Tackling the Double Helix: On the Road to Sustainable Behavior Change. Sustainable health behavior change is possible. To be successful, you must equally commit to health at the individual level and the social level.

1. Consumer-Centric Health
Models for Change ‘11

2. Tackling the Double
Helix: On the Road to Sustainable
Behavior Change
Social Context
Individual Context
Steven M. Schwartz, PhD
Director of Outcomes Research & Data Analytics
Wellness & Prevention Johnson & Johnson

3. Is Sustained Population Change
Possible?
Yes!

4. Components of HealthPass
 Annual invitations
 Confidential Health Risk Assessment – Succeed! (web or paper)
 Biometric screening
– Total Cholesterol, HDL, Glucose
– Blood Pressure
– Height, Weight, Body Fat, BMI
 Individualized or group counseling
 Digital Health Coaching
 Referrals to healthcare resources and interventions
 Communication with the member’s provider for continuity of care
 Educational information
 Assist members in finding a Primary Care Physician

5. Figure: Return On Investment of HealthPass® by Year
4.00
Positive ROI 3.00 2.83
1.98 1.93
2.00
1.56 1.58 1.56
1.30
1.16
ROI=1:1 1.00
2002 2003 2004 2005 2006 2007 2008 2009
Negative ROI
0.00
-1.00
-2.00
Average ROI = 1:1.74
For every 1 million invested in HealthPass®, 1.74 million saved on Healthcare expenditures

6. Figure 3: 2009 Total Member HealthCare Costs by Number of Years
Using the HealthPass® Program among Members with 2009 Costs > $0
Note: Health care costs include inpatient, outpatient, medical, and pharmacy costs. Data were derived from members with 2009 total health
care costs >0. Members who had conflicting sex in multiple data sets, who reported pregnant or more than 365 total inpatient days in any
one year were excluded. Savings were adjusted for sex, age, morbidity in 2002, and total health care cost in 2002. The 2009 health care
costs were significantly different by number of participation year, F(8, 159993)=11.52, P<.0001.
Key Message: There is a dose-response-like relationship of program participation to total
expenditures. The more years participated in the HealthPass®, the lower the average costs.

7. But What About Behavior Change
& Risk Modification?

8. Figure 4: Changes in Total Cholesterol by 2002 Cholesterol Status
among HealthPass® Users Since 2002
100% 100.0%
Total Cholesterol ≥ 240 (%)
80%
60%
40% 34.2%
25.3% 26.1% 27.8%
22.9% 24.3%
16.9%
20%
5.3% 4.8% 6.7% 4.4% 5.3%
3.6% 3.8%
0.0%
0%
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year in HealthPass
Total Cholesterol in 2002 < 240 Total Cholesterol in 2002 ≥ 240
Note: NHLBI Guideline: Total Cholesterol <240 mg/dL; 86% of yearly HealthPass participants in 2002 met the
guideline.
Total cholesterol in 2002 under 240 mg/dL: N = 13,381; total cholesterol in 2002 240 mg/dL or above: N =
2,182.

9. Figure 6: Changes in High Stress* by 2002 Stress Status
among HealthPass® Users Since 2002
100% 100.0%
90%
80% 75.7%
70%
High Stress* (%)
62.8%
60%
50%
39.9% 37.7%
40% 35.5% 33.3% 32.8%
30% 22.1% 20.7%
20% 13.7% 13.3% 13.2% 12.5%
9.9%
10%
0.0%
0%
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year in HealthPass
Low stress in 2002 High stress in 2002
Note: High stress cut-off < 8/10 in Succeed HRA Behavior Score; 41.8% of yearly HealthPass participants in
2002 fell within the recommended guideline.
High stress in 2002, N = 9,080; low stress in 2002, N = 6,517.

10. Figure 5: Changes in Body Mass Index (BMI) by 2002 BMI Status
among HealthPass® Users Since 2002
100% 100.0%
86.7%
90% 83.2% 82.8% 83.5% 82.6%
79.2% 78.0%
80%
70%
BMI ≥ 30 (%)
60%
50%
40%
30%
20%
10% 2.8% 2.4% 3.0% 3.3% 3.8% 3.9%
0.0% 1.8%
0%
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year in HealthPass
BMI < 30 in 2002 BMI ≥ 30 in 2002
Note: Obese and extremely obese cutoff: BMI ≥30; 85.7% of yearly HealthPass participants in 2002 fell within
the recommended guideline.
BMI < 30 in 2002, N = 13,362; BMI ≥ 30 in 2002, N = 2,225.

11. The Key Ingredients: A Dual Perspective
Social Perspective
• Culture of Health
• Organizational
approach
To be
successful, you
Participation &
Engagement
must equally
commit to health at
the individual level
Individual and the social
Perspective
• Activation Segmentation level.
• Behavioral Science
• Meaningful Incentives
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12. Wellness & Prevention, Inc. National Landmark Study
Attitudes and Behaviors Regarding Health
• Comprehensive and proprietary study
– Current motivations / priorities, behaviors, and barriers to improving health
– Their starting point, their language, their struggles and needs
• Two Phases Conducted
– Phase One: Qualitative Needs Assessment Exploration
• 4 InQuest Focus Groups in 2 US Cities
• 18 One to One interviews in 2 US Cities
• Completion of extensive homework journal.
– Phase Two: Quantitative Online Assessment of Needs, Attitudes, and Behaviors
• Sample of 3,007 full-time employed U.S. adults
• 60 minute questionnaire covering a broad array of topics
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13. In my company, programs are…
6 6% Integral part of company mission/culture
5 20% Strongly promoted/supported
4 32% Offered, somewhat promoted
3 15% Offered, but not promoted/supported
2 14% Talked about, but not put into practice
1 14% Not visible/evident
Wellness & Prevention, Inc. Landmark Study, 2009
13

14. The Culture of Health and
Confidence/Motivation
Level of Motivation & Confidence
1 1 2 2 3 3 44 5 5 6
6
Strength of Culture of Health
Wellness & Prevention, Inc. Landmark Study, 2009
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15. Establishing a Culture of Health is Critical
Positive Impact – If Authentically, Consistently Supported
Individuals’ Feelings if Company Were to Provide Population Health Programs
Skeptical Grateful/Loyal
Wellness & Prevention, Inc. Landmark Study, 2009 * % of Respondents, indexed to % among total sample
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16. An Individual Perspective:
Evaluating Values and Activation Segmentation
16

17. 0.5%
Which value, trait, or characteristic best 3.2%
completes the following sentence: 23.3%
0
"Being _________ is important to me." 1
Please choose up to three. 72.9% 2
3
• Successful 22%
• In control 22%
• Responsible 34%
• Disciplined 11%
• Strong in character 21%
• Energetic 22%
• Independent 28%
• A good parent 36%
• A good grandparent 11%
• A good spouse/partner 38%
• A good community member 4%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0%

18. 48.6% Parent Spouse
28.7% Responsible Spouse
26.8% Responsible Independent
26.5% Responsible Parent
23.9% Control Independent
21.6% Energetic Independent
20.5% Control Energetic
20.1% Successful Control
Strong links are heavier

19. Does Value Increase Motivation & Confidence?
- Baseline
10
8.0
Disciplined
9 Successful
7.9
Baseline Confidence to Manage Health
8
Baseline Confidence to Manage Health
Have value Strong in
Responsible
7.8 character
7 Spouse
No value Parent
6 7.7
Community Energetic
5 Grandparent
7.6
4
7.5 In control
3
Independent
2 7.4
1 7.3
0
7.2
0 1 2 3 4 5 6 7 8 9 10
8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 9.0
Baseline Motivation to Manage Health
Baseline Motivation to Manage Health
High motivation is associate with high confidence.

20. THE SIX “ACTIVATION” EMPLOYEE SEGMENTS
I’m already stretched Help! It’s scary to think about
Sharing the journey really keeps how much I need to do
taking care of work and family.
everyone’s momentum up. We learn For me to focus on my own well-being, and whether I can even do it.
from, help and encourage each other, it has to be a company goal Frankly, I don’t even know
and we have fun along the way. that I have team accountability for. what the first step should be.
Permission-Seeking
Booster Clubbers Insecure Rookies
Team Players
I’m already on the fitness bandwagon. What and when I do is up to me There are much bigger issues
It’d be great if my company and it will be on my own terms. to be dealt with
provided me some resources, It’s not something I want my employer / before I can even think about
but my challenge is simply consistency. coworkers concerning themselves with. health & wellness.
Energized
Free Agents Forced Forfeiters
Champions

21. Well-Being: Overall, Physical, Mental, and
Emotional
70
60
50
40
30
20
10
0
Booster Perm Seekers Insecure Energized Free Agents Forced
Clubbers Forfeiters
Overall Physical Mental Emotional
The pattern of well-being is the same across segments.
Physical well-being is always the lowest regardless of segment.
Insecure are the worst off and that is true for all aspects of well-being.

22. Energy Levels Through the Day.
70
60
50
40
30
20
10
0
Before Beginning Middle End After Weekend
Booster Clubbers Perm Seekers Insecure
Energized Free Agents Forced Forfeiters
The pattern of energy levels is similar across segments.
Insecure have the lowest energy throughout the day.
Perm Seekers have an unusual burst when they get home.

23. Motivation and Expected Difficulty
80
70 High Motivation Segments
60
50
Low Motivation Segments
40
30
20
10
0
Booster Perm Seekers Insecure Energized Free Agents Forced
Clubbers Forfeiters
motivation difficulty
Segments fall into high and low motivation groups.
Insecure rates expected difficulty higher than the others.

24. Social Connection Attitudes
80
70
60
50
40
30
20
10
0
Booster Clubbers Perm Seekers Insecure Energized Free Agents Forced Forfeiters
I will make it a higher priority if I know someone else is counting on me
Sets me up with a partner -- and we do it together
Relieved when I find a buddy / partner to do it with me
Provided by someone who has been where I am, but has been successful in making real progress
Consistent Pattern across segments.
Booster and Perm Seekers are the most social.
Having others depend on you is more motivating than having help
from others.

25. Segmentation Demands Flexibility
Booster Permission- Insecure Energized Forced
Free Agents
Clubbers Seeking Team Rookies Champions Forfeiters
Players
D
Facilitator of Core
Permission
The Role Connections (Private) Provision Tools Teacher…
Granter…
You Play …”Social Tutor/Teacher (Healthy Supplier Enlighten
Absolver
Chairman” foods, gym)
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26. Key Point…
• Individuals have different needs, wants,
and desires and are on different points in
their journey!
One Approach will not
reach the majority of
individuals.
A variety of approaches are required to
meet everyone’s needs!
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27. Conclusions
• We must address the double helix – interventions
at the societal and individual levels
• Changing behavior on a large scale is an
imperative to success
• We cannot rely on Cultural change to come from
the traditional medical establishment or
government
• Effective solutions will combine deep
understanding of human nature and leverage
technological innovation to reach them in situ