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A Q&A with Ashley Reynolds, PhD, RN, ACSM-HFS

Executive Vice President of Operations, Sensei

Part 2: Measurement

In the second part of an exclusive interview with BioIQ, Dr. Ashley Reynolds shares how organizations can measure digital engagement in wellness programs, best practices for building a digital strategy and more.

Read part one of the interview to discover why digital engagement is a critical component to today’s population health programs and how organizations can leverage technology to increase their wellness ROI.

BioIQ: Can you share an example of a traditional engagement method that was successful in the past but is no longer effective, due to the emergence of digital technology?

Dr. Reynolds: Absolutely! Call center models of engagement have struggled with a lack of participation for a while now – for several reasons. For example, fewer and fewer homes have a landline phone and mobile numbers aren’t always available. Plus, people are busier than ever before and asking them to commit to a 30-minute telephonic coaching session may not be feasible. I cannot tell you how many programs I’ve seen where a majority of the coaching efforts were spent just trying to connect with members.

Digital tools such as email, text messages, push messages, apps and wearable devices can deliver interventions consistently throughout the day. In a traditional care management environment, the nurse reaches out to the member to find out how well they are managing their conditions. With digital tools, nurses can see what is happening with their members by monitoring wearable data. They receive alerts when action is required. Nurses can communicate easily, so the time they do spend on the phone is much more effective. With automated decision support tools, self-monitoring dashboards and secure communications, users receive a rich experience that that aids in self-management but requires less human effort to deliver.

BioIQ: How can organizations encourage the adoption of digital channels while considering the age-related differences and varying levels of technical skills of their member populations?

Dr. Reynolds: Digital tools for older users should accommodate visual and cognitive preferences to make the experience less overwhelming and more enjoyable. Keeping the user interface clean, without extraneous details and simple, concise instructions will aid usability for older adults. The tools should also make concessions for people who have physical limitations. It is helpful to allow people to set the level of difficulty to suit their needs.

The importance of usability cannot be overestimated. Organizations should test the tools with the intended user group, elicit feedback, then monitor satisfaction and participation. Also, it’s critical to involve consumers as well as the internal staff who will be assisting with or using these tools.


BioIQ: When it comes to the design of mobile apps, websites and other digital tools, why is the user experience so critical?

Dr. Reynolds: Consumers are much more sophisticated than they used to be. As tools have improved, so have consumer expectations about how they should work. If an interface is clunky or confusing, users simply won’t engage. An even worse scenario is when programs incorporate participation incentives for engaging with these tools, and then they don’t work as intended. This frustrates members, who feel like they’re being forced to use a clunky tool just to receive their incentives.

If the expected outcome is tied to participation and the experience is poor, then participation will flag and you will not be able to impact the outcome. This will mean your organization has spent a great deal of resources implementing something that winds up never being used.

BioIQ: What do organizations need to consider in terms of HIPAA compliance when engaging with members through digital channels?

Dr. Reynolds: When considering using digital technology platforms, be sure your member data is encrypted. Find out where it is going to be stored. Will any data be kept natively on the devices or in the cloud? Make sure to ask who will have access to the data and what their policies are for breach notification. Confirm that they will not use patient-generated data for any purpose to which you have not agreed. Work with your compliance team to identify potential pitfalls and screen digital health providers accordingly. Finally, be sure to include descriptions of this data, how it will be used and how it is protected in your member terms and privacy statements.


BioIQ: Let’s talk metrics. How can organizations measure digital engagement?

Dr. Reynolds: First, let’s differentiate between outcomes metrics and tools metrics. Up till now we have been talking about health outcomes. Tool metrics gauge the effectiveness of the tools themselves. For years, improving outcomes metrics such as fitness levels, weight changes or cholesterol levels were the cornerstone of many population health programs. While digital tools can influence these outcomes metrics, measuring engagement with the tool itself is much newer. However, it is important and should be included as part of any program’s reporting.

Some metrics, such pageviews or the number of sign ins, have been considered standard reporting components since the advent of Web-based portals. Newer technology like wearables and mobile applications can provide even more information. Organizations should also look at metrics such as the average number of daily users, the average time since the last sign in, session intervals, the total number of active users, retention rate, launch and load times, and satisfaction rates.

BioIQ: For organizations just beginning their digital engagement journey, what are some best practices for building a strategy?

Dr. Reynolds: One best practice is to take a multidisciplinary approach to program design and include these components: consumer feedback, health behaviorists, user experience/interface designers, clinicians, marketing and feedback from key business leaders to ensure the final product is effective.

Clearly communicate the benefits of the digital tools and explain what users can expect to gain from them. Weave these tools into your overall culture of health. Be sure to identify the consumer value, define your organizational goals for using the tools, and make sure the tools fit in with other engagement efforts.

BioIQ: What role do screenings, lab tests and other measurement methods play in developing a comprehensive well-being solution for today’s consumers?

Dr. Reynolds: Digital tools are just one piece of a comprehensive population health strategy. Ideally, this strategy would include primary, secondary and tertiary levels of prevention. Primary prevention includes healthy lifestyle management interventions and immunizations (keeping healthy people healthy), while secondary prevention includes testing (screening and early identification of disease). Tertiary prevention includes condition support (maximizing health in chronic illness). True population health programs recognize that in order to achieve optimal outcomes, you cannot ignore any portion of the population.

Laboratory testing, health risk assessments and biometric screenings are critical to a successful population health program or well-being program. These preventive steps form the basis from which program interventions are derived. Digital tools should absolutely be integrated with these steps so the user receives maximum value from the experience.

Dr. SDr. Ashley Reynolds is the Chief Executive Officer for Kaviva, a precision-infused health engagement technology platform. He is an expert in eHealth, wireless technologies and digital tools that inspire positive behavioral changes.

With more than 20 years of healthcare experience, Reynolds has expertise in disease management, health promotion, health behavior, managed care, emergency nursing and critical care. He has lectured nationally and is a member of the American Nurses Association, the Society for Behavioral Medicine and the American college of sports medicine.

Dr. Reynolds participates in several industry-leading professional committees, including the CDC/NIH Diabetes Health Sense Task force, the Population Health Alliance (PHA) Engagement Committee, and the alliance’s Technology Engagement workgroup, for which he serves as a chair. He is a frequent peer reviewer for technology and health behavior research.