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Infosys Labs Briefings
VOL 11 NO 3
2013
How to Make Healthcare Wellness
Programs More Effective?
By Praneshkumar Wahil and Arshad Karim
Gamification- Transforming Enterprise
Healthcare Wellness Programs
I
n United States of America majority of the
In United States of America, healthcare
healthcare money is spent on treatment of chronic
costs have been spiraling continuously over the
non-communicable diseases. These diseases are
decade and is of huge concern to the economists
preventable to a certain extent by stimulating
and planners. A lot of time and money has
the individuals towards a healthy lifestyle. With
been spent by government and enterprises to
the new Affordable Healthcare Act, there is
reduce healthcare costs while improving the
an emphasis on preventive care and Wellness
quality of healthcare. 75 cents of every dollar
Programs in order to reduce healthcare costs.
spent on healthcare in United States of America
Employer based Wellness Programs encourage
is on treatment of chronic non-communicable
companies to improve health of their employees by
diseases. These diseases are often preventable by
offering to lower their monthly premiums which
motivating the people to live a healthier lifestyle
will lead to lower overall spending on healthcare
[1]. It is evident that higher spending on treating
later. Even though these programs offer healthy
diseases does not always lead to better, healthy life
living and incentives, there is very little awareness
for patients. Healthcare should be a system that
or participation in these wellness programs.
pursues promotion of healthy lifestyle and not that
The Gamification technique which is
aims to treat sick people. Traditional healthcare
being used in other sectors can help Healthcare
system provides no long-term benefit to people to
Industry achieve this goal. Gamification,
prevent themselves from getting sick, and results
in simple terms, is the use of game design
in higher spending on treatment of diseases.
techniques, game thinking and game mechanics
to enhance non-game contexts. This paper will
WELLNESS PROGRAMS– KEY TO REDUCE
provide information about different Gamification
HEALTHCARE COST
techniques that are, or can be used in HealthCare
An existing provision of Health Insurance
Wellness Programs.
Portability and Accountability Act (HIPPA)
40
permits employers to provide premium
or far he/she is from the target. It ends
discounts up to 20% to employees who maintain
up giving a feeling of chasing a moving
certain criteria designed to promote health and
target which causes the employee to give
prevent disease. The new Affordable Care Act
up in certain situations.
has a provision to increase the wellness discounts
to 30% for group health plans which can be
■■ N o F e e d b a c k M e c h a n i s m : M o r e
increased further to 50% subject to discretion
Often, there are not enough feedback
of the secretary of HHS [2]. Another provision
mechanisms to keep the employee
of healthcare reform indicates government
engaged in the wellness program due to
funding would be made available to small
which the employees feel clueless about
employers to launch wellness programs for
their progress.
their employees. Recently, many of the US
companies have been putting more emphasis
■■ Lack of Progression or Competitiveness:
on “Wellness Programs”. These “Wellness
There is no mechanism to compare the
Programs” encourage companies to improve
effort spent on wellness programs
health of their employees by offering to lower
among employees. Although health
their premiums which will lead to reduced
data is very personal and employee may
spending on healthcare later. $1 investment in
not like being compared on the basis
wellness programs saves $3 in health care costs,
of their vital statistics, a mechanism
according to the Wellness Council of America
promoting mutual competitiveness helps
and according to the Centers for Disease
in keeping people interested. Employees
Control [8].
get a feeling of isolation in traditional
Even though these programs offer
wellness program and tend to lose
healthy living and incentives, there is very little
interest soon.
awareness or participation in these wellness
programs. According to Maslow’s theory,
■■ Lack of Motivation: The existing
financial incentives can motivate people to a
premium discounts do not appear
certain extent but beyond that there is a need
to provide enough incentives when
for a higher level of satisfaction to attain the
compared to the amount of dedication
level of participation and achievement required.
needed for a behavior change.
PROBLEMS WITH TRADITIONAL
GAMIFICATION–TRANSFORMING
WELLNESS PROGRAMS
TRADITIONAL HEALTHCARE WELLNESS
Traditional Wellness programs fail to keep the
PROGRAMS
employees interested for several reasons, few of
Gartner Group defines Gamification as the
which are listed below
concept of employing game mechanics to
non-game activities such as recruitment,
■■ Absolute Milestones: The milestones
training and health and wellness.
set for eligibility of premium discounts
Gartner predicts that by 2014, more than 70
are in absolute terms and never give an
percent of global 2,000 organizations will
employee a visual feeling of how near
have at least one “gamified” application,
41
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Elements of
Gamification
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Figure 1: Elements of Gamification
Source: Infosys Research
which can range from mastering a specific
indicating they will leverage online games as
skill or improving one’s health .
well as other types of competitions between
4
The “Gamification” technique can help
business locations or employee groups [3].
an Enterprise to increase the effectiveness
of its Healthcare Wellness Programs. In this
GAMIFICATION FOR WELLNESS
era where video games, mobiles games are a
PROGRAMS
habit or addiction for many; ‘Gamification of
Improved Engagement by Rewards
Healthcare Wellness Program’ might interest
This can be achieved by awarding badges.
most of us.
For Example, a person signing up for a Yoga
It is important to recognize the
Class could be awarded a Yoga newbie badge.
philosophy of game engagement to understand
Employee will have a feeling of achievement
the success of gamified wellness programs.
whenever a new badge is awarded to him/her
According to a survey released in
and this will give them incentives to attend the
March-2012 by Towers Watson and the National
yoga class. Badges must be predefined for each
Business Group on Health, Gamification of
level of progress. Pre-defined badges will help
health and wellness will increase in companies,
the employee in identifying milestones and
with 60% of the sample of 500 employers
work towards them.
42
1
2
Figure 2: Daily Challenges e.g like one above would
motivate individuals to have carrots in a diet.
Source: Infosys Research
3
Figure 3: Let others know how you have improved.
Source: Infosys Research
For Example: An employee recording
Creating personal missions which
2000 calories of workout in a week could be
would help them to challenge themselves or
awarded a Super Healthy Badge. This shall help
their colleagues can keep them engaged in a
create small achievable milestones pointing
longer run.
towards final goal of healthy living. Similarly,
a surprise Health conscious badge for recording
Sharing Success Stories: A gamified social
data from recent routine physical exam can
platform could be provided that will help
encourage employees towards preventive
employees to share their success stories and
care too.
achievements. These stories may motivate other
employees and also help the individual build
Leaderboards- Employees log their effort spent
self-esteem. Testimonials from fellow employees
towards wellness program. This data on daily
could be used to support a success story which
basis could be updated to create leaderboards.
would influence more people.
This creates competitiveness in employees
By now it is evident that solely monetary
and keeps them engaged and addicted to the
incentives in form of premium discounts are not
chosen wellness program. Badges along with
motivating enough to drive behavioral changes
Leaderboards can help employees achieving
in employees towards health living.
small goals in order to reach a larger goal by
competing against each other.
GAMIFIED WELLNESS PLATFORMS FOR
ENTERPRISES
Define Missions/ Challenge a Buddy-
Enterprises can make use of use of various
These are some of the creative Gamification
online Gamification social platforms available
techniques used by wellness programs for
to increase effectiveness of Employee Wellness
advanced users.
Programs. These platforms provide multiple
Once the users have obtained the
engagement opportunities to employees aiming
badges and charting the leaderboards there is a
improvement in individual health and wellness,
possibility that they would lose interest.
and help them lead a healthier and balanced life.
43
to create small teams and work towards fitness
goals, challenge and support each other through
online interaction [5].
GAMIFIED WELLNESS FOR INDIVIDUALS
As human behavior we resist changes for many
reasons like lack of interest, a mental block and
moving out of comfort zone. On the flip side
we engage easily in anything that seems fun.
The concept of Gamification for individual based
wellness program is solely based on blending
fitness activities with fun. The behavior change is
fructified without an individual even noticing it.
Individual wellness has been gamified through
community/web based wellness programs,
mobile applications and console based games.
An example of community based wellness
programs for individuals is weight watchers
program. This program consists of logging the
food intake and exercise through the week and
Figure 4: Cover of ‘Your Shape Fitness Evolved
Source: Ubisoft
tracking the points in online portal. During the
weekly meeting members are rewarded on the
basis of their performance during the week
www.Sweatequitycoalition.com , www.keas.
(short term goal).
com and www.AetnaEveractive.com are few of
Many companies are now making the
proven products in gamified wellness platforms.
various online gamification social platforms
These platforms can not only be
available to individual healthcare customers.
customized for enterprises based on employee
These platforms are aim to improve your
demographic and wellness needs but also
health and wellness, and help you lead a
can facilitate monitoring and tracking the
healthier and balanced life. www.Keas.com
effectiveness of wellness programs at individual
and www.AetnaEveractive.com are couple
level and enterprise level. Enterprise may opt
of proven products in social platforms for
to use in-house gamified wellness platforms
wellness. Aetna Everactive is an easy-to-use
or ready to use gamified wellness platforms to
site designed to get (and keep) individuals
ensure sustained healthy behaviors which in
healthy. Whether one is seeking information
turn could result in reduced healthcare costs
on beginning a fitness program or training
and increased productivity.
for a marathon, one will find the resources
Gamified
wellness
program
and inspiration one needs to reach his/her
“Wellvolution” was implemented at Blue Shield
personal goals [6].
of California was with a notable 3:1 ROI,
With the advancement of motion sensing
they introduced a social platform for employees
technology and its usage in a growing video
44
game market, console based games have also
motivating factors based on age groups.
emerged as a means to promote healthy living.
Younger workers participated in the screening
Xbox console games ‘Shape your fitness’
because of financial incentives whereas for
and ‘Kinect sports’ are a couple of popular
older employees getting healthier was the top
examples. These games let the user have a
driver [7].
good time while working on his/her fitness.
Gamification should be used with
These games are easily accessible and can be
caution by enterprises. Employers will have
incorporated as a part of the wellness program
to ensure that non-participation by employees
for individual.
must not be used as criteria for discrimination
These gaming options provide challenges
or punishment. Instead the main cause of this
and opportunities for individuals to test their
non participation should be understood and
abilities. The exciting and relaxing effects of
wellness program should be tailored to suit the
these games are very appealing and help build
need of the audience. Just Gamifying wellness
the self-esteem of the individual. ‘There is an
program does not guarantee continuous
app for everything’ on mobile platform and so
engagement. The implemented tools and
a Gamified application for ‘Fitness’ programs
techniques need be flexible. Rapid changes
is another means to promote fitness among
should be possible bearing in mind target
individuals. These apps can help individuals
audience. Lack of monitoring and tracking
monitor their weight and provide feedback
might lead to dull and boring gamified
on a balanced diet; create and track monthly/
wellness programs. Wellness solutions like
weekly fitness goal, Share one’s achievements
mobile or console based games for individuals
instantly with friends and family. One of the
have limited feedback mechanism and must
most popular mobile fitness app for both iOS
be continuously upgraded to present a new
and Android users is the Nike+ running app.
challenge level for the consumer.
This app has very well implemented majority
of gaming elements to keep the user engaged.
CONCLUSION
Traditional Healthcare Wellness programs
CHALLENGES WITH GAMIFICATION
failed to gather employee participation.
The key to the success of Gamification is to
There has been continuous emphasis on
understand the audience well. There is no
behavioral change to live a healthy life style but
solution that fits all for Gamification of wellness
the existing monetary incentives are not proving
programs. The first and foremost step towards
to be sufficient to motivate the employees on a
Gamification would be to understand what
long term basis.
motivates your target audience. e.g. Elderly
There is certainly a need to increase the
population would seek motivation by reading
monetary benefits along with a mechanism to
the success stories instead of badges and
continuously engage employees in healthcare
leaderboards. On the contrary for a younger
wellness programs. Gamification has not only
audience leaderboards and badges will show
proven to improve employee engagement
good results.
but also attracted more employees for
At Ridgeview Medical Center, a survey
participation in wellness programs. Finally with
on biometric screening identifies contrasting
implementation of these techniques,
45
enterprises have been successful in controlling
Available at http://www.paulrauseo.
overall cost of healthcare and provide better
com/wellness-as-a-business-
and healthy life for employees.
strategy/2011-how-should-businesses-
Nevertheless gamification of wellness
be-preparing-for-obamacare.html.
program must be carefully designed and
4. Performance in era of uncertainty
reviewed based on the employee demographics.
(2012), Survey released in March-12
These techniques must be applied with caution
by Towers & Watson the National
as it should not be misused by employer in
Business Group on Health, gamification
discriminating against the non-participating
of health and wellness. Available at
employees. Also, the success stories from
www.towerswatson.com/assets/
colleagues must be a source of inspiration
pdf/6556/Towers-Watson-NBGH-2012.
for fellow employees and taken in a positive
pdf accessed September 2012.
collaborative manner.
5. Gartner Predictions about Gamification
in enterprises (2012). Available at
http://www.gartner.com/it/page.
REFERENCES
1. C e n t e r s f o r D i s e a s e C o n t r o l a n d
jsp?id=1844115.
Prevention, (2012), Prevention and Health
6. The Gamification of Wellness program
Promotion, National Center for Chronic
at Blue Shield of California. Available
Disease. Available at http://www.cdc.
at http://www.hfma.org/Templates/
gov/nccdphp/overview.htm#2.
InteriorMaster.aspx?id=34850.
2. Information based on PPACA, Sec.
7. Based on information from Aetna
2705 Available at http://www.nciom.
Everactive.com.
org/wp-content/uploads/2010/10/
8. With Health and Wellness For All (2010),
PR_Provisions_Full.pdf.
Shape Up news. Available at http://
3. R a u s e o P . ( 2 0 1 0 ) , I n f o r m a t i o n
about
Affordable
care
www.shapeup.com/news/article/with-
Act.
health-and-wellness-for-all.
46
Author’s Profiles
PRANESHKUMAR WAHIL is a Senior Consultant with Infosys’ Process and Domain Consulting
services. He can be contacted at Praneshkumar_Wahil@infosys.com.
ARSHAD KARIM is a Project Manager with Financial Services and Insurance Practice of Infosys. He
can be reached at Arshad_K@Infosys.com.
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© Infosys Limited, 2013
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