In part two of a major guide, Stephen Haynes looks at emerging wellbeing technology in the workplace that has the potential to reshape how employers help employees manage their health. (Click here for Part 1)
The growth in health and wellbeing technology is exponential. According to Rock Health’s December 2016 Digital Health Consumer Adoption report, 88% of people are now using at least one device or another, whether smartphone based, telemedicine or a wearable.
Technology is revolutionising employee wellbeing and engagement with real-time engagement survey models allowing data to be captured and interventions made instantly (eg by using Glint).
Google Maps for Healthcare
Google’s “Baseline” health study, originally intended to begin in 2014, officially went live in April 2017. It is a longitudinal study which explores transitions between health and disease with the goal of trying to understand why people get sick.
Verily (previously Google’s life sciences arm) launched a four-year study to examine the chemistry of healthy people to identify when something changes, indicating early onset of disease or illness.
Daniel Kraft, chair for Medicine at Singularity University, was quoted as saying “Verily is building a Google Maps for health care”.
The study will identify the links in the human body, not unlike the way geographical mapping tools compile information on locations and nearby facilities.
The research will use Verily’s investigative smartwatch (called Study Watch), which has multiple physiological and environmental sensors that measure heart rate, electro dermal activity and inertial movements (with features not widely available in the consumer market).
Verily will also use Google’s mobile app to enable participants to actively and passively provide continuous, multi-dimensional health data – much of which has never been captured or combined for an individual.
The 10,000 participants from various study sites in the US will also have their entire genome sequenced. The baseline data from this study will hopefully identify early warning signs for illness and not only benefit development of health technology – but also medicine as a whole.
Google Brain is also currently working with hospitals to predict health outcomes from medical data, training computers to predict when you might get sick. This is the latest in a series of research projects from Google to apply its machine learning expertise to health care.
Wellbeing monitoring is available with platforms from Virgin Pulse, Welltok, Kin Wellness and start-ups like Soma Analytics and Psychological Technologies, as well as from health insurers such as Bupa (Boost) and AXA PPP (Health Gateway).
Technology is also helping to simplify the traditional health screening model. For example, LiveSmart launched a six-month digital health programme in September 2016 which looks at a person’s internal health through blood testing and then provides tailored advice and coaching on the individual’s nutrition, exercise and lifestyle by phone.
Another example is GSK’s MyAsthma app developed in partnership with Nottingham Respiratory Research Unity, the University of Nottingham and Earthworks.
For asthma sufferers it provides lifestyle and environmental information combined with data relating to the status of a person’s asthma. It connects with various health tracking apps (eg Jawbone, Strava and Fitbit) and lets users share the history with their doctor.
DNA testing is now readily available to consumers and can help show genetic variants that are risk factors for various health conditions. We are also likely to see companies use DNA testing to deliver even more accurate and personalised health coaching to employees.
Wearable devices encompass a broad range of products including wristwear (wristbands and smartwatches), headwear and eyewear (including augmented and virtual reality devices), footwear (both casual and special purpose footwear), neckwear (including fashion, jewellery, ties and collars), bodywear (innerwear, apparel, arm and legwear for example) as well as other wearable technology such as ring scanners (hands-free wearable computers), body-worn cameras and internables (internal sensors that measure well-being in the body) and implantables (devices inserted under the skin).
In the workplace, the most common wearable devices are wristwear and pedometers. However, do employers know what to do with all this data? And by itself, what value is this data to an organisation?
Today’s wearable technology can simply track your activity, but devices are increasingly integrating data sets and can push smart notifications via paired smartphones. Last year, a study of mobile phone apps showed that they can be an effective component of help self-management of diabetes Glycemic Control (HbA1c) (Hou C et al, 2016).
Technology is also available for the visually impaired. According to the Royal National Institute of Blind People (RNIB) more than two million people in the UK are visually impaired, with only one in four of working age in employment. Technological advancements to aid people who are visually impaired have improved significantly.
Last year, Oxford University spinout OxSight undertook a successful trial of their smart glasses that can help sight impaired and blind people to navigate independently, see in the dark and even describe people standing meters away.
The future of wearable technology
Scott Sullivan, author of Designing for Wearables: Effective UX for Current and Future Devices, believes the future of wearables lies in augmented reality, effective design and optimal integration.
Sullivan believes that the traditional pedometer and smartwatches are ‘first-generation’ and that traditional wearable devices are ‘just not that useful’. He argues that activity trackers fail to help weight loss because they ignore “the much larger factor of our diet and they’re just a cheap pedometer that links to our phones”.
Paul Roberts, workplace health consultant at Enlighten, believes smart phones will overtake the wearable device because they are more cost effective and in most cases readily integrated and available within most working environments.
Roberts adds that “wearables are generally too expensive for the majority to be a proper work tool – wearable tech will be built into the phone or the work shirt. The challenge will be what to do with the mass of data this creates and translating it into productivity or wellness”.
What role will smart phone technology play in the future of health & wellness tech? Professor Sir Muir Gray from the University of Oxford, says: “They [smart phones] open up information, giving [people] access to the best current knowledge and offering new opportunities for patients and new challenges for professionals.”
There are also a huge number of online health and wellbeing communities, such as HealthUnlocked, the winner of the 2017 AXA PPP’s Health Tech & You ‘Wow Award’. It is the largest social network for health in the world with over 500,000 members and over 40 million site visits a year allowing people to access peer support and self-management.
According to HealthUnlocked, it is the third largest health website in the UK and is integrated into NHS Choices, Clinical Commissioning Groups and NHS provider websites.
Technology is also fuelling simpler access to consultation and coaching services. Employee assistance programme (EAP) providers have been extending phone based services to connect employees with counsellors and coaches, while OH providers have been using video and online assessments for some time now.
Personal health records – employer or consumer?
A personal health record (PHR) or patient portal is a secure online platform that gives people access to their personal health information where they can view information such as previous doctor visits, medication information, allergies and test results.
Some healthcare providers offer PHRs to patients (particularly in the US) and there are platforms that consumers can purchase themselves, for example Microsoft’s HealthVault and UK-based health platform Medelinked.
Plans for centralised UK GP patient records were put on hold in 2016 when NHS England closed the care.data programme following the publication of the National Data Guardian (NDG) review from Dame Fiona Caldicott.
The review found the NHS had made insufficient progress in data safeguarding since 2013 and “should follow the same standards as the financial sector”.
Could health portals work in a workplace health setting? While the concept of one central platform where employees can store and manage their health data, integrating tracking devices, absence data and health insurance data may sound interesting, it is unlikely to work.
Ian Gallifant, CEO of Medelinked, which provides services to consumers says: “Your health record is no different to your career record on LinkedIn – it is the individual that owns the data, not the employer – and people choose to share their data with whom they deem appropriate.”
Data privacy combined with the average length of time someone works for one company are just some of the reasons that an employer-provided PHR is unlikely to work.
However, just as with pension schemes, we may see the growth in PHR’s compatibility with their employer’s workplace health programme whereby an employee may elect to share or integrate their profile with their employer in return for rewards or other forms of incentives.”
Dr Justin Varney, national Lead for adult health and wellbeing at Public Health England, sees the smart phone as a key component in coaching and consultation.
“Our smart phone knows more about our mental health than our partner does, and we already tell ‘Amazon’ more than we tell our doctors,” says Varney. “Our smart phones… can recognise disruption in our patterns – so through the effective combination of all this data, our smart phones have the potential to learn, adapt, evolve and intervene”.
In response to a shortage of GPs in the UK, providers are offering remote GP services. Providers include Medical Solutions, Babylon Health, Square Health, Now Healthcare Group (Dr Now), Doctor Care Anywhere and Push Doctor. It is estimated that over five million people in the UK already have access to remote GP services largely through existing health insurance related products.
The two main types of access to remote GP services for employers are direct or as part of an existing insurance or membership based arrangement.
Two contrasting examples are Medical Solutions and Babylon Health. Medical Solutions, established in 1998, only distributes services via partners. Approximately 3.5 million people in the UK and Eire are covered by their GP services which are built into a number of UK and Eire health-related insurance products as well as membership based arrangements.
Babylon Health, established in 2014, primarily sells services direct to consumers and employers (although they also use some of the leading health related insurers such as Bupa and Aviva as distribution channels).
Babylon’s services are currently offered by over 120 UK employers, including Sky, Bupa and LinkedIn, and they average over 700 appointments a week.
Workplace wellbeing and the employee benefits market
Health insurers, protection providers and cash plan providers have been in this space for some time with some employee assistance programme providers and employee benefit consultancies joining them more recently.
Vitality, known for its innovative status reward programme when the company entered the UK private medical insurance (PMI) market in 2004, enhanced its model in 2015, introducing the ‘Active Rewards’ programme which gives members achievable weekly targets as opposed to annual goals.
Vitality also simplified access and engagement with a device-agnostic platform where members can capture, store and track their activity, combined with frequent and positive reinforcement.
AXA PPP’s Gateway digital platform accessible via web and app, has seen continuous refinement since its launch in 2011. Using a person’s ‘health age’ as the baseline, calculated through a combination of online self-assessment (focusing on general health, activity, nutrition, lifestyle and mindset) and a phone or face-to-face assessment with a physiologist, Gateway delivers tailored tools and support to users.
Gateway learns and responds to an individual’s personal circumstances and status, and has the capability to signpost to other services available to the employee, including both AXA and non-AXA provided services.
Bupa Boost, initially trialled internally with Bupa employees, was offered to the company’s customer base in 2015. Boost combines the ability to track data from personal wearable devices (or manual input), set goals, add friends, join team challenges and send instant messages via the app. The client portal (boost manager), enables the employer to review engagement and outputs to help tailor their wider strategy.
In March 2016, EAP provider Ceridian LifeWorks formed a joint venture with WorkAngel, forming LifeWorks, a holistic employee wellbeing company, combining EAP services with a digital reward, recognition and perks platform. The integration of EAP and reward platforms can improve communication of counselling and support services.
Employee benefits consultants
Employee benefit consultancy firms (EBCs) range in their approach from traditional benefit broking services to broader more consultative approaches.
Arguably, because of their independence, EBCs have the potential to be in the strongest position to provide holistic analysis, guidance and recommendations to employers that takes an integrated view of all data outputs (from OH, attendance, insurance data to engagement and wellbeing outputs), providing they have the skills to analyse and interpret the data.
More recently, a couple of EBCs have dipped their toe into the camp of suppliers of wellbeing services by introducing their own workplace wellbeing solutions, eg Mercer’s Harmonise platform and Havensrock from Punter Southall.
Harmonise from Mercer evolves the traditional benefit platform by combining employee’s health data and management alongside financial/retirement education/guidance and flexible and voluntary benefits. It means employees can set health and financial goals, choose benefits, adjust their savings and compare themselves to their peers.
In addition to being able to consult across the full suite of workplace health & productivity, the data outputs from Harmonise in theory can offer potential to influence health related insurance expenditure for employers.
In October 2014 benefits consultancy Punter Southall introduced a group income protection (GIP) scheme underwritten and administrated by Aviva that combines health promotional initiatives with traditional disability insurance.
Aimed at employers with over 50 staff, the Havensrock group income protection (GIP) arrangement includes a movement and sleep tracker (Fitbug Orb – free for insured members, discounted for non-GIP members) and at least one annual onsite access to the interactive health kiosk (provided by Wellbeing People), which provides staff with results of their general health indicators (height, weight, BMI, blood pressure, resting heart rate, hydration and life balance).
Outputs are combined on the Wellbeing Tracker portal which provides information, advice and challenges. Damian Stancombe, partner at EBC Barnet Waddingham, does not believe wellbeing is about ‘product’ but would agree with his peers that data is critical in developing credible and sustainable solutions for their clients.
Consultancy Barnet Waddingham combines traditional workplace health benefit consulting with an employee survey and modelling tool (BWell). This seeks to understand employees’ perception of their wellbeing against six pillars (job, financial security, support, protection, health and work/life balance), compared against specific company demographics and data such as absence and insurance claims data.
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Stephen Haynes is a workplace health specialist, and currently the programme lead for Mates in Mind, which provides the UK Construction industry with a framework to improve mental health by raising awareness and addressing the stigma of poor mental health.
Reference
Hou, C., Carter, B., Hewitt, J., Francisa, T., & Mayor, S. (2016). Do Mobile Phone Applications Improve Glycemic Control (HbA1c) in the Self-management of Diabetes? A Systematic Review, Meta-analysis, and GRADE of 14 Randomized Trials. Diabetes Care, 39(11), 2089-2095.
