experience more powerful and memorable. Now be honest: does your program’s HRA provide that kind of experience to participants now? I seriously doubt it.


How can you make the HRA a “wow” experience for your program’s participants? I would like to share four steps to help you do just that.


Step #1 – make sure that each participant clearly understands that the HRA is part of an ongoing process to provide practical help for improving their personal health and well-being.  Plan on at least three carefully crafted messages about this issue, used at least three separate times each with employees.  Don’t assume that they know this…  We know it but I have found employees often don’t!  It’s an important tool for health improvement!


Step #2 – make sure the participant knows that the HRA is important to your organization. That happens when you connect completion to a lower health plan premium contribution or by posting organization wide completion goals and actuals. It also helps to repeat messages about the value of the HRA to the organization and its value as a tool for health improvement. Emphasize the confidentiality of the information they share. Let them know that the process of completing the HRA has been shown to have positive effects on people’s health and their use of health care. (Cite the JOEM article) Finally, make sure your messages about the HRA are all written from the perspective of the benefits to the user. It’s important to your organization!


Step #3 – make sure the entire HRA completion experience is technologically pleasant for the user, from the moment they sign on to the point that they have completed it. This includes a number of key things: ease of access and entry, single sign on, quality of screen views, color and graphic standards used, flow of questions, presence of branching logic, helpful explanatory links, and an interesting range of comprehensiveness of topics and issues (“actionable insights”). Of course it goes without saying that the experience should be as short as possible, and visually hide questions and pages that aren’t relevant. If you aren’t using the information, ditch the question sets. Use technology to make it painless!


Step#4 – make sure you given them an almost instantaneous version of a graphically attractive personal report that is: easy to read, provides comparisons with previous HRA results, lays out small practical steps that can be taken to improve health, contains active links for selected self-tests and actionable follow-up steps, and each year the individual’s personal report from the HRA should cover fresh health and wellness issues based on the responses of the participant. Also each year new questions should arise from the previous year’s information provided by the participant. Reward the employee for every data-point they shared with rich feedback and details. The HRA must provide valuable information for the user!


Push your team, your vendors, and yourself for WOW and you will see participation improve and employees keep filling out these instruments.


Next week we’ll look at how to make the HRA process a more powerful behavioral change intervention.


Don’t forget, strategies for effective use of HRAs is one of the key skills we teach in our Level 1 WellCert worksite wellness certification program!

The HRA: Your Wellness Program’s 2014 MVP?





OK, hear me out… This isn’t 2004, I know, but some new research has shown us again not to pan the humble HRA. The Journal of Occupational and Environmental Medicine for December just came out with a great new study that shows that the HRA ALONE drove significant reductions in seven of eight key health risks and led to CUTTING THE AVERAGE HEALTH CARE COST IN HALF AFTER THREE YEARS (You can get the abstract of the article here).


This is interesting timing because in meetings with wellness program managers in the Midwest just a couple weeks ago, I was hearing about how passé HRAs are. One seasoned wellness leader said, “My employees often say that their HRA results are the same every year–so why should they fill one out?” Another said, “[HRAs] are boring and hard to get people to complete.”


I have to think that these well-meaning wellness professionals must be somewhat representative of many of you out there. Have you had a challenge getting folks to complete HRAs? Tell us in the comments your challenges and your ideas for getting more out of your HRA…


So as an ode to the humble HRA, I want to do a couple posts on them in the New Year. First, we’ll look at how to make the HRA more of a memorable and powerful intervention, second, how to drive much greater participation, and third, we’ll give you some edgy ideas on how to push your vendors (or reasons to fire vendors that can’t cut it).


But first …..take a few minutes over the holidays to consider your HRA. This thing should feel like one of your children or at least a beloved pet! It is such an important part of delivering results-driven wellness. How can you plan program interventions without it? How can you risk stratify your population without it? How can you measure your program’s effectiveness without it?

For something so important, of course you would have to fight for every percentage-point of participation, and doggedly look for ways to improve the user experience.


Join us in January to learn about breathing new life into the humble HRA!


May these last two weeks of the year be a time of enjoying family, friends and the joys of the holidays!

More Power Plays: Using economic arguments for wellness

flickr, aswendener

flickr, aswendener


I just went through a list of key humanitarian arguments for wellness programming in our last post, but we also need to play our economic cards as well!  Remember our series on how to measure the five major economic variables that wellness programs impact in work organizations? Health plan cost, sick leave absenteeism cost, workers’ compensation cost, disability insurance costs and presenteeism costs.  Now let’s talk about how to effectively position the economic rationale for wellness.


Economic Rationale: It’s the Money Stupid!

For decades wellness advocates have promoted programming to senior managers as tangible ways to affect health plan costs, whose rapid increases have deeply troubled all organizations.  But over the past decade single digit increases have replaced the double digit increases of previous decades removing some of the economic pressure for wellness.  Looking forward under the ACA it’s difficult to know exactly what is likely to happen to national medical trend.  My opinion is that we are likely to see high single digit annual increases for the foreseeable future because I believe that there are ample market and population undercurrents that will guarantee this pattern.  Even with steady rates of growth in per capita health plan costs I believe it makes good sense in most cases to position wellness as addressing all five economic variables that are important to employers.


We have pulled together a few arguments you can use to connect the dots between wellness and bottom-line impact:


Argument #1: Good health is good business!

  • We intuitively know that healthy employees cost less and can produce more.
  • Most organizations including yours can benefit from increased efficiency.
  • Wellness can help employees increase their efficiency.


When to use this argument: In businesses with management that is new to wellness, this general argument is very powerful.


Argument #2: Wellness can be focused on specific (and multiple) economic variables

  • We have a large number of scientific studies of the economic return from wellness programs. (Watch for our updated eBook that examines 90+ peer reviewed studies)
  • We can implement specific interventions targeted on each of the five economic variables.
  • Wellness can be designed and implemented to maximize economic return.


When to use this argument: In companies with an aging workforce, increasing market competition or ailing profitability, this argument would be most effective with all levels of management.


Argument #3: The economic return of Wellness can be rigorously measured

  • To gain an accurate accounting of the full economic return from a wellness program requires a sound evaluation design and some money spent on evaluation research.
  • Most organizations including yours can design and conduct a rigorous economic evaluation with a little focused help.
  • Wellness can be economically validated through sound program evaluation methods.


When to use this argument:  In companies with a high expectation for quantitative evaluation, this argument works best with managers.


Argument #4: Wellness economic return needs to reflect a valid and fair comparison between the program’s costs and savings

  • We need to recognize that wellness programs affect all five economic variables but if we only look at one or two and then compare it with the total direct cost of the wellness program we are unfairly examining economic return.
  • Most organizations including yours probably don’t look at all five economic variables.
  • To be fair the total cost of a wellness program should be compared with all the economic savings caused by the program.


When to use this argument:  When a company’s management places great importance on Return-on-Investment (ROI) but fails to see the full economic picture this argument is often helpful.



Argument #5: Wellness can be configured to better balance short and long term economic return

  • Wellness programs need to take a balanced approach to short and long term economic return.
  • Most wellness programs are heavily weighted to produce long term economic return.
  • Wellness programs can be configured to include short term economic return through interventions such as:  medical self-care, consumer skill building, injury prevention, high risk pregnancy prevention, intervention for somatization disorder, presenteeism interventions, etc.


When to use this argument: When an organization’s management have an immediate need for economic return, this argument works well.



Other arguments indirectly related to the organization’s bottom-line that might help…


Argument #6: Wellness can directly improve the economic condition of the average employee

  • Healthy people have lower out-of-pocket health costs and can benefit from using pre-tax dollars to pay for their out-of-pocket health costs. In addition wellness financial incentives can benefit those who participate in wellness programs.
  • Wellness programs that address “financial wellness” often improve the financial well-being of employees and their families.
  • Wellness can lead to significant financial benefits for employees.


When to use this argument: In organizations with collective bargaining, labor force and employee relations challenges and recruitment needs management often resonates to this argument.



Argument #7:  Wellness can be used to help reduce the “entitlement mentality” of employees

  • Employers need to reduce the sense of entitlement that characterizes most employee groups.
  • Wellness can be positioned as part of the emerging partnership between employers and employees, particularly if information on the relationship between health risks and health costs is shared with employees.
  • Wellness should be seen as an opportunity to work together to help preserve the generosity of health plans, insurance benefits and future compensation.

When to use this argument:  Organizational managers that have a long history with a work force that evidences a deeply held sense of entitlement should be good candidates for this economic argument.


As with playing your humanitarian cards, it is critical that you narrow your choice of arguments to focus on one main argument in the economic area.  Even though we may see all the many benefits of wellness, executives can easily get overwhelmed with a laundry list of rationales.  Often they perceive that many ‘good’ arguments aren’t as convincing as one or two powerful ones that fit their strategic imperatives and are followed up with particularly cogent (and pragmatic!) examples.


When you think about your audience, one key question is how they think about the total health-related cost of their employee base. How much are employee-related costs on their minds?  How much pain do they feel today about health-related costs? Are they worried about future costs or trends? Have they determined what the effect of future cost increases will be on the organization?  Are they feeling the burn on the total employee costs of their business?  How do these costs compare to expected after-tax-profitability (or net revenue in the public and non-profit world)?  National data shows that these five economic variables represent between $25,000 to $35,000 of annual cost per employee per year.  If they grow at a rate of 10% per year…. can your organization survive another decade?


Executives who feel cost and competitive pressure strongly are typically the best targets for the economic message, but in almost every setting, your best bet is to pair one strong humanitarian argument with an equally strong economic argument to seal the deal!


Don’t forget, strategies for building executive support for wellness is one of the key skills we teach in our Level 1 WellCert worksite wellness certification program!