Home  >  Engagement   >   The Human Equation in PHRs

The Human Equation in PHRs

by John Moore | April 17, 2009

healthstringThe highlight of my trip to Chicago and HIMSS’09 had nothing to do with what occurred within the halls of the McCormick Center, but in the offices of a small company based out of Chicago, HealthString, where I had the opportunity to meet and go to dinner with one of its co-founders and CEO, George Willock.

First came across HealthString last year while compiling the iPHR Market Report.  Of the 40+ PHR vendors interviewed, HealthString made the cut of having a solid footing (albeit very much a start-up), interesting model and good technology. They were one of the 20 such PHR companies that were profiled in the report.  Now, a year later, I stopped in to get an update. What an inspiring update.

Some Background:

HealthString began taking shape around 2002 when the founders started interviewing a wide range of people both within and outside of the healthcare sector to see where the pain points were, what was working and what was not.

Several years and several million dollars later (yes, they spent that much time and invested that much upfront before even taking their solution to market) they launched HealthString.

HealthString is a health & wellness solution combining online tools with health coaching services.

They are targeting the employer market, but are discriminating who they chose to work with, i.e., only those employers truly interested in the health of all employees.  Employer must also be willing to accept the fact that they will not see any employee health information, only general population health data.

While there are several similar services in the market, virtually all competitors focus on those already sick and provide disease management-type services.  What sets HealthString apart is that they are interested in everyone, not just the 20% that have a condition or disease to manage.  Their argument, keep the healthy 80% of your workforce healthy today to avoid costs in the future.

HealthString is not the cheapest option in the market for employee health & wellness programs, but it may well be the most complete.

How it Works:

Once a company signs up for the service, employees are asked to take a Health Risk Assessment (HRA) to set a baseline.  The baseline is important as it establishes the foundational elements for the health coach to assist employees.  HRA data is also used to establish the baseline elements for the employee’s PHR, which is hosted by HealthString.

Health coaches call all employees for brief conversations and go over HRA results.  Coaches may offer suggestions, e.g., encourage check-up and ask if there are any other concerns, needs, etc.  All conversations are strictly private between the employee and their assigned coach and are structured to foster trust.  In addition to encouraging healthy behaviors, coaches assist employees with navigating the healthcare system, e.g., what questions to ask when going to an appointment, how to get the most benefit out of their chosen plan, establishing and effectively using an HSA, etc..

In addition to the PHR, other online tools and coaching, employees also receive a quarterly newsletter in the mail.

Customer Story:

wrigleyWrigleys became a client of HealthString about 18 months ago after a full vetting of solutions in the market.  They had hired one of the largest consultant firms to assist them in the process, but the firm failed to give HealthString a fair shake (a problem many start-ups face). Wrigleys and their Medical Director, Dr. Caroline Nawara liked the HealthString philosophy of addressing the health needs of all employees and took a risk with HealthString.  (BTW, that consultant firm could not believe HealthString intended to call all employees.)

Wrigleys’ motivation to adopt a health and wellness solution was financial.  Up to four years ago, Wrigleys, a paternalistic company who does not use the term employees instead associates, paid 100% of health insurance costs.  Increasing costs of coverage led to the decision that some cost sharing was required but Wrigleys wanted to insure that associates had tools at their disposal to make wise and informed healthcare choices.

With full transparency and strong senior executive support, associates were informed of coming changes in healthcare insurance coverage (cost sharing) and incentives for associates to encourage them to take the HRA and use HealthString services.  In the ensuing 18 months, two HRAs have been performed at Wrigleys and what may be a record 96% of covered lives have completed the HRA.  A phenomenal number as most employers we have spoken to report 30-45% participation rate in such HRAs. Note: it has nothing to do with the level of incentive as Wrigleys’s incentive was on average.

When I asked Dr. Nawara what she thought were the reasons for such high success, she listed three key points:

1) The right company culture and senior executive commitment to assist their associates with all aspects of their health and wellness needs.

2) Choosing a good partner that shared a similar perspective of addressing all associates’ healthcare needs and questions, not just those that are currently grappling with a condition.

3) An open and transparent process that engaged associates from the outset.

Where’s the Money?

As with any such endeavor, one needs to ask: So what is the payback, the ROI, have you seen a decrease in insurance costs, etc.?  When asked, Dr. Nowara stated that at this juncture, they do not yet have a clear picture of demonstrable ROI, but they do have anecdotal evidence, via numerous “near misses,” which were associates in danger of ending up in a hospital, or on a medication or in some other potentially costly healthcare encounter. These near misses have been avoided through active, personal coaching.

But Dr. Nowara was adamant in stating that if one goes into this just thinking about ROI, they missed the whole point.  This is not about ROI, it is about doing the right thing for associates, which in turn will readily pay for itself if it is perceive by employees to be genuine. Radical thinking indeed but this may be just what is required to garner engagement on the part of employees and other employers would be wise to consider such a model.


There is quite a lot more behind this story, which is one of the most successful I have heard in the PHR market.  But it is important to point-out that this is not just a PHR story, actually the PHR plays an extremely small role overall.  This is a story about a PHR with strings attached and those strings (health coaches) appear to be the magic.

We are inherently social creatures and you can throw all the technology you want at a human but at the end of the day, we most often need someone to talk to, to encourage us to take the right steps, to guide us along the path of continued good health and wellness as well as point out to us in a gentle way how some of our actions may be detrimental to that health and what actions we need to take to get back on track.  And we need to establish a trusting relationship with that individual, the coach, that whatever we share with them is held in strictest confidence. Health is extremely personal.

Which makes one wonder, are we becoming too enamored with technology?  Does throwing up a PHR, asking employees to take an HRA, providing automated e-Alerts based on that HRA going to truly change behaviors? From what we have seen to date in most PHR deployments, the answer is no.  Serious rethinking is required on the part of the PHR industry to go beyond simple technology fixes and truly understand what motivates a human to change.  HealthString appears to have figured it out, will others follow suit?

4 responses to “The Human Equation in PHRs”

  1. […] in the report. Now, a year later, I stopped in to get an update. What an inspiring update.” Article John Moore, Chilmark Research, 17 April […]

  2. This is a great point, John. Our research also shows that, for patients (people), the highest valued advice comes directly from PCPs and those “intimately involved” with care. It seems that for other players in the online health management space (i.e. HealthVault and Google Health), the biggest obstacle is lack of PCP-to-patient recommendations.

  3. […] Mayo is striving to build such bridges as evidenced by Health Manager but as pointed out in the previous post, the human component is missing and at this juncture in the evolution of the PHR market, this human […]

  4. John: thanks for the heads-up and write up on HealthString – never heard of them!

    A couple of thoughts:

    1. An ROI from the point of view of bending (slowing) the rate of increases in the medical care or medical loss ratio is by definition a long term evaluation metric. No quick and easy way to say we did X intervention and Y was the result; aren’t we good? So the jury is out and will be for a while.

    Until then, corporate “skin in the game” has to be the intuitive notion that a comprehensive wellness program that incorporates HRA’s, coaching, behavioral support, disease management, and a PHA with data integrity, will in the aggregate promote health, better coordinate utilization care resources, and ultimately impact costs.

    2. Yes we probably are a little gadget dependent or technology addicted, fantasizing a painless digital solution to essentially diseases of lifestyle choices.

    Much like yearning for the “silver bullet” or “magic pill”, there is no fast track to improving health and well being; just a series of regular and disciplined choices (over and over again – yawn!), e.g., running, walking, cycling, hitting the gym. surfing, skiing, eating right, practicing moderation, etc. Yet, many often say “….what an order, I can’t go through with it”, followed by “where’s the remote” or “gotta check email or my twitter feed” ergo, we are where we are.

    Be well bro…

Leave a Reply

Your email address will not be published. Required fields are marked *

Stay up to the minute.