What’s app in health and wellness.

Health-related apps number in the hundreds of thousands today—yet when it comes to their utility for employers, the market is really just getting started.

Apps can play an important part in all stages of the health continuum, from simple engagement to prevention and chronic disease management. The vast majority of apps today belong at the start of that continuum, engaging users with simple challenges or gamified learnings that boost general awareness of healthy behaviours. It is unclear whether these apps lead to long-term health gains, in part because users tend to be generally healthy to begin with; or, conversely, because users in poor health need more targeted, personalized digital tools that sit at the other end of the continuum—and these apps are relatively few in number at this point in time. Cost may also be a factor: people tend to prefer free apps, yet the more evidence-based, clinically driven apps may have a fee attached.

A 2017 survey of more than 4,000 Canadian adults, conducted by CEFRIO and funded by Canada Health Infoway, indicated that 78% of Canadian adults owned a smartphone. Among them, 38% used one or more apps to monitor aspects of their health in the last three months. Nine out of 10 of these users described their health as good, very good or excellent, while 28% reported having a chronic illness/condition or rated their health as fair/poor. They were most likely to use the apps to monitor their physical activity (64%), nutrition/eating habits (41%), weight-related information (36%) and sleep (36%).

While most of today’s apps are more likely to engage rather than lead to big improvements in health, they still provide value. “They help further a positive workplace culture and employees will feel their employer goes the extra mile by offering new, fun experiences. Those that offer rewards are most successful,” said Sandie Ventin, associate vice-president of Accompass, a division of Gallagher. “Therefore we should talk about this as being part of employee engagement, and not just in terms of wellness or health benefit plans. Costs, if any, would come out of the total compensation budget.”

The good news is, employers can leverage cost-free options from employee assistance providers or, more recently, insurance carriers (e.g., Great-West Life’s Health Connected programs, Manulife’s Vitality, Sun Life’s Lumino Health). Some benefits consulting firms have also invested in their own suite of apps (e.g., LifeWorks by Morneau Shepell).

From engagement to chronic disease management.

The providers of these programs believe their apps can do more than engage employees. Their offerings are set up to traverse the continuum by helping employees identify personal health risks, and from there they can proactively educate on how to improve health and try to nudge behaviour change through personalized goals or suggested actions that are incentivized with rewards. Some programs, such as LifeWorks, also already offer access to coaching via chat or video.

“Clients’ expectations have increased,” said Paula Allen, vice-president of research and integrative solutions at Morneau Shepell. “They want a wellbeing program that addresses the fact that a good number of their employees now work from home. They don’t want to wait until their employees have a health problem; at the same time, they want to make sure it’s not just the healthiest people who engage in programs. They are looking for something that supports health from start to finish, from prevention to crisis response, and technology is now at a point where it can help make this happen.”

Apps that effectively support chronic disease management—and reduce disability claims—are the endgame, coupled with reporting that makes the connection to health benefit costs. “Chronic disease management is the biggest area of opportunity in health apps. It’s a new area, with hurdles to overcome, yet I predict these types of apps will land in employers’ benefit offerings in the next two to four years,” said Tim Clarke, president, tc Health Consulting Inc.

“Other parts of the world are at the point where doctors are prescribing apps,” he added.

“Apps will become a critical component for the delivery of health services,” agreed Allen. For organizations and employers, apps for internet-based cognitive behavioural therapy (iCBT) are an excellent starting point, since many group insurers have allowed for coverage of the cost of iCBT in their benefit plans, or access to those on disability benefits.

Connecting with benefit plans.

Clarke also predicted that it’s just a matter of time until the more sophisticated apps for chronic disease management—which work with data from medical devices, and likely include proactive coaching services—become eligible medical expenses under Canada Revenue Agency (CRA) rules. “Once that happens, there are many ways plan sponsors can set things up to connect apps with benefit plans, without opening the purse strings to everyone.”

For example, employees on short- or long-term disability leave would be eligible for appropriate apps. CRA-approved apps could comprise an additional category under paramedical benefits. Or plan members who can be identified as having medical needs, based on claims experience, could qualify for and be directed to coverage of an app. “The thinking is that if someone’s utilization of traditional health benefits indicates a chronic issue, let’s help them access an app that could provide additional support,” said Clarke.

The integration of apps into health benefit plans, in ways that can support behaviour change for both the prevention and management of chronic disease, is still very much in early days. Yet their inclusion is inevitable, given today’s instant feedback, 24-7, mobile-first technology era. “We’re able to support someone’s health continuously, not just when they see a provider face-to-face,” summarized Clarke.

Added Allen: “I definitely see apps becoming a first point of entry for health care. They will be an entry point into prevention programs, into crisis management, and into health navigation. Apps give people access to what they need, when they need it, and they can create a circle of care so that healthcare providers can proactively assist in real-time.”

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