U.S. states are some of the largest employers in the country, so it only stands to reason that they are and can be some of the most influential advocates of preventive medicine and wellness programs for Americans.

There are nearly 7.4 million full-time employees working for state and local governments, according to Census data crunched by Governing magazine. That makes approximately 232 public employees for every 10,000 Americans.

Why Wellness Programs?

Wellness programs not only save money, they save lives. According to the Agency for Healthcare Research and quality, 86 cents of every dollar spent in 2010 on health care went to treating people with a chronic condition.

Today, more than 190 million Americans–or about 59 percent of the population–are affected by one or more chronic diseases, according to the Partnership to Fight Chronic Disease (PFCD). “Without change, the number of people with three or more chronic diseases is expected to increase to 83 million by 2030, and overall costs will accumulate to more than $42 trillion.”

The support of both public and private sectors on the national and state level are critical to the fight against costly chronic disease, says Ken Thorpe, PFCD chairman. “Constant reinforcement and facilitation of prevention and better health management are the key to overall wellness. In order to truly reverse the tide of chronic disease, we must have layers of sustainable health care solutions that work cohesively together and provide the coordinated approach to health care that has been proven to save lives and health care dollars.”

Faced with this staggering challenge, many states are leading an effort to move health care away from treating illness and more toward preventing illness—a trend that is reinforced by the changes being made under the Affordable Care Act.

The National Governors Association’s (NGA) most recent assessment of state wellness efforts found that most state efforts fall into several categories, including:

  • Health assessments and monitoring.
  • The use of financial incentives.
  • Healthy work environment initiatives.
  • Fitness challenges and events.

States Using Apps to Promote Health

NGA found that most states focused on one or two of these strategies, but a few were implementing comprehensive employee health initiatives that incorporated a number of them.

MeriTalk caught up with a couple of states that have developed extensive wellness programs in recent years, both using health IT as part of their strategies.


Since 2013, Colorado has been using the CaféWell Health Optimization Platform, developed by Denver-based Welltok, to promote health and wellness among its 31,000 benefit-eligible employees. The effort has been fueled by Gov. John Hickenlooper’s (D) goal to make Colorado “the healthiest state in America.”

. ‘The healthcare industry can no longer use a one-size-fits-all approach,” said Brian Garcia, chief technology officer and chief procurement officer at Welltok.
“The health care industry can no longer use a one-size-fits-all approach,” said Brian Garcia of Welltok.

According to Welltok, the CaféWell platform, available on an app, makes it easier to maintain a healthy lifestyle–with fun activities, challenges, resources, and rewards that keep users moving forward with their health, at their own pace. The platform organizes the growing spectrum of health improvement and condition management resources, obtains consumer insights through advanced analytics, and uses multichannel communications to connect consumers to the right resources, at the right time.

A recent survey conducted by the state found that more than 60 percent of eligible employees are using the CaféWell platform, with 88 percent finding it valuable.

Colorado’s survey also found that:

  • 60 percent of state employees have a better perception of the state as an employer with the availability of CaféWell;
  • Nearly three quarters (71 percent) of respondents feel their health has improved since joining the program, including feeling less stressed (41 percent), losing weight (38 percent), feeling happier (32 percent), and having more energy (28 percent);
  • 77 percent of employees reported they feel more educated about their health; and
  • 38 percent of employees say they feel more educated about their health benefits.

June Taylor, executive director of the Colorado Department of Personnel & Administration, said the program has produced happier, healthier, more productive and loyal employees, all while lowering health care costs for the state. “As one of Colorado’s largest employers, we saw an opportunity to not only lead by example, but also to realize the benefits of a well workforce,” she said.

Hard data is not currently available on return on investment or health outcomes because the program is relatively new, she said, but the subjective data gathered by the survey have given Colorado officials hope for good things to come.

The key to Colorado’s success? Personalization. ‘The health care industry can no longer use a one-size-fits-all approach,” said Brian Garcia, chief technology officer at Welltok. “We designed CaféWell to create a Personal Health Itinerary for every consumer and connect them with the resources, benefits, and rewards available that are most relevant and actionable”

Garcia says Welltok’s future plans for Colorado include to continue homing in on the personalization capabilities of the platform, leveraging advanced analytics, employer-provided data, HRA completions and consumer activities to refine and target recommendations.


Washington began its wellness program, called Making the Healthy Choice Easier, in 2008—adding an online component in 2014, according to Scott Pritchard, health manager of public employee benefits at the Washington State Health Care Authority. The state now uses a platform from Bellevue, Wash.-based Limeade, a corporate wellness technology company. Limeade claims to “measurably improve employee health, well-being, and performance, while building cultures that support well-being.”

 “We use data and insights to create tailored strategies that resonate with specific populations,” said Steven Parker, vice president of customer success at Limeade.

“We use data and insights to create tailored strategies that resonate with specific populations,” said Steven Parker, vice president of customer success at Limeade.

Since the state added the app and online component from Limeade, more employees have become interested in the wellness program, Pritchard says. The app works best on an Apple operating system, but is available on other systems, and uses behavioral, economic, and social networking principles to improve health. “It’s really fascinating. It’s all based on human behavior change,” Pritchard said. “How do we make a change?”

According to Steven Parker, vice president of customer success at Limeade, the State of Washington employs political officers, educators, social workers, and ferry drivers–to name a few–so having varied, well-developed activities and challenges that engage each of these different employees is critical.

“Limeade does this with smart technology that learns peoples’ preferences and needs and presents them with recommendations to improve their well-being,” Parker said. “We also use data and insights to create tailored strategies that resonate with specific populations.”

Some of the upcoming challenges Washington will be conducting with the help of Limeade include a “showdown” between two of the state’s universities that will compete for the most physical activity and a Hike the Pacific Crest Trail challenge for the Department of Transportation, which they helped create, Parker said.

“Our technology also gives employees integrated and [incentivized] access to other programs that promote well-being, like training, financial well-being services, and preventive care,” Parker said. “Most recently the state saw a measurable increase in the utilization of preventive dental coverage–a win-win for employers and their people.”

Pritchard said the assessment data gained as one of the first steps when an employee signs up for the app can be used by the individual and can also be aggregated for the state’s use, to help determine where efforts should be focused next. This data has shown that getting enough sleep is one of the top problems employees face, and the program now offers activities to help employees get a good night’s sleep.

Washington has 134,000 employees and more than 100 agencies—and each agency has different health issues. The Limeade program helps the agencies to see what their unique opportunities are for health improvement, Pritchard said.

Like Colorado, Washington doesn’t have hard data to show the success of the program–yet. But that will come, said Pritchard. However, the state does know that well visits to the doctor have increased by 1.7 percent. “That doesn’t sound like much, but it’s a huge change,” Pritchard said. The savings is also substantial. The average cost to send postcards to employees to remind them to visit the doctor is between $30,000 and $40,000, he said.

Employees earn a $125 incentive when they meet all the goals required on the program, which Pritchard agrees is somewhat low, but it is based on legislated funding. But the effects on an employee’s health are priceless.


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