How to Hone Wellness Programs Using Social Determinants Data

February 02, 2022 - Are wellness programs working? This question is a common refrain for employers and their payer partners, but the answer remains ambiguous.

On the one hand, some studies have supported wellness programs as a cost-effective way to address the obesity pandemic. They have also proven useful in boosting employee morale. In some surveys, more than three-quarters of individuals who had access to wellness programming reported that wellness programs had improved their health.

However, other studies have found that wellness programs do not have as significant of an impact on healthcare spending or health outcomes as employers and payers might hope. And additional research has emphasized the need for long-term participation in a wellness program in order to maximize the impact.

To Margaret Rehayem, vice president for the National Alliance of Healthcare Purchaser Coalitions (National Alliance), the answer was clear.

“Wellness programs hadn't really been working for employers,” Rehayem told HealthPayerIntelligence. “Employers have tried really hard to reduce healthcare costs by putting the right wellness programs in place.”

Despite employers' efforts, the programs worked to a certain point but ultimately fell short of enabling employees to meaningfully take control of their health.

To address this issue, National Alliance started a year-long learning collaborative with the Kentuckiana Health Collaborative and the Pittsburgh Business Group on Health (PBGH), with support from the Centers for Disease Control and Prevention (CDC), exploring how employers can improve wellness programs and interventions by better utilizing social determinants of health data.

Rehayem explained what prevents wellness programs from reaching their full potential and how to refine wellness interventions using community data. She also offered advice to employers and payers as they seek to improve wellness programs.

Challenges of wellness programming

One of the key barriers to effective wellness programming is a failure to acknowledge or seek out the underlying reasons for employees’ current health conditions.

If employers only observe certain aspects of employees’ health and neglect to include social determinants of health factors, they are not seeing the full picture of employee wellbeing. Acknowledging these factors leads to more targeted and, according to Rehayem, potentially more effective ways of engaging the workforce in their own healthcare.

However, employers cannot singlehandedly achieve whole-person health for their employees. They must partner with employees, just as payers must partner with their members in order to improve both member engagement and member satisfaction.

This presents a second challenge: employees’ lack of ownership of their own health. If employees are not able or not willing to become engaged in their own wellbeing through preventive care, employer-sponsored wellness programs will be futile.

“Wellness created this cookie-cutter approach—if you did X, you'll get Y,” Rehayem explained. “The majority of the time that wouldn’t happen because you're dealing with human beings that live work and play in various areas in the community. Diving into social determinants, social needs, social risks, each of these has different nuances that are important for an employer to address.”

If employers fail to resolve these issues and refine their wellness programs, employees may not leverage their benefits to the fullest extent, causing out-of-pocket healthcare spending to grow, and, ultimately, deferred care to increase. Meanwhile, employers will continue sinking funding into underutilized benefits and may face heftier claims.

Employers who are aware of this find themselves stumped by the third challenge: how to narrow the focus of their wellness programming efforts. National Alliance started the learning collaborative to address this problem.  

Step one: gather the data

In order to abandon the cookie-cutter approach, employers have to familiarize themselves with employees’ communities to ascertain what social determinants of health factors employees might face.

The learning collaborative took on this challenge in four steps.

First, employers have to gather data on their employees’ social determinants of health.

To achieve this, employers must reach outside of their internal data on employee health, such as healthcare claims data or health risk assessments.

Rehayem urged employers to start overlaying their internal information with contextual and demographic data from community data sources. This data should extend beyond age and gender, encompassing race, ethnicity, and zip code data where possible. 

Employers and payers alike have struggled historically to gather such information, particularly when it comes to race and ethnicity, Rehayem acknowledged. But the coronavirus pandemic may have created an opening for employers to acquire this data more easily. Given racial disparities that the pandemic amplified, the urgency behind acquiring this data is undeniable.

“Whether it's a program, service, approach, culture, or whatever it is that employers are putting together that has more meaning for the employee, if you don't understand what is happening in their zip code, you are not going to be able to get them to engage appropriately with a provider,” Rehayem emphasized.

National Alliance’s learning collaborative relied upon a digital healthcare company to investigate and share social determinants of health insights with most of the participating employers.

The partner offered healthcare access data by zip code and information related to neighborhoods and built environments, economic stability, and education. Each of these fell under one of the five domains of social determinants of health.

Lastly, employers also have to validate their data. Choosing the right partners can do a lot to ensure that data is accurate and viable.

Step two: prioritize subpopulations based on data

After collecting and validating the data, the second step is to leverage the data to prioritize the subpopulations that require support, instead of trying to reach the entire workforce with a single wellness program.

“You need to take a look at the impact of your interventions,” Rehayem said. “Are they going to hit the people that actually need the most support?”

That being said, while the goal has shifted from broad-stroke solutions to more targeted interventions, it is still appropriate to prioritize solutions that will impact a higher number of employees.

Employers also should abandon any assumptions they might have about what employees need and what risks they face, relying instead on data to direct their efforts.

The company culture and mission must support the employer’s role in tackling social determinants of health barriers among employees. The report recommended establishing a multi-pronged business case that focuses on how addressing social risks aligns with the employer’s overarching vision.

Taking this approach—as opposed to a “cookie-cutter” method—may directly address the challenge that employers face in trying to convince employees to take ownership of their health.

“Employers need to meet their population where they are if they want to get them to engage in their health,” Rehayem said.

Step three: design, implement an intervention

In the third step, employers put all of the internal and community data into action by developing and implementing a plan to support their prioritized subpopulations.

Due to the targeted nature of these solutions, many of the insights gleaned from the collaborative’s experiences on this step will be narrowly applicable, as opposed to a more general imperative for employers following in their footsteps.

However, Rehayem offered a couple of pointers for employers and their payer partners to keep in mind as they design and implement their new social risk interventions.

Employers can benefit from including payers in the design and implementation of their new social risk plans. However, when engaging payers, employers should ensure that they are talking to the right representative from their health plan.

If the representative with whom they are engaging is not knowledgeable about the company’s internal data or demographic information, it will hinder their ability to help employers reshape data collection goals.

Employers should also consider engaging employees at various levels of management in the design and implementation of their social risk plans and ensure that the human resource team in charge of this process feels empowered to take action.

“If there was any employee's job position that impacted employees, they could be a part of that internal team,” Rehayem said. “That allows for a lot of really important conversations to happen so that the work plan that they put together can actually be influenced or better informed by that team.”

Additionally, not all interventions have to start from scratch, the report reminded employers. If there is an existing offering that could bridge gaps in the company culture, employers should take advantage of that opportunity.

For payers, the best first step toward helping employers address employees’ social risks is to address these risks internally in their own workforce. In fact, the learning collaborative included a couple of health plans.

“The more that payers look at how they're addressing their own employees, they can look at how they're improving upon what they're offering to their clients, to employers,” Rehayem shared. “We did have that happen and, in both cases, the payer participants are moving forward in different ways with their employer clients.”

Payers also need to recognize the gravity and complexity of the issues that employers face when addressing social determinants of health among employees. These partners must commit to looking at employees as more than just a number, Rehayem stressed.

Step four: measuring outcomes, gathering insights

The final step is a major challenge for employers: outcomes measurement. While the learning collaborative has not yet broached this step, the report laid out a few guiding principles.

Employers should regularly review the intervention to ensure that it is still meeting its goals. As part of that review, employers should investigate whether the intervention is sustaining health equity and whether it is hitting interim targets for success. Evolving measurements should be checked against an established baseline.

“Multiple factors are critical to success, including stakeholder partnership, program design and impact, strategic communications, building trust, and employee engagement,” the report underscored.

Another part of this step is transitioning to the next social risk that requires intervention. Once employers successfully implement a single solution, the question that will immediately present itself is: how should employers continue supporting the first subpopulation while also moving on to support other groups?

“You'll probably have to do a phased approach,” Rehayem recommended.

She noted that many of the report’s participating employers found that they needed to stagger different solutions across their workforces using a phased approach.

When employers work with community partners to leverage social determinants of health data appropriately and rework their wellness programs, it can reshape how they engage with their employees which, in turn, can have a significant impact on employee wellbeing.

“At the end of the day, you can actually see progress beyond health risk improvement and really take a look at: are people really thriving in our environment, in what we're doing and what we're offering?” Rehayem said. “You start going down a few levels now and make sure that the work that you're doing is really of value for people.”