this morning i presented on workplace wellness trends at people report’s 2011 best practices conference. i’ll report on the conference later. for now, i want to share the slides. they contain a lot of important data on what’s happening with wellness.

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health 2.0 SF is the speed dating scene of the health technology world—except you sit pretty while tech companies, not a potential partner, take their best 3-minute shot. if you like what you hear, set up a date. they’re there for the asking. if you don’t, no worries. they’ll be vacating their spot, ceding it to the next company for their 3-minute spot.

i was there to moderate two panels at the first-ever employers 2.0 preconference workshop and to moderate another panel on social games at the main conference.

employers 2.0

employers 2.0 covered topics unique to employers’ concerns: workplace wellness, onsite medical clinics, and consumer tools for purchasing insurance and health care services. the panels i moderated gave me the chance to talk about wellness with some familiar faces—limeade and keas—and to learn more about stickk, a solution based on personal commitment contracts. luckily, we also had the employer represented by clif bar, pfizer and the pacific business group on health, a non-profit business coalition with 50 large-employer members. sure, we touched briefly on the employers’ role in creating a culture of health, using their influence to improve health care, providing well-rounded wellness efforts that focus on the four biggies (stress, nutrition, fitness and tobacco). but we also discussed the behavioral, financial, aspirational, communal and spiritual—and not in a “granola” way. we talked about career development, volunteering, and finding deeper meaning with the work we do and the relationships we form. each of these wellness solutions supports this deeper definition of well-being.

next, we heard from cisco about their onsite clinic, launched in 2008, and from american well, an on-demand service that connects consumers and physicians. cisco’s comprehensive clinic offers a comfortable, inviting, convenient place for cisco’s employees and their family members to get comprehensive services, not just biometrics. the clinic offers primary care, laboratory and radiology services, and houses a walgreens pharmacy, vision care, disease management and employee assistance program counselors—even an acupuncturist. cisco offers employees who use the clinic a lower-cost structure, including waived copays. it’s a model that’s working for cisco, with satisfied employees reporting less time away from work and shorter wait times for care.

finally, six companies that offer tools for health care purchases, including insurance, demoed their product. it’s worth checking these out so you know what’s available to you and your employees now. as we move toward 2014, more tools and resources will be available to employers and consumers alike.

• health expense.com—helps employees track their medical bills and health insurance payments
• ehealth government systems—guides individuals to find the right health plan in an exchange
• connectedhealth—leads employees to the best health plan for their needs and offers additional guidance and support, including live support
• castlight health—provides unbiased information about price, quality and convenience of different health care providers so employees can truly become health care consumers
• trustnode—teaches employees how their plans work and helps match them to the best plan
• benefitsconnect (product)—handles online benefits enrollment for employers

massively multi-player games

i moderated this panel pulled together by rajiv kumar, CMO and co-founder of shapeup. joining us were jonathan atwood, ceo of zamee and michael kim, ceo and founder of kairos labs. the game approach these guys talked about comes from PERMA, a new model for well-being created by martin seligman. (thanks to michael kim for introducing me to PERMA and the book from which this acronym comes, flourish.) PERMA stands for: positive emotions, engagement, relationships, meaning, accomplishment/achievement. about now, you should be sensing a theme, as this echoes the conversation in the workplace wellness panel. games, these three felt, powerfully and effectively created an avenue for an individual to achieve all five ends.

demos, demos and more demos

but demos are the heart of health 2.0. it’s an astonishing rotation of over 130 companies hand-selected by the health 2.0 team for their creativity and impact—or potential impact, as some of these companies are being showcased for the first time and are looking for investment, alliances or buyers. companies that aren’t invited to demo can set up shop in the exhibition hall. it’s the leading showcase of cutting-edge innovation, and its intent is to keep its eyes—and ours—on what’s coming down the pike.

so, what’s coming down the pike? tools that’ll inform, guide and connect us. tools that’ll help us make better benefits and health care decisions, whether we’re working through an employer or buying direct as a consumer. tools that’ll connect us with others to pursue a lifestyle or help us overcome addiction or allow us to conveniently tap into a doctor from wherever we are, about whatever we need. tools that are personalized and work from where we are: physically, mentally or spiritually. tools that’ll make the technology we sometimes feel encumbered by our servant.

for employers, here’s a slim sample of companies to check out in addition to the ones already mentioned:

• mindbloom—released at health 2.0 by aetna, this “life game” is billed as a “fun, simple and effective way to improve the quality of your life.”
• onerecovery—focused on recovering addicts, this social network helps addicts, as well as their family, work through and keep to their recovery.
• healthtap—connects you to thousands of physicians who can answer your questions for free via online and mobile solutions.
• liv.n it—not yet released, this is a “mobile habit gaming network” from kairos labs that’s designed to encourage us to complete small, daily acts of healthy living.

after watching a slew of demos, you notice things you might not otherwise notice if you were using only one product. facebook features are infiltrating many products, with status updates, “likes” and so on becoming ubiquitous. i’m sure this aids ease of use, since it’s all familiar, but one has to wonder when we’ll have facebook fatigue (outside of facebook). similarly, i saw more than a few tweets suggesting that attendees are experiencing a similar fatigue with gaming elements. it’ll be interesting to head back out to health 2.0 next year and see what we’ve learned and where we’ve landed.

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penjerdel employee benefits and compensation association (PEBA) asked me to record the presentation on employee wellness i gave at their 29th annual forum. in the presentation i cover seven levers for making workplace wellness more effective.

andre blackman was our guest on the last cohealth tweet chat (recap), and he answered most of our questions about how employee wellness efforts can incorporate mobile health (mhealth) solutions. a few questions from the cohealth community were left dangling, so andre’s answered them here.

how do you track changes in behavior as a result of short message service (AKA text) health interventions?

ab: tracking changes with SMS will depend on what sort of behavior change you’re measuring. something such as medical adherence may take some time, and i believe that’s something that can be tracked through a feedback module as well as pre- and post-data comparison. my delicious account has relevant studies and information on behavior change with mhealth.

there are people who don’t text or use smartphones. must we support all audiences?

ab: we’re hardly in a time where anything is a must, especially related to mhealth. knowing who you’re trying to reach will help you decide on whether you should look into SMS-based or mobile apps.

as we move from Gen X and Gen Y to baby boomers, how effective is SMS?

ab: the age of those individuals who are using mobile phones to communicate continues to rise, especially as boomers have grandchildren and want to stay in touch. it’s similar to what we’ve seen with social networking sites. mobile’s being integrated into our society—and although there may be younger natives to the platforms, older adults are using these tools.

would an example of two-way SMS be texting with a personal coach?

ab: that would be a great example. coaching and advice on specific topics (e.g., sexual health for teens) are great uses for two-way SMS/texting. you can get reminders, personalized feedback, etc.

with mobile wellness sites that organizations build, is it important to remove the password so families can easily access?

ab: having fewer access barriers is important in the mobile world. you want consumers to easily use the information. privacy restrictions and basic caution aside, allowing members of the family to access relevant health information without passwords can be very helpful in allowing for great adoption. when you start looking at confidential personal health information/records? that may be an area to have more restriction.

what about the adopt and drop rates of app usage? how do we hook people and keep them?

ab: you need to do your homework about the types of people you’re looking to use your mobile tool. we’re also living in the days of co-creation, where instead of making assumptions, we can go ahead and ask for beta feedback from potential users. that way, we can get an idea of what actually works rather than relying on the “see what sticks” method. user interface design and usability are things to really consider.

we’re just diving into mobile. what are the easiest tools and apps for us to use?

ab: i’d suggest looking at case studies and examples of how it’s been done already for the health world. for example, look at the CDC example about how to set up a text messaging campaign. get a sense of the why first. then you can start to look at the tools to get it done.

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we love our phones. we sleep by them. we interrupt conversations to respond to them. we choose them over some surprising things. we truly can’t do without them. that’s not all bad, particularly when it comes to health. as susannah fox at pew’s internet & american life project has said, “information has become portable, personalized and participatory. once someone has a mobile device, they’re more likely to use the internet to gather information, share what they find and create new content.”

what are the opportunities with employee wellness? that’s the focus of april’s cohealth tweet chat. we’ve invited andre blackman to lead the discussion.

andre’s the director, digital communications/new media at the american heart association and an advisory board member at mayo clinic for social media. andre’s been a featured speaker/commentator and strategist on a number of public health 2.0 related conversations around HIV/AIDS, mobile health, health disparities and new forms of health journalism. he’s worked alongside organizations such as the black AIDS institute, USC annenberg school for communication & journalism, centers for disease control and prevention, U.S. department of health and human services, and the north carolina division of public health to educate and promote innovation around important health initiatives and opportunities. for just over four years, he’s written about public health and innovation on his blog, pulse + signal. you can find him on twitter as @mindofandre.

tweet chat agenda

we’ll talk about the following topics. let us know in the comments if there’s anything in particular you’d like to explore that’s not covered here.

presentations, articles and reports

• the advance of mhealth (presentation by andre)
• 5 must-read mobile health reports (mobihealthnews)
• mobile health: hype and hope (presentation by jane sarasohn-kahn)
• women, chief household officers, like to manage health via smartphones (also from jane and her excellent blog, healthpopuli)
• SXSW 2011: four landmines mhealth needs to clear (mobihealthnews)
• U.S businesses spend more on wellness programs, but don’t measure results (PRweb)
• self-tracking, sensors, and mhealth: trends and opportunities (presentation by carol torgan)
• the power of mobile (presentation by susannah fox)

about cohealth tweet chats

cohealth’s tweet chats are held the third wednesday of every month from noon to 1 pm ET.

• recaps of past chats
• new to tweet chats? read this.

see you on the 20th.

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i’ve just returned from south by southwest where i facilitated a discussion on employee wellness and attended the one-day health track. south by southwest added the health track this year after seeing the appetite for it when shwen gwee and dana lewis held a social health unconference last year (note: i missed that. won’t make that mistake again. their next unconference is in philadelphia on september 19. mark it down.)

i already posted a slew of links to tools and other interesting resources from these health sessions. now i want to share my take-aways, which i’ve grouped by themes and tensions that spanned the sessions.

data and usefulness

data came up in most of the health sessions i attended: freeing up data. the various types of data (individual/population/reference). data siloes.

todd park from the department of health and human services (HHS) spoke about the government creating an environment for improving health. by releasing the data, the government’s creating opportunities for entrepreneurs who can benefit themselves while benefiting the public, and the response has been enthusiastic. (see my other post for examples.) there are scads of tools and innovations. what’s not as abundant is usefulness.

aza raskin of massive health raised the same issue in the behavior change checklist: down with gameification. he spoke about the tools we have versus the tools we need, like tools that give us feedback on how what we’re doing today affects our body tomorrow or on how well we’re doing at not doing something, like not eating that cake again and again and again or not sitting on the couch—these things that improve our health but we receive no feedback on otherwise.

while it’s exciting to witness all of this health innovation, what we need is innovation that targets specific end users and end goals.

tools, apps and target audience

in health: is there really an app for that? jane sarasohn-kahn shared statistics on health apps and those who’ve downloaded them. there are 8,000 apps in the itunes library that fall under the health umbrella. 20% are for cardiofitness, 16% for food, 7% for sleep and 9% for strength training. the single largest audience downloading these apps are black, young and live in the city—not the audience who’d most benefit from these apps, but obviously the audience who finds them cool.

in mobile health in africa: what can we learn?, jaspal sandhu shared a story that started out the same. many developing countries had wondrous donated incubators, all shiny and new. until, that is, they broke and were abandoned because the locals didn’t have the parts or know-how to fix them. in an ah-hah moment, a team fashioned incubators out of old car parts, materials that were abundant and the locals knew how to use. to me, this true story is an allegory for creating solutions that are right for the audience you’re trying to support.

the asthmapolis inhaler tracker is my favorite discovery and an example of bringing together data, usefulness and target audience. asthmapolis is an inhaler combined with a GPS system. when an asthmatic has an attack and uses the inhaler, the GPS maps the location. this data directs public health efforts as they look into environmental reasons for clumped asthma attacks, and it directs individuals’ routines as they use asthmapolis to avoid asthma trigger “hot” spots.

people, not patients (or employees)

in the health: is there really an app for that? session, john de souza from medhelp remarked that “the market is consumers, not patients.” we need to “bring the consumer perspective to health.”

in health data everywhere: not a drop to link, we saw instances of consumers doing it for themselves. jamie heywood talked about patients like me, a service where people opt to share all of their health data in order to better understand their condition or disease. gilles frydman highlighted the association of cancer online resources’ (ACOR) mailing lists that connect cancer patients and caregivers with others. both provide more up-to-date and personalized information than can be found elsewhere—not to mention community.

this same “for the consumer!” rallying cry was discussed by indu subaiya regarding health 2.0′s developer challenges and in apps for healthy kids: government challenges FTW, where challenges are setting the stage for us, as consumers, to come together as a community of solvers. health 2.0′s developer challenge extends the consumers reach to actual developers who solve the real-life health problems we pose.

privacy

it wouldn’t be a health discussion without privacy popping up. and it did, in more than one session, but no more powerfully than in patients/caregivers on facebook: establishing boundaries without barriers. this session brought together mayo’s legal counsel, web and social strategists, and health providers to discuss how they use social media to benefit their patients while still respecting their privacy. it’s a question that’s very relevant to employers as they seek to add social solutions to their wellness efforts. daniel goldman and ed bennett shared practical solutions, such as collecting HIPAA releases and other releases electronically and answering first-person questions in the third person. but it was an anonymous tweeter who asked, “what is privacy?” that raised the point we need to address in social + health + work relationships.

that complex question of what is private and who defines it came up in my session on employee wellness, too. companies already enter our lives in many ways. stress from work distracts us from our home life. work demands interfere there, too. now add in wellness efforts and their intent to change the way we eat, move and more, and you have to ask: where do you draw the line between the part of our personal lives companies can enter and the part they can’t? we discussed but never adequately answered this question, and it’s one that needs resolution—perhaps only satisfactorily on a person-by-person basis.

environment

my favorite quote was todd park’s: “the one thing that trumps process is culture.” truer words were never spoken. put in all of the policies and programs you want and communicate the heck out of them. if your culture doesn’t support whatever change you’re trying to drive, you’re not going to get it. actions will revert to what the culture supports, drives and rewards. if you want healthy behavior, build a culture that creates it.

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this wellness digest deviates from the norm. i want to share some links and other resources i’ve learned about at south by southwest, particularly in this year’s fantastic health track. i’ve noted the hashtag for each session so you can check the twitter stream for other highlights.

i’m working fast, so excuse any mistakes or oversights. i’ll blog on the experience and take-aways when i get back to the real world.

1. apps for healthy kids: government challenges FTW (#a4hki)

a few of the winning apps and tools from this government challenge:

• pick chow!
• the snack neutralizer
• smash your food

this session also highlighted the current challenge—recipes for healthy kids challenge—and challengepost, who is the government’s partner and also helps organizations run challenges, host contests and solve problems.

2. health data everywhere: not a drop to link? (#health2dev)

this session explored how to take all of the suddenly available health data and use it to benefit individuals and populations at large.

• asthmapolis—an asthma inhaler with GPS, benefiting the individual while mapping asthma breakouts.
• health 2.0 conference—learn what’s happening in health + technology.
• 2011 health 2.0 developer challenge—pose a health challenge you want to crack. an app you wish existed.
• blue button—a government website that provides veterans and medicare beneficiaries access to personal health information.
• patients like me—this site aggregates patient-provided health information across multiple dimensions, giving patients vital information to manage their own care and conditions.
• ACOR acorlists—mailing lists for people with cancer and their caregivers.

3. health: is there really an app for that? (#healthapps)

this panel kicked around what’s currently happening with health apps and whether they’re really changing behavior (answer: not known yet).

• i’m expecting—medhelp and healthymagination app for soon-to-be moms
• my diet diary—medhelp and healthymagination app for tracking food intake
• mobile therapy—intel’s mood tracker
• bj fogg foggstuff—bj fogg shared a matrix for determining the usefulness of health apps (not yet online) and a link to all of his work

4. how open health data can improve america’s health (#sxswod)

todd park is like no government official. energetic, passionate and a good dresser, he fired up the room talking about how the government is providing an environment to improve health care. he profiled some of these solutions that put the government’s health data to work:

• itriage—app that helps you understand symptoms and use your GPS to find care
• meyouhealth community clash—a game that tells us about our community’s health
• rockhealth—a seed accelerator and supportive community for developing health apps that kicked off at south by southwest. applications open in april.

5. save the date: social health unconference, philadelphia, september 19

shwen gwee and dana lewis announced the plans for this year’s unconference at south by southwest. working with an advisory board that includes greg matthews (my cohealth co-founder), ed bennett, livestrong’s brooke mcmillan, andre blackman, marc monseau, fabio gratton and bryan vartabedian, they’re bringing together all of the different voices and streams invested in health for a daylong event.

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my friend and co-health founder greg matthews introduced me to chris hall, director, clinical platforms at healthcentral. chris is intent on suicide prevention, and he’s working toward that goal through a mood-tracking tool, mood 24/7. i asked chris to walk me through how the tool works and what it offers individuals and employers.

fm: chris, what’s healthcentral?

ch: healthcentral empowers people to improve and take control of their health and well-being through more than 35 condition- and wellness-specific interactive health sites. what makes healthcentral different from other health sites is our focus on people living with and caring for those with life-changing conditions. our users have “been there” and have a deeper level of understanding for people with long-term health conditions. our users talk with and support one another, while connecting about their health conditions.

fm: now, what’s mood 24/7?

ch: mood 24/7 was developed by healthcentral based on technology licensed exclusively from johns hopkins university.

it’s an SMS- and web-based service that allows people to track their daily moods by text message. users pick a time of day and are prompted via text message for a text message response rating their mood on a scale of 1 to 10. these daily responses are charted privately and securely at the mood 24/7 website, www.mood247.com, where users can access their mood charts to visualize mood triggers and track their mood.

fm: what kind of action does someone take based on the info they see?

ch: that’s where it gets interesting. i recently interviewed a few power users, and they all said that mood 24/7 has helped them get to know themselves and their conditions better as a result. what i discovered from talking with these people was that we don’t always know the triggers behind our mood fluctuations. daily mood tracking serves as a starting point for that understanding. we’ve also established a sharing capability, where mood 24/7 users can opt to allow members of their trusted circle—friends, family, doctors—to see their mood charts as well. all they need to know is the email address of the person they’d like to share their chart with and we do the rest.

fm: since you’re providing information at one period of time, how does this help me isolate what makes me happy or unhappy? whether i’m happier at work or at home? or what are my triggers?

ch: that’s a question that comes up a lot, and being somewhat of a data nerd myself, i do understand the desire for more data. however, the beauty of averaging your mood once per day is that it forces you to reflect on the day’s events in aggregate and come up with a number for how you felt in general. one event could have ruined your entire day, and taking the time to make that internal calculation lends itself to discovery. mood 24/7 also allows for journaling via text message, so users can take notes while submitting their daily mood to help them further identify mood triggers and patterns from the website. we think this process makes it easy for people to add mood 24/7 to their daily routines, while also adding a great deal of value to their lives.

fm: is self-reporting accurate?

ch: we think so. in general, there doesn’t seem to be much incentive for people to lie about how they’re feeling among their trusted circle. in fact, dr. adam kaplin, mood 24/7’s inventor, relayed a story to me of a patient he hospitalized because he was able to identify in the mood chart that the individual was suicidal. dr. kaplin later asked the patient why he even bothered to update mood 24/7 while seriously contemplating suicide, and the response was that it was part of a daily routine. the patient had woken up that day, brushed his teeth, combed his hair and got dressed like any other day… and when the mood 24/7 text came in, it was answered honestly without hesitation. it had become routine.

fm: that’s interesting, especially when you consider bj fogg’s work with stanford’s persuasion lab. he suggests that any new routine be latched onto an existing routine. that way it becomes more readily habituated.

ge healthymagination just came out with their mood app, moody me. then there’s intel’s mobile therapy and the military’s t2 mood tracker. these use smartphones and other technologies. why are you using SMS?

ch: we’re high on SMS because 91% of americans have a cell phone capable of texting according to the CTIA, and we’re focused on helping as many people as possible. we also know that every age demographic knows how to send and receive text messages. we’ll definitely be looking to open up the ways people can provide their daily mood ratings in the future, but based on its near ubiquity, we felt that SMS was the best place to start.

fm: what evidence do you have that mood 24/7 works?

ch: right now we have two unpublished studies and a lot of anecdotal evidence that mood 24/7 works, but i’m working very hard to get more proof. many of dr. kaplin’s patients used mood 24/7 in 2010, and we’re in the process of getting approval to study that data for outcomes.

fm: are any employee assistance programs (EAPs) or insurers using this as part of their mental health benefits?

ch: not yet, but we have some things in development that we should be able to talk about in the near future. plenty of studies have been conducted around stress and depression in the workplace, and we feel that mood 24/7 can add a lot of value to employee wellness benefits.

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read more free-ranging interviews with health innovators.

i’ve been reviewing RFPs from online wellness providers for one of my clients. your mind can dull after slogging through page after page of “this message is habitually presented and becomes the habitual experience of the learner, empowering the learner to apply their knowledge in daily life.” keep your mind sharp and your selection sound by asking (at least) these questions when you’re seeking an online wellness partner.

strategy

1. what audience are you trying to reach?
2. does the online solution offer these employees something they want or need?
3. what do you need this online solution to help you accomplish?
4. how will this site interact or integrate with online information from other providers and sources?
5. are the provider’s services unique or can you find comparable services elsewhere —and maybe for free?
6. does the site have a content management system that lets you easily update the information?
7. is the site flexible enough to grow with you as your strategy evolves?
8. how healthy is the potential partner? are they likely to stay in business?

user experience

1. is the site engaging?
2. can employees find what they want quickly, easily and intuitively?
3. is the site personalized? can it mine their data to deliver information that’s useful and helps them take action?
4. is the health information from reliable sites and date-stamped to validate it’s current?
5. can employees rate articles so the best information rises to the top? can they print and forward the good stuff?
6. can employees and dependents access general, public information without authentication (login)? does authentication occur when it’s needed: when someone wants to access secure, personal information?
7. does the site offer social or community opportunities to talk about health interests and concerns? what access is there to health experts?
8. does the provider offer mobile solutions that sync with the website (e.g., pedometers and other data trackers)?
9. is the site mobile-friendly?
10. what customer support does the provider offer your employees by phone, email or online chat?

measurement

1. what data does the site track? does it measure traffic and actions taken?
2. who controls the data? do you have ongoing access to this information?
3. how granular can you get? can you see by company, department or whatever demographic slice you need?
4. how easily can you share the information? can you forward reports?

these are communication-related questions. in addition, you’ll want to know more about how they ensure data privacy, measure customer satisfaction, structure their fees, market and promote their solution, and on and on. remember: no solution delivers everything, so determine early on your priorities.

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i need a health app. so said a client.

why? i asked.

some employees are asking for them.

mobile health apps are the new sexy. their explosion is fueled, of course, by the growth in smartphones overall; the interest in their use as a health tool driven by the knowledge that mobile health facilitates health engagement.

does that make health apps the place to put your limited benefits communication budget? the pew mobile health 2010 study found that 9% of cell phone users have downloaded a health app onto their phone (any phone, not just a smartphone). by and large, this 9% is younger, african american and has some college education. they’re also english language speakers and live in an urban setting.

nine percent isn’t small potatoes, as brian dolan at mobihealth news writes. but it’s not massive, either. and depending on your workforce demographics, not too many of that 9% may work for your company. this doesn’t mean health apps should be ignored. you should find ways to incorporate them into your communication strategy:

• seek health partners who offer them.
• review health apps in your print or online vehicles.
• invite employees to act as citizen journalists and research and write about their favorites.
• buy health apps for employees to test.

by doing any of this, you’d get a sense of how your workforce responds to and uses health apps, making you smarter by the time adoption rates are higher and greater evidence of their effectiveness is available.

what i wouldn’t do is make them the first place to spend your hard-fought communication dollar. instead, put that money toward getting your benefits information on the internet, adapting your most sought-after information for mobile access and exploring ways to make your information social. while health apps are beguiling, resist their sirens’ call a little longer and get the basics in place.

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you might also be interested in:

• the rise of apps culture
• in review: the mhealth attendee gaining in notoriety