Mechanics of Meaningful Health Engagement: Five Levers of Employee Engagement

Maximize your reach and chances of achieving meaningful engagement results with an optimal strategy that taps into the 5 Levers of Employee Engagement: Communication, Culture, Experience, Solution Design and Incentives.

January 09, 2020

Maximize your reach and chances of achieving meaningful engagement results with an optimal strategy that taps into the 5 Levers of Employee Engagement: Communication, Culture, Experience, Solution Design and Incentives.1 Each of these are fundamental drivers of employee engagement and should be considered as part of a holistic approach that takes into account the employer’s entire vendor partner ecosystem.

Individually, each lever is critically important; working together, they have an even greater impact on engagement results. Each lever may dictate different oversight and accountability (i.e., employer vs. vendor). For this reason, it’s important that the employer and vendor predetermine roles and devise a plan for holding each other accountable.

Five Levers of Employee Engagement: Commuication; Experience; Incentives; Culture; Solution Design

Lever One: Communication

The role of effective communication in influencing behavior, and thus health engagement, is pivotal. Communication should match personal motivation wherever possible and clearly map out the road to a desired outcome, while emphasizing the removal of any potential barriers to action. Some of the most effective communication stems from a strong employee affinity for you and your vendors. This is critical to build and cultivate early on, as it greatly influences how a message is heard and internalized.

So What? 

    Employees are listening to their employer. The numbers tell the story:

  • 75% trust their employer and expect them to "do what's right."2
  • 80% expect their employer to provide personal empowerment.2
  • Targeted messaging influences behavior when it matches personal motivation.3

Now What? 

  • Use trusted messengers. Ensure their motives match your employees’ motives.
  • Differentiate mass communication efforts from personalized communications.
  • Align your messaging and directional efforts with the desired role (rational consumer or concerned patient?).
  • Since motivation cannot be sustained, design frequent and timely behavioral prompts. 
  • Measure outcomes (e.g., health results), not outputs (e.g., click-throughs, “likes”).

Lever Two: Culture

Organizational culture reflects the shared values, attitudes and norms of an organization, and influences the behaviors and decisions of leaders and employees. It is the context—positive, negative, or somewhere in between—in which all health engagement strategies and tactics must operate. Instead of attempting to create a culture of health in a vacuum, employers should consider ways to integrate well-being initiatives into the business and across the organization, essentially weaving health and well-being into the organizational culture.

So What? 

In companies with health woven into their organizational culture, employees are more likely to perceive their employer positively and be actively engaged in managing their health.4 Employees are:

  • 70% more likely to cite health and well-being programs as one of the reasons they stay with their employer;
  • 67% more likely to compare health services costs;
  • 25% more likely to have not avoided necessary care; and
  • 32% more likely to have a normal BMI.

Companies that improve their culture of health (as defined by the CDC Worksite Health Scorecard) realize some important benefits, including:5

  • Reductions in biometric and behavioral health risks (i.e., high blood pressure, high BMI, poor nutrition, alcohol use, depression and tobacco use) and health care utilization (i.e., prescription drug use).
  • Lower health care cost trends.

Now What? 

  • Consider having your corporate mission statement or business objectives incorporate employee health and well-being.
  • Recognize, reward or celebrate employee health achievements (e.g., employee awarded a badge to include in email signature).
  • Leverage your leadership team as health advocates and role models. Consider having senior leaders share personal stories or sponsor/participate in health events (e.g., zoo walk with the CEO).
  • Consider all actions that improve overall employee health (e.g., employees given one afternoon off each month to focus on personal well-being priorities such as time with children, a hobby or getting preventive care).
  • Actively encourage your employees to incorporate health activities into the workday (e.g., a sponsored film screening, discussion or challenge centered around the documentary, The Walking Revolution, which offers a new perspective on the physical environment and demonstrates the impact that a walking routine can have on an individual’s life).
  • Encourage your employees to share their health-related efforts with others (e.g., free mammogram offered to someone in need for each employee who receives a mammogram).
  • Cultivate a work environment that makes it easy to get and stay healthy (e.g., stand and/or stretch breaks every 90 minutes for increased energy and focus in meetings and throughout the workday).
  • Ensure your cafe/vending services offer many convenient and affordable healthy options (e.g., nutritious food items displayed in the cafeteria express line).

Lever Three: Experience

An individual’s experience with health spans across various contexts, whether it is experience with health care, with health benefits, or with healthy living efforts. Positive and negative experiences can boost or erode engagement over time, so it deserves intentional focus. Experience can be considered both an outcome (e.g., overall satisfaction) and a process measure (e.g., satisfaction with a specific interaction or service). Measurement should take into account two perspectives: the interaction itself (What happened?) and the individual’s perception of what happened (Did they find it valuable? What emotions were felt?). Intentional measurement and experience-driven decisions are vital in driving sustained engagement.

So What? 

  • Positive employee experience is related to increased discretionary effort and work performance. However, high engagement with negative experience leads to frustration.6
  • 91% of employees with high well-being and organizational support are less likely to leave.7 Companies that invest heavily in employee experience are 11.5 times more likely to earn a place on Glassdoor’s Best Places to Work list, compared to their counterparts.8
  • Evidence has shown improved engagement in preventive care and disease management with more positive health care experiences.9 Likewise, health care consumerism is higher among those with positive health plan experiences.10

Now What? 

  • Measure experience at both the interaction and cross-interaction levels and include in your regular dashboarding.
  • Integrate experience and engagement data together to uncover and prioritize key drivers.
  • Loop learnings back into design (to address drivers) and monitoring (to catch drivers upstream).
  • Implement standards for vendor partners.
  • Involve employees regularly to validate and supplement other experiences.

Lever Four: Solution Design

Most employers/health plans approach individuals with a benefits-driven solution. Individuals who do not use health care on a regular basis are generally unaware of their available benefits and thus exhibit poor engagement. Solution design should look to provide employees with the opportunity to interact regularly based on what they find valuable (e.g., incorporate preferences, goals, personal information). The design of the future may look to integrate various parts of people’s lives (e.g., health + well-being + career), providing a truly seamless experience. Ultimately, meaningful engagement can never occur if the call-to-action doesn’t resonate or align with the values and perceptions of the employee workforce.

So What? 

  • An integrated system approach allows employees to make more frequent touchpoints (with their benefit offerings and the system as a whole) that are relevant to them. 
  • An integrated platform is more likely to motivate employees to make repeated visits to the platform out of sheer curiosity about their total health. The goal is to create an intrinsic motivation vs. a simple habit.

Now What? 

  • Identify the various programs and services to support an employee’s well-being and health care journey.
  • Ask your chosen vendor partner to outline how the user experience is configured and prioritized to present the relevant programs and services available in support of the user’s well-being and health care journey.
  • Define your key objectives driven by data.
  • Request data points to show that users are accessing the platform for total health care needs (vs. simply checking in on their incentive/ challenge status).
  • Request data points to show that users are accessing the various third-party programs.
  • Ensure the user experience is personalized to the individual’s unique needs, while not becoming overwhelming.

Lever Five: Incentives

Incentives drive engagement in health survey and biometric screenings and other wellbeing activities. Incentive strategies are evolving and vary by employer, but typically involve a financial component (e.g., cash, premium discount, health savings account contributions).

Employers should examine whether they’re utilizing incentives in a way that’s consistent with the evidence and the movement to a culture that weaves in well-being.

Incentives of the future should reduce barriers to entry into health programs and should align with the evidence on engagement and behavior change (e.g., If it takes nine interactions with a program to change behavior, then we should design the incentive to encourage engagement through at least nine interactions).

Incentives work well for achieving short-term goals but will not work forever and not for every population and not without the other engagement levers at work.

So What? 

Employer survey data show that the positive impacts of incentives have increased from 2016 to 2018.

Two-thirds of employers believe incentives are highly effective in increasing participation (e.g., screenings, surveys, coaching and other population health activities) and outcomes (e.g., improved blood pressure, cholesterol, BMI and blood glucose).11

Participation and incentive amount have a linear relationship until they hit the point of diminishing returns, at which point they are no longer linear, but level out (lower bound of $100 and a point of saturation or diminishing returns at $600 total incentive value).12

Employers with richer incentive plans are observed to have higher user acquisition and participation in benefit offerings. There is higher participation in plans with incentives that include activities combining well-being, risk reduction and disease management.12

Now What? 

  • Ensure equitable value across the continuum of care: a) all have equal opportunity to earn and b) the action is fair for the level of effort.
  • Align incentive activity set to overall strategy and goals, then use choice architecture or points economy to drive to desired activities.
  • Consider ancillary reward options including discount offers, charitable donations and the ability to earn tangible rewards to keep the program relevant for all.
  • Ensure that the program is long enough for members to earn their rewards.
  • Keep the program understandable and simple for the members to comprehend; complexity will erode response rates.

With special acknowledgment and appreciation to Aon, EVIVE, IBM Watson Health, Optum, ROC Group, Sharecare and employer members of the Leadership Forum on Employee Experience for their contributions to the creation of this resource.

  • Aon: Jim Hoff, Senior Partner, Strategic Advisory Communication; Janet Faircloth, Senior Vice President
  • EVIVE: Prashant Srivastava, President & CEO
  • IBM Watson Health: Stewart Sill, Watson Health, Senior Health Advisor
  • Optum: Seth Serxner, Chief Health Officer, SVP Population Health; Mindy Fox, Global Client Executive
  • ROC Group: Janice Burnham, CEO; Amy Finsand, Managing Director
  • Sharecare: Howard Gruverman, Executive Vice President of Enterprise; David Toomey, Senior Vice President, Enterprise


  • Optum. Engagement: The key to value. 2018. Accessed October 10, 2019.
  • 2019 Edelman trust barometer. Edelman. 2019. Accessed September 19, 2019.
  • Keller, J.M. What is motivational design? Accessed September 19, 2019.
  • 2017 Alight Consumer Health Mindset StudyTM conducted with Aon, the National Business Group on Health, and Kantar Consulting. Accessed September 19, 2019.
  • Henke, RM, Head, MA, Ken,t KB, Goetzel, RZ, Roemer, EC, McCleary K. Improvements in an organization’s culture of health reduces workers’ health risk profile and health care utilization. Journal of Occupational and Environmental Medicine. 101-96:)2(61;2019.
  • IBM and Globoforce. The Employee Experience Index. 2016. The_Employee_Experience_Index.pdf. Accessed September 19, 2019
  • Quantum Workplace and Limeade. 2016 Well-Being and Engagement Report. uploads/2016/11/QW-LimeadeWellBeingEngagementReport-final.pdf. Accessed September 19, 2019.
  • Morgan, J. Why the millions we spend on employee engagement buy us so little. Harvard Business Review. 2017. https:// Accessed September 19, 2019. 
  • CAHPS. Why Improve Patient Experience?. Content last reviewed January 2018. Agency for Healthcare Research and Quality, Rockville, MD. Accessed October 10, 2019.
  • McKinsey. Customer experience: Creating value through transforming customer journeys. 2016. com/~/media/McKinsey/Featured%20Insights/Customer%20Experience/Creating%20value%20through%20transforming%20customer%20journeys.ashx. Accessed October 10, 2019.
  • Optum. 10th Annual Health and Well-being at Work Study. Accessed September 19, 2019.
  • Internal Rally/Optum Incentives Database Analysis. Not published.

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