Even when taking baby steps, you can still cover a lot of ground.

Perhaps that was the biggest takeaway from a recent study of 5,500 BlueCross BlueShield of Tennessee employees by Brentwood-based Onlife Health, a BCBST partner company with two decades of experience offering comprehensive wellness solutions to employers and health plans nationwide. Over three years, Onlife looked at the impact incentivized wellness programs – including exercise, health coaching, wearable fitness-tracking technology and financial incentives – had on employee engagement and healthcare costs

The results highlighted the gains made with even moderate exercise, defined as employees who took as few as 5,000 steps per day (or the equivalent of about 38 minutes of activity). Findings included:

• Contrary to the popular guideline of 10,000 steps a day, employees who took as few as 5,000 steps per day, had annual healthcare costs nearly 20 percent lower than their sedentary counterparts who did not exercise. Spending was $2,038 per member per year (PMPY) for non-exercisers compared to $1,646 PMPY for moderate exercisers.
• Emergency room visits and inpatient hospital stays were more than 50 percent lower in the moderate exercise group, as well. There were 219.6 ER visits and 59.9 inpatient stays per 1,000 for overweight non-exercisers compared to 73.6 ER visits and 30.1 inpatient stays per 1,000 for overweight moderate exercisers.
• Average claims cost PMPY dropped from $5,712 for non-users to $4,248 for employees who participated in one program and $3,120 for those participating in two programs. Employees engaged in three programs saw their claims cost cut almost in half at $2,892.

Looking at BCBST overall, Danny Timblin, president and CEO of Onlife Health, noted, “Over a three-year period of time when we did this study, their claims were essentially flat. Compare that to a national average where medical claims costs were rising on average 6-7 percent year over year … that’s pretty powerful.”

He continued, “It’s not like everyone is going to get up and run a marathon tomorrow so 5,000 steps are the baby steps to get people to replace bad habits like sitting at your desk all day.”

Catherine Bass, PhD, director of Analytics and Reporting for Onlife, said while hitting 10,000 steps would be optimal, getting people to make small, easy changes still has big rewards. She noted that most people get in about 2,500 steps each day just going through their normal routines so adding an additional 2,500 steps really only amounts to a little more than 15 extra minutes of concerted effort. “When you get up to 5,000 (steps), you’re going to start seeing some significant biometric changes,” she said.

Setting the Tone

Timblin said the road to success starts in the C suite. “The key piece for us when we start talking to health plans and employers is to assess the cultural appetite for wellness,” he said, adding his team has walked away when it didn’t appear a potential client was ready to take on the hard work required to move the needle on health. “It’s a total commitment to wanting to do what’s right for the employee base,” Timblin added.

After moving past the cultural commitment component, Timblin said the next step is to drive awareness through an aggressive information campaign to make sure everyone knows about the program and how it works. Then, he said, comes the ‘high touch’ part where the Onlife staff meets specific needs for individuals. “We work with people to drive and effect positive change,” Timblin said. “We’ve got a highly degreed, accomplished workforce who specializes in the areas of wellness. We can figure out what motivates you.”

While the high touch part of the program is critical, Timblin noted the company also relies on the high tech to analyze habits and reach out to participants. Onlife uses mobile applications, phone calls, virtual coaching and data from wearable technology to nudge people in the right direction.

“Consistently over time, members who engage in the program cost less than members who do not engage in the program,” Bass said, adding the Onlife staff is constantly working on enhanced engagement and looking for effective ways to get people to buy into the program.

The Value of a Good Incentive

Bass and Timblin said it was important to recognize the value of a smart incentive program. How those incentives play out, however, is really unique to the employer. Typically, individuals accrue points for hitting certain targets or milestones and then are allowed to cash those points in for rewards. Some companies offer cash or prizes; others feature premium reductions or extra vacation days.

Timblin noted employers might offer a flat cash rate to employees who take a risk assessment. While that data is an important, foundational step in crafting a wellness program, it’s what comes next that can really improve an employee’s health and a company’s bottom line.

Bass said Onlife has created matrices filled with activities that are assigned point values. “The activities are directly related to behaviors and lifestyle choices that will have a positive impact on a member’s health,” she added. Bass noted activities that are known to drive better health, such as smoking cessation, are more heavily weighted to incentivize change.

“Coaches align strategies to your particular struggles,” Bass explained.

Timblin recalled a member who was really tempted to smoke when stuck in traffic. His health coach got him to put a pack of cigarettes in the trunk so the crutch was still there but not really in reach. Timblin noted after a couple of weeks of this new routine, the member was willing to move to the next step of using a nicotine patch.

Baby steps, he stressed, are important milestones to celebrate. Demanding too much, too fast only sets people up for failure.