A Three-Pronged Strategy for Strengthening the Achilles Heel of Wellness Initiatives

The story of Achilles is perhaps one Western culture’s most recognizable Greek myths. A passionate demigod, blessed with near-immortality, is killed by a well-placed arrow to the heel, his only weak spot. This story is often used to warn of the hidden weaknesses present in even the most well-conceived, planned and executed products, services and programs. Here’s how this story relates to population health and wellness.

A popular form of population health initiative, wellness programs, have come under fire in recent months. Viewed by government officials, corporations, payers and others as essential tools for improving the health of millions, recently published research — in particular by RAND — has raised questions about their effectiveness. RAND found that most wellness program participants lose little weight and do not stay engaged over time. More tellingly, wellness initiatives do not appear to save employers much money over the short and long-term.

It’s not all bad news. RAND identified disease management programs, which are designed to help people with chronic conditions better care for themselves, as a bright spot. Its research suggests 87% of employers’ health care cost savings came from preventing hospital admissions and improving outcomes among those with chronic diseases.

One reaction to these data might be to declare, as some have, that wellness initiatives are a complete waste of time and money. Another might be to ask basic questions about why so many have failed the efficacy test. Could it be that forces largely outside of program developers and administrators’ knowledge and control have combined to blunt their impact? If so, what can be done about this major Achilles heel?

Understanding the External Forces Buffeting Wellness Programs

People in public health have long understood that their programs, communications and technology initiatives will be less effective if the social determinants of health are not recognized and addressed. The World Health Organization defines this as “the conditions in which people are born, grow, live, work and age.” For example, asking people to purchase healthy food is difficult within food deserts where local stores lack a variety of fresh produce.

Unlike their peers in public health, some producing wellness initiatives have not spent time enough studying and accounting for external forces that limit engagement and depress health outcomes. Some of the most important of these include:

  • Carehacking: Forced to take more responsibility for their care (especially financially), consumers are using data from a range of sources, including the Web, social media, PHRs and other tools to manipulate healthcare’s source code and “hack” the system. Consumers’ “carehacking” activities can have a positive influence on population health when it supports healthful behaviors. But, if consumers take action based on inaccurate or misleading information, carehacking can be harmful.
  • Life: Work, financial and family pressures can scuttle the best of intentions. Having to work long hours to make ends meet, frequent travel and other factors can make exercising regularly and eating healthy foods difficult at best.
  • Social and Mental: It can be hard to stick to an exercise regimen or change one’s diet when facing competing social pressures. Short- and long-term depressive episodes can also make engaging in daily activities a struggle.

Traditionally, those implementing wellness initiatives have had little awareness of and information about these external forces. Fortunately, this is starting to change as new technologies are providing unprecedented data about people’s health and well-being.

A Strategy for Improving Awareness of External Forces That May Affect Wellness Initiatives

In a recent webinar co-hosted by Dossia, “The Emerging Carehacking Revolution and Population Health: Understanding its Scope, Managing its Impact,” I discuss the importance of recognizing, studying and measuring the external forces influencing wellness initiatives. This three-layered strategic approach involves:

  • Gathering data from mobile devices, sensors, Websites, PHRs and other sources that can provide information about people’s activity levels, location, dietary habits, biometrics and more.
  • Analyzing this data to derive insights about people’s health, wellbeing, external forces influencing their perceptions (such as carehacking) and behaviors.
  • Most importantly, developing interventions that can be delivered via human and digital means that are personalized, relevant and meaningful to patients, caregivers and others.

Boosting Engagement and Success Using Data: Flying Cars or Reality?

Some may view these recommendations – gathering vast amounts of data, analyzing it for meaning and using it to deliver effective, personalized interventions – as difficult if not impossible to implement. Yet, a few leading-edge companies are starting to pursue parts of this strategy currently. One is Ginger.io, which is using a rich array of data collected via mobile devices to help health organizations deliver personalized content and interventions to patients. Welltock has partnered with IBM’s Watson to help it use its data to predict when people need support, encouragement or assistance. Dossia is using personalized behavioral “nudges” (grounded in a range of data) to improve engagement, compliance and more.

It’s worth repeating that the Achilles heel of wellness initiatives is lack of knowledge about external forces that are either blunting or boosting the effectiveness of these programs. Addressing this weakness will require recognizing the need to venture outside of wellness initiatives’ sphere of influence and use novel technologies and data collection methods to understand people in a much more nuanced and effective way.

To learn more about this strategy and how it is being executed, you can view the recorded webinar here.

Fard Johnmar is a digital health futurist and researcher. He is also co-author of the new bestselling book ePatient 2015: 15 Surprising Trends Changing Health Care , which explains carehacking in more detail.


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