Communications between employee health management (EHM) suppliers and participants tend to focus on motivating participants to make the behavior changes that relate to the particular goals and objectives in each case. They may also include efforts aimed at helping participants overcome barriers or master the skills needed to make such changes. But there is at least one other “leg” to this “stool”, namely reminding participants at the right time, through the right channel, about the right behavior needed at that time.

When EHM participants rely on their own face visits to physicians or other physician practice staff for motivation and empowerment support, the communications involved may not have to be frequent. Monthly, even quarterly contacts may be able to move and maintain participants’ commitment and capabilities. When incentives are used in motivation, for example, they are often delivered at monthly or quarterly intervals. But when participants need to be reminded of when, what, how, and where they are to execute necessary actions, such reminders may have to be far more frequent.

This can be a problem when participants get mainly face meetings or phone coaching, since for these to be as frequent as weekly or daily would add dramatically to the cost of EHM interventions. Fortunately, there are many technologies that can deliver weekly or daily reminders at very little cost, thanks to computer-generated content and online communications links. Such reminders can be delivered with partially or fully personalized and tailored content for literally pennies each.

The personalization part is pretty simple, since addressing online content to individual participants by name has long been mastered by scammers, spammers and direct mailers – and can be similarly used by EHM suppliers engaged in “permission management” efforts. The degree of tailoring, however, may vary widely among suppliers. The best suppliers, however, can incorporate and reflect participants’ personal input into health risk and productivity impairment assessment surveys, and even their health screening or claims analysis results, where these have been used to identify the EHM challenges and goals being addressed.

At a minimum, EHM communications to participants can easily be customized to the “segments” engaged in specific disease, risk behavior or risk condition interventions. Automated computer-generated communications can easily be customized to sub-segments, based on their risk levels, for example, with more frequent and intensive content sent to high- vs. moderate- vs. low-risk/reward members of those participating in a specific problem/goal-focused intervention. Separate communications may be sent when more than one behavior is the focus, so that each gets its own focused content.

But real customization tends to emerge relative to the precise personal motivations, state of commitment and self-efficacy, perceived barriers, and degree of change needed for each individual. And this can be achieved through automated computer-generated online communications almost as easily as can segment-only customization.

For example, while it is always possible for more than one individual to have virtually identical answers to surveys, screening result, and claims, this becomes extremely unlikely when there are many information points involved.

If a survey contains as few as ten questions with five possible answers to each, then there will be almost ten million (510 = 9,765,625 to be precise) different possible combinations of answers. If there as many as 30 questions with even two possible answers to each, there will be over one billion possible combinations (230 = 1,073,741,824). If there are as many as fifty questions, as is frequently the case when productivity impairment queries are added to health behavior and condition questions, with five possible answers to each, there would be 8.88 followed by 34 zeros worth of possible combinations, and the chances of any combination being repeated exactly becomes virtually nil.

But customization need not mean that every communication is absolutely unique to each recipient. After all, participants will rarely compare notes to learn how different are the messages that their peer participants get. The reason for customization is simply to promote a high degree of relevance for each individual, along with a high degree of recognition by each that the communications are focused on each as an individual. As long as this is achieved — and asking participants how relevant and useful each rates the communications involved is more important than asking them how unique they seem to be – the chances are good that sufficient customization has been achieved.

Reminders about specific commitments each individual has made must, of course, be unique to those who made them, even if more than one participant has done so. Reminders about timing for specific actions, such as taking medications, checking on measures such as weight for congestive heart failure patients which should be done at least daily, or weekly weigh-ins, monthly blood pressure checks, etc. may be timed for segments based on different frequencies, rather than content. Reminders for daily activities such as 30 minutes of challenging physical activity, or blood glucose for diabetics can be customized as to frequency based on participants’ reports of their patterns of activity and blood glucose readings.

Reminders can and should be used to support the motivation and empowerment functions as well. By reminding participants of the progress they, themselves have made, though less frequently than they report it, EHM suppliers can reinforce their awareness of progress achieved and thereby their confidence in achieving even more. Or by reminding them of lack of progress compared to their personally set objectives, perhaps asking them about reasons for such lack, communications can identify new or greater barriers than were originally reported or described.

Because reminders must almost always be significantly more frequent than are communications aimed solely at motivation or empowerment, it is a good idea for EHM interventions to include computer-generated online communications in almost every case. Special handling may be needed for participants who lack any access to computers or the Internet at home or work, such as automated phone reminders, which can be almost as inexpensive.

In many cases, the spouses, parents or children of participants may be enlisted as reminder supporters. They can frequently serve to help in the empowerment function as well. In addition, participants may also invite their fellow workers, particularly those who are involved in an online or at-work support group, to function as reminder “buddies” at work or via phone, wireless, or online communications as well. This may be even more effective than suppliers’ own methods, and can cost EHM suppliers no more than the staff time it takes to create and supervise the support network involved.

While motivation and empowerment are more challenging, they are no more important, in most cases, than the reminding function, even though the latter is pretty mechanical, rather than challenging. The more reminder mechanisms and sources, involved, within limits of becoming perceived as “nagging” rather than merely prompting action, the better. When employers or the EHM suppliers they hire simply include the reminder function in their overall strategy and tactics, they are likely to succeed far better than if they ignore it entirely.