i’m testing storify as a way to capture our chats. please be sure to give this approach a thumbs up/thumbs down in the comments.

hellowallet joins us on february 15 at noon for next month’s chat on tools to increase employee financial well-being. don’t miss this one or any other. check out the entire 2012 chat calendar.

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what wellness trends will we see in 2012? find out on wednesday, january 18, when jane sarasohn-kahn—health economist, consultant and blogger—joins cohealth.

tweet chat agenda

we’ll start with these lead questions and branch out from there. if you have particular questions you’d like to pose to jane, leave them in the comments.

Q1. what are the health and wellness trends you believe employers should be paying attention to?

Q2. how might the growth in the direct-to-consumer health industry alter employees’ expectations of what their employers offer?

Q3. do you expect mobile health and devices for health (e.g., fitbit, bodymedia) to alter employers’ strategies?

Q4. you write often about how social and economic factors affect our health. should employers play a role in influencing policy to address these determinants?

about cohealth

there’s no need for me to introduce this month’s cohealth chat topic with a slew of statistics. i’m going to let mercer’s infographic do the heavy lifting here. i’ll simply sum things up by stating the obvious: a vast number of employees are financially struggling to make end meets today. tomorrow? they can’t even think about college tuition and retirement. this financial wear and tear is showing up in skipped doctor’s appointments, stress-induced health problems and an unpreparedness for the golden years.

tweet chat agenda

join us wednesday, december 14, at noon ET as we talk about financial well-being and the employer’s role. here’s our starter set of questions:

Q1. let’s start with a classic: what keeps you up at night about your employees’ financial well-being?

Q2. what impact is your employees’ financial insecurity having on your business? consider: absences, lower productivity, health expenses.

Q3. what are your employees’ financial needs and concerns? how do you learn about these?

Q4. there are two horizons for financial well-being, today’s and tomorrow’s. what guidance and advice do you offer employees to help them manage today’s financial needs?

Q5. what about tomorrow’s: retirement readiness?

Q6. what steps have you taken to nudge employees? for example, 401(k) auto enrollment, automatic contribution escalation or company-paid basic life insurance.

Q7. do you differentiate your support or your materials by demographic group or level?

use the hashtag #co_health to join the conversation. as always, sidebar discussions are both welcomed and encouraged.

about cohealth chats

cohealth tweet chats are held the third wednesday of every month from noon to 1 pm ET. (we moved this chat to avoid holiday conflicts.) you can follow us on twitter and join our linkedin group, where we regularly share information and discuss ideas, approaches and outcomes.

want to know more about cohealth? look here.
interested in past chats? browse recaps.
new to tweet chats? read this.

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[image: mercer m/think]

so, tell me what you want, what you really, really want
i’ll tell you what i want, what i really, really want

the spice girls’ girl-power cry is the perfect summation of this month’s tweet chat topic about whether employers should give employees the benefits they want or the ones they need.

wasting no time, we launched immediately into q1: which employee benefits are essential to an employee’s physical, financial and emotional health and well-being? the group response focused on, as @raygoldberg put it, “those benefits that employers are uniquely positioned or expected to provide.” these included health insurance, life insurance, disability insurance, 401(k) and other retirement products, employee assistance programs and behavioral support. of course, want vs. need is all perception when you get beyond food, shelter and water. we immediately saw this tension with disability insurance. “employees need disability insurance for financial stability, but no one ever thinks they’re the one who will be out of work,” said @carolharnett. we also recognized that “if you don’t know how to use them or their impact, benefits are a waste for everyone,” as @fitfeud and @calshana both commented. want vs. need gets even trickier with less tangible benefits. my tweet, “i also believe [essential benefits include] a company with senior leadership that one trusts, a job that fulfills and a path with opportunities” resonated with many.

when we moved into q2: which employee benefits and perks do you think employees want?, @betterworks raised the notion of customization, something employers wrestle with and is increasingly difficult with three generations in the workplace. “employees’ needs and wants change over time, and employee-driven choice allows for flexibility,” @betterworks tweeted, “but building those programs is a lot of work.”

some weren’t altogether sure the work was worth it. after @tcoughlin tweeted, “one desire is for greater employee choice rather than fixed employer-defined packages,” we discussed the pros and cons of choice. meeting the needs of all employees naturally leads to greater choice. but does greater choice lead to more confusion? @wellwork thought so, particularly “when it comes to medical,” he said. “i think a lot of employees want less choice. more simplicity.” @calshana added, “too much choice can lead to inaction according to behavioral economics research, so a balance needs to be struck.”

diffusing the tension between choice and simplicity is handled differently, depending on the benefit. speaking solely of health insurance, we know better communication and decision-support tools guide employees quickly and confidently through personal choices and lessen their feelings of ineptitude, fear and dissatisfaction. beyond health insurance, greater choice responds to the needs of a three-generation workplace and better life+work integration. “if employers make life less stressful, there will be less stress at work,” @betterworks said.

this statement segued us into q3: are there employee benefits we can offer that improve employee life satisfaction and well-being? my POV is that work-life flex is the #1 benefit employees need to improve their overall well-being. @carolharnett and @betterworks got more specific, calling out concierge benefits, such as gyms, food, dry cleaning, dog walking and even auto detailing.

talking about “wants vs. needs” begs the question, q4: should employers require employees to participate in a core set of benefits? @michellewjames shared that intel created an opt-out core with “a core set of benefits based on what we think employees need.” the opt-out approach, which we see with 401(k) plans, resonated with many, particularly with our determined core: health, disability and retirement. after that, we looked to culture and better management to guide people to what they need, such as better nutrition and more fulfilling work experiences.

we didn’t fail to recognize how our conversation echoed the national conversation on the constitutionality of an individual mandate, which led us to q5: as health care reform changes are implemented, how might employers package their benefits differently? this group felt the move to exchanges would be based on size, company and industry, and that companies may offer employees either fixed benefits with buy-up options or a fixed contribution to freely spend on a package of benefits.

ultimately, the conversation reflected a continued desire to make sure employees were safe, secure and taken care of balanced by a wariness of how rising health care costs will alter employers’ perspectives. @johnlapuma projected, “i can see required weight loss or penalty, esp if job impairment demod.” i’m not sure that’s a projection, when incentives are tied to lower BMI and bus drivers are told to lose weight or lose pay. as we move deeper and deeper into a post-reform world, it’ll be interesting to see what form our paternalistic bent takes.

read the complete transcript.

big news: this was the inaugural chat for our new co-host, carol harnett. greg and i are delighted to have carol join us. she brings a deep understanding of health and well-being, enthusiasm and fresh ideas. greg will stay on as grand poobah, ceding cohealth’s management to carol and me.

december chat date change! we’re moving december’s chat to wednesday, december 14, when we’ll be talking about financial well-being. money (that’s what i want). cohealth tweet chats are always held at noon ET. follow @co_health to stay informed and involved.

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this is a guest post by carol harnett, who will be co-facilitating our november #co_health tweet chat on this topic.

My elementary school teachers told me I should focus my attention on the front of the classroom where they were imparting facts I needed to succeed in school. “Talking with your neighbors,” as they phrased it, was a minor crime.

But, I simply couldn’t resist exchanging comments with my classroom friends. Sometimes, our teachers said things that went begging for some kind of reply or discussion.

Fast-forward several decades to the July 2011 CoHealth tweet chat with MetLife’s Ron Leopold on wellness programs and employee retention. Ron’s information was terrific, but one of the more interesting exchanges was a sidebar discussion on—of all things—pet insurance.

Ultimately, we were left with a question: “Should we give employees what they want?” More specifically, should we give employees what they want when it comes to employee benefits and perks—even if we don’t think the employees’ wants match what we think employees need?

Since July, a spiral of online posts and exchanges evolved:

Bob Merberg of the Employee Wellness Network, Paige Craig of BetterWorks and I created a YouTube discussion of he said, she said and I said. And there were additional discussions on Bob’s website and LinkedIn. I even dedicated my September HR Executive Online benefits column to the topic.

My colleague and friend, CoHealth’s Fran Melmed, wisely saw the opportunity for a focused tweet chat on the topic.

Tweet chat agenda

Join us Wednesday, November 16, at noon ET as we debate these and other questions.

Q1. Which employee benefits do you believe are essential to an employee’s physical, financial and emotional health and well-being?

Q2. Which employee benefits and perks do you think employees want?

Q3. Are there employee benefits or perks we can offer that improve employee life satisfaction and well-being or that simply make employees happy?

Q4. Should employers require employees to participate in a core set of benefits?

Q5. What are some ways employers can design benefit and perk offerings? (For example, cafeteria plans, opt out versus opt in, concierge benefits and employee clubs.)

Q6. As health care reform changes are implemented, how might employers package their benefits differently?

So, what do you think? Should we give employees what they want, what they need or a little of both?

Sidebar discussions are both welcomed and encouraged.

- Carol

about cohealth chats

cohealth tweet chats are held the third wednesday of every month from noon to 1 pm ET. you can follow us on twitter and join our linkedin group, where we regularly share information and discuss ideas, approaches and outcomes.

• want to know more about cohealth? look here.
• interested in past chats? browse recaps.
• new to tweet chats? read this.

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we spoke about social health games during our september cohealth chat. this month we want to dive in to real-life examples of who’s doing what to make workplace wellness social. we’re going to talk tools, tips and techniques.

tweet chat agenda

here’s our starter list of questions. if you have one you’d like to add, leave it in the comments.

Q1: how are you making workplace wellness social?

Q2: what social media tools are you using? think: blogs, twitter, facebook, patient communities, social wellness solutions.

Q3: how have leaders supported your efforts? have they embraced or been skeptical (or worse) of social tools?

Q4: how have employees responded to social initiatives?

Q5: what’s your approach when it comes to different employee segments? have you created a separate social strategy for employees with chronic conditions, for example?

Q6: what are your HIPAA concerns and how are you addressing them?

Q7: how are you approaching your social strategy’s effectiveness?

about cohealth chats

cohealth tweet chats are held the third wednesday of every month from noon to 1 pm ET. you can follow us on twitter and join our linkedin group, where we regularly share information and discuss ideas, approaches and outcomes.

• want to know more about cohealth? look here.
• interested in past chats? browse recaps.
• new to tweet chats? read this.

see you october 19.

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on september 21, the #co_health tweet chat welcomed trapper markelz, head of product at meyouhealth. we spoke about why social health games work (and why they don’t), and we left a few unanswered questions, which trapper’s addressed here. during our chat, we also announced the opportunity to participate in a cohealth pilot of meyou health’s product, the daily challenge. this is your chance to test a soon-to-be-released enterprise solution and give feedback on it. don’t miss out. sign up now.

q: many of us were confused by the idea that a game should have no goal. could you help us better understand your position?

tm: this is a hard one. it isn’t that games should have no goal, but more that games don’t need a goal. based on what i’ve learned in the last two years, there’s something immediately disingenuous (from the perspective of the player) about a health game. if i need to lose weight, the fact that you’ll make a game that successfully tricks me into eating differently and running around more is absurd. equally absurd is the idea that if i need to lose 40 pounds, your game is the intervention i need. it might be for some tiny fraction of the population, but people are far too complex—and, thus, so is behavior change.

before most people can tackle weight loss, they may need to change jobs so they decrease their two-hour commute. or they may need to repair an abusive relationship with a parent or spouse. they may need to find long-term care for their parent with dementia to reduce their stress. or become mindful of their food-buying habits. and so on. i’ve personally become overwhelmed by the complexity of people as we dove into this design challenge at meyou health.

so far, i believe the best we can do is create a supportive, educational environment that guides people toward some small epiphany. gamification can help with this. we can create a context where interacting with people is deemed required. essentially, we generate a reason to reach out and form support networks—even with people you’ve never connected with before. and we can impose constraints so that the entire spectrum of behavior change isn’t the focus. instead, the focus is these seemingly arbitrary small actions that generate momentum.

the product doesn’t need to be a game at all. it doesn’t need to be about abstractions. it can be about real people, and it can be about real small changes that you make in your real life. in such a product, there is no “goal.” that doesn’t mean that people don’t create their own goals as they have their own epiphanies, but the game doesn’t create that; the participants do.

q. what works best to prompt engagement long term?

tm: long-term engagement is all about relevance. if a product continues to be relevant (therefore valuable) to someone’s daily life, he or she will continue to pay attention to it. gamification can help with this because it can create permission for a product to reach out and, therefore, remain relevant. for example, with daily challenge, participants agree to receive a daily email invitation. they receive a daily challenge in a method that’s comfortable, non-intrusive and convenient. we have a reason to contact someone and remain relevant—and we have permission to do so.

q. are there any studies that show that games help people make long-term changes?

tm: as far as i’m aware, there are no studies that show that long-term behavior changes were made specifically from a game. and even if there were, my bet is that it would probably cite a social dynamic rather than the game itself.

for instance, competition is a social dynamic that arises out of a game mechanic like a leader board. the game could be something simple, like collect the most coins in 30 seconds. i might keep playing the game every day—not because collecting coins is particularly fun, but because my friends have collected more and i’m trying to beat their record.

that said, there are plenty of studies showing that long-term behavior change was accomplished using social interventions. what we’re trying to do at meyou health is make social more relevant to someone for a longer period of time by setting up specific interactions that come through a gamified product.

q. picking up from my recap of our #co_health chat, “what is it that makes some games accomplish this [social interaction] while others don’t. how else can we evaluate a game?

tm: if everyone knew this, then every game would be a hit, right?

a game is a complex mix of dynamics that lets you know what you’re supposed to do and when to do it, mechanics that let you know where you’ve come from and what you can achieve in the future, and aesthetics that deliver on your tactile and emotional connection to the content. all of this produces an extended journey of ups and downs that culminates in some form of peak-end (http://en.wikipedia.org/wiki/peak-end_rule) judgment over what you experienced.

the way we evaluate our products at meyou health is to ask ourselves: do people keep using our products? if you don’t have engagement, you can’t possibly have effect. if you don’t have effect, you can’t possibly generate a measurable health outcome. to people in product development, that sounds pretty normal (first, we need people to use it!), but i’ve learned that in the health space, it’s normally, “let’s prove this intervention is effective, and then let’s hope we can get people to use it!”

q. will games make health programs more personal? if yes, how?

tm: i think they really can. if you use game elements, you can create a reason for people to interact. you can create scenarios where social taboos fall away. games can truly bring people together because they can immediately share a common context. if you see a guy sitting on the street, how likely are you to go up to him and start talking? if that same guy is sitting on the street with a chess board in front of him (assuming you’re somewhat confident in your chess-playing ability and you have the time for a game), you’re far more likely to stop and interact.

q. how could a game help someone train for a 5k run, for example?

tm: there are two scenarios where i’ve heard gaming applied to this question:

1. how can a game motivate someone to run a 5k?
2. how can a game help someone (who is already motivated) train (and complete the training) for a 5k?

there’s confusion between products that motivate you to do something and products that take advantage of your motivation. doing #2, working with existing motivation, is a lot easier and ultimately where a lot of health games end up shaking out (in my opinion).

creating motivation is much harder. i believe you can only approach it indirectly, as there are just too many reasons why someone chooses not to do something. i don’t have a good answer for how you create motivation at scale. at meyou health, we hope that by encouraging people to complete daily, small actions and to have conversations with their support network about these actions, we’ll create the personal epiphanies necessary for behavior change to take hold from within.

q. do things like sports leagues fit into the discussion someplace? or are electronic games more personal?

tm: sports leagues are successful because they add that social element. for team sports, it’s obvious. for golf leagues, bowling leagues, fantasy football, etc., they’re fun because of the social interaction (in the form of cooperation, competition, comparison, knowledge sharing, etc). how fun would a sports league be if you went every week and no one talked to you? if no one knew your name and you didn’t interact with anyone? you probably wouldn’t play in that league for very long.

the use of gamification is really about figuring out a reason for people to be social. we all want support and someone to share our experiences with so we don’t feel alone in our health struggles—and so that we have people on our side when we try to change.

from the beginning of time, games have been an equalizer. it didn’t matter who we were, or where we came from—when we sat across from each other at a board game, we felt comfortable interacting. the rules and constraints provided the comfort we needed to be human with one another. in health games, i’m curious to find the same thing. what combination of dynamics, mechanics and aesthetics produces the highest quality interactions that move the needle on personal well-being? if we can figure that out, the world truly can be a healthier place.

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more information:

• tell me more about the cohealth pilot.
• i don’t need to hear more. i just want to sign up!

Don’t miss the next #co_health tweet chat. check our calendar for details.

i think it’s safe to say that i’m not the only one whose brain was working overtime during september’s #co_health tweet chat.

we were talking about games for health and engagement with trapper markelz from meyou health. we also introduced a cohealth pilot of daily challenge, one of meyou health’s products. trapper’s done a great job recapping his response to our questions, so i’ll direct you to his blog to read that and use this space instead to share my takeaways.

• games are an ally in companies’ efforts to motivate employees to lead healthier lives. as trapper explains, games create a shared environment that builds upon our natural inclination and desire to be social and cooperate. they create an opportunity for us to come together as competitors and as support.
• games softly lead employees’ attention to their health. as allison kohler (@amkohler) put it, games “get people to focus on their health.” games facilitate a shared experience or one that makes us feel capable. in this stealth mode, they lead us to healthier behaviors and small actions that improve our well-being.
• games give us power and control. when we’re unhealthy or tackling a huge challenge we fear we’ll fail, we don’t feel powerful. or in control. games allow us to develop and show mastery—an antidote to those feelings of powerlessness.
• social interaction is what we should measure. we know social interactions can positively affect our health outcomes. trapper expressed that games help generate and sustain these interactions—and it’s these interactions that we should measure. i’m still struggling with this concept, to be honest. i want to dig into precisely what it is that makes some games accomplish this while others don’t. how else can we evaluate a game?
• games need to be designed for a personal experience and a personal win. games with a known path or ending don’t cut it, per trapper. “in health games, it is most important [that] the participants be allowed to find their own win state. the goal someone has when they start pursuing health (lose weight) might be different by the end (change jobs).” this statement is both a DOH! and a-hah! moment for me. of course people transform as they go through a change. haven’t we all seen this? a game must morph with them as they change. i’m also chewing on what another #co_health chat participant, alex gekker said: “a good health game is one that has (re)playability beyond its health benefits.”
• games go wrong when they have a specific goal. this is another brain tease for me. the notion, as i understand it, is that if the game has a goal and you reach it, you’re gone. you won’t play anymore. quoting trapper: “if the game is to lose 10 pounds, it becomes much more important to lose those 10 pounds than to play the game. if we leave the game, we stop interacting with the content and other participants that really matters.” if i’m understanding trapper’s perspective, he’s calling into question the effectiveness of games that focus on increasing activity or improving eating habits, for example. does that mean there isn’t a game that helps someone with a concrete goal like quitting tobacco? what does that say about a game like re-mission, which has the concrete goal of helping young kids better understand and manage, psychologically and physically, their cancer. is the idea to be on an endless health quest, which is basically daily challenge’s desgn? i need to delve into this more with trapper to fully understand his point of view.
• most of us have a lot to learn. we think we know games because we play them. but games and game theory and behavior-change gaming are something quite different. as trapper says, “the main consideration is that this is all new to employers.” you can say that again. i know i’m on a quest to get a better handle on the subject.

one of greg’s and my goals when we launched cohealth was to give the workplace wellness community a way to influence thinking, design and outcomes. i’m delighted to announce our first pilot opportunity to do all that and more. between september 21 and october 20, cohealth members can sign up and use meyou health’s daily challenge. on october 25 at 2 PM ET, we’ll invite participants to share their feedback. read on for information about daily challenge and our cohealth pilot.

about daily challenge

daily challenge delivers small, daily, doable activities to your inbox. activities include checking something off your to-do list, ridding yourself of one unwanted piece of clothing, stretching once during the day. the activities are based on six domains, as identified by the gallup-healthways well-being index, and include emotional and physical health as well as basic access, work environment, healthy behaviors (like eating), and life evaluation. as you complete these activities, you can share what challenges you took and how you completed them, and also encourage others to complete a challenge.

anyone who joins our cohealth pilot and completes daily challenges will earn points that turn into tokens. tokens can be redeemed for keys that unlock premium content and topic-focused challenges for 28 days at a time—for instance, “exercise for everyone” and “wonderful walks.” there are others that focus on workplace movement, stress relief, healthy eating and sleep, and next week meyou health will launch a new one focused on professional development.

daily challenge is currently a consumer product. it’ll be available to employers in 2012.

sign up!

sign-up is simple and free. to join our cohealth challenge:

1. sign up. visit the cohealth meyou health page to sign up for the daily challenge via facebook or email.
2. set your preferences. you can set how you’d like to receive daily challenges and who you’d like to be connected to. you can also personalize your page with a photo and brief bio.
3. invite connections. you’ll get more out of daily challenge if you create a social circle. if you sign up via facebook, you can invite your facebook network to join you. or you can send invites to friends and employees via email.

learning from cohealth: hold the date

we agreed to offer this opportunity for two reasons. we believe it offers our community the chance to test an interesting product that’s soon to be launched as an enterprise solution. it also provides an opportunity for the cohealth community to share their perspectives and needs.

we’ll conduct a focus group at the end of the trial and invite you to give your unvarnished feedback about what you liked, what you didn’t, and what features or changes you’d like to see. i’ll facilitate this focus group with meyou health as i’d also like to understand what you’d like from future pilots.

date: tuesday, october 25
time: 2pm ET
logistics: we’ll send invites to all participants closer to the date

questions? ask below or shoot me an email.

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i’m speaking at two events that focus on health, health innovation and health collaborations this month.

social health summit (SXSH)

details: september 19, philadelphia
twitter hashtag: #SXSH

the social health summit (SXSH unconference) is an annual event that consists of structured, previously announced presentations in the style of a TED conference, as well as an unconference portion, where topics are decided by the participants. you can review the lineup and register here.

cohealth meetup

details: september 19, philadelphia, 11 am
twitter hashtag: #co_health

i’m facilitating an unconference session at SXSH as part of their innovation/government/wellness track.

both SXSH and cohealth believe the various constituencies involved in improving health need to work more closely together. with our track, we’ll bring employers, innovators, payers, pharmas and more into the room to enrich our discussion. as we always do with the #co_health chat, participants will decide the topic.

health 2.0 san francisco

details: september 25–27, san francisco
twitter hashtag: #health2con

i’m excited to attend health 2.0 san francisco (SF) this year, since last year i monitored it from the twitter sidelines. health 2.0 SF offers a great lineup from “the worlds of technology, health plans, providers, pharma, government, health plans, finance and more” to see demos, discuss the latest changes in health care and investigate new health care technology startups.

this year they’re also offering an employers 2.0 preconference workshop that focuses exclusively on those issues unique to employers: health care, health care reform, workplace wellness, benefits enrollment and onsite medical clinics. all main conference attendees get free admission to this workshop.

i’m moderating the following panels, joined by such companies as clif bar, tesla, pfizer, limeade, keas, shapeup, kairos labs and zamzee:

• opening segment: the role of employers in a post-reform world (employers 2.0)
• workplace wellness (employers 2.0)
• game on: massively multi-player approaches to healthy behavior change (main conference, day one)

it’s a busy but fun and stimulating month. there’s still time to register and attend. but if you can’t, use the twitter hashtags to follow along.

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