To pull off population health, no matter your geography, everyone in the continuum — executives, physicians, the clinical support staff, administrative workers, and ultimately the patient — must be locked on one central goal: well-being. This mindset is a quantum shift from providing care primarily when an illness presents itself. It starts by engaging every individual in the healthcare workforce on how their part of the process impacts patients and ultimately extends to fostering healthy lifestyle changes by patients themselves.

What will it take for everyone in a healthcare organization to understand their impact on patients? It begins by showing everyone in the healthcare delivery process how their role impacts patients, especially by their actions or inactions, says Jordan Safirstein, M.D., a cardiologist and member of the Google Healthcare Advisory Board, and assistant director of the Cardiac Catheterization Laboratories at the Gagnon Cardiovascular Institute, Morristown Medical Center. Dr. Safirstein gave an example of how this can impact the life — or death — of patients requiring an emergency catheterization procedure.

“It is important to show the emergency management system (EMS) crews and the first responders how they can affect door-to-balloon times if they do not meet certain time points, and the emergency room staff is crucial to expediting the patient once they arrive in the ER,” says Safirstein.“Then the cath lab receiving staff is essential to rapid prepping and troubleshooting, even before the physician steps into the room.

Safirstein continues, “Finally, there’s the role the doctor plays in the technical achievement of timely success. All of these time points and goals are reviewed monthly and consistent sore spots are remedied with changes in protocols. It is an ever-improving process, like healthcare itself, as technologies and paradigms change. The strategy is to get people to understand their roles, make sure they see the results on the end product, and to be accountable by making those results visible to the rest of the team.”

While the impact on well-being is most dramatically illustrated in an emergency situation, it is important for everyone in the continuum of care to understand the importance of their job and its impact on the patient, from physicians and nurses to the administrative staff. Healthcare executives might assume that all the players are sensitized to the patient impact, but, says Jennifer Zimmer, Insigniam partner, this isn’t always the case.

Making such false assumptions is a huge barrier in the workplace, she explained. “This behavior does not create innovative or breakthrough results. It’s business as usual.”


While the healthcare industry traditionally defines the “continuum” as actions taken to address a patient’s particular disease state, addressing lifestyle issues is no less important when it comes to preventing or slowing the progression of disease. Again, engagement is key, especially in the workplace, directly reaching patients with interventions that motivate healthy behaviors.

Based on research conducted by Gallup in 2012, (tweet this!) engaged employees are more likely to report a healthier lifestyle than their unhealthy counterparts , and they are less likely to be obese or have chronic diseases. Although obesity, as a general category, is hard to quantify, one study, published by the Harvard School of Public Health in 2012, (tweet this!) estimated that 21 percent of the total U.S. spending on healthcare was devoted to obesity related issues.

Insurance providers and the private sector are jumping into the game, providing tools and incentives to encourage lifestyle changes. “We’ve done a good job reaching people who are inclined toward a healthy lifestyle,” explains Joan Kennedy, Cigna vice president, customer health engagement. However, she acknowledges that these people aren’t in the majority.

A universal problem, Kennedy notes, is that countries such as China are equally befuddled about how to motivate their society on wellness, which is facing a growing epidemic of obesity and diabetes. China’s woes are largely due to an increase in sedentary jobs as the country becomes more industrialized, as well as adoption of a more westernized diet.


Reaching at-risk individuals revolves around empathy, says Alexandra Drane, founder and president of Eliza Corporation, which provides health engagement management solutions. Teaming with the Altarum Institute, a healthcare research organization, they surveyed more than 30,000 individuals and found, overwhelmingly, that life obstacles often made it too difficult for people to make health a priority.

“Life obstacles like caregiving, financial, and relationship stress were cited as key factors throwing life out of balance,” Drane explains, adding that unless healthcare organizations help people address these stressors, which she calls “unmentionables,” their wellness efforts are likely to fall on deaf ears.

This is why programs traditionally focused on disease states have been met with low enthusiasm, she says. Simply put, messaging that lectures people about what they aren’t doing, hasn’t worked well for the broader population.

“People have told us that they simply don’t have time to focus on their weight, for instance, because they are too stressed out caring for an elderly parent. When we listened, and we offer information on resources, nearly all of those surveyed sought help.”

Building on the research, Eliza developed a tool called the Vulnerability Index that helps health organizations quantify the prevalence and impact of contextual life factors, which are influenced by negative and positive coping responses.

Believing in the directional vision of this approach has helped Cigna rethink its messaging, Kennedy explains. “We asked ourselves, is there a way to re-architect our approach to wellness, putting the pressing issues first?” We found that once you get the larger stressors calmed, you have a better chance of addressing a person’s underlying health issues.”

Today, Cigna is in the midst of a pilot, which, based on vulnerability, leads to different types of interventions. “We are architecting incentives and interventions to tie to the whole person, instead of using a fragmented approach,” Kennedy says. Part of the solution involves tying Cigna coaches with members and their physicians, both receiving rewards for improvement.

The approach is also driving better use of employee assistance programs, or EAPs, which have become stigmatized for singling out individuals seeking emotional help. “We encourage organizations to reinvent EAPs so people feel comfortable turning to them as a resource.”

How well is this kinder, gentler approach working?

“We are getting good participation in our pilot,” Kennedy says; however, she is cautiously optimistic, adding that “none of us know the answer, because we’ve never tried this before.”


The use of mobile technology is also emerging as an important enabler, with apps and fitness devices helping individuals monitor their progress. “There are more than 40,000 health and wellness apps currently in the marketplace, which is a bit overwhelming,” Kennedy explains. “We have a team of experts who are evaluating and recommending some for our online ‘Go You’ marketplace. Go You, a Cigna portal, allows members to access tools and services that monitor their wellness activities.

She notes that use of apps especially makes sense in countries where the population is highly mobile.

“In South Korea, for instance, people are entirely mobile and you have to reach them through their phone. In other regions of the world, you may have to work around the healthcare architecture.”

The main point, says Kennedy, is to give support in ways that people want to receive it — and in a way that shows you care.

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