This Hospital Life: Question for biometric screenings is, what’s my motivation?

Getting a biometric screening is good for your wallet and possibly for your organization. Those aren’t the best reasons to do it.
March 30, 2016

So you’ve completed your biometric screening or plan to before the April 8 deadline – after which you turn into a pumpkin or something much less healthy. If you skip it, you will be lighter, at least in the wallet, because you’ll fork over $10 more in health care premiums every pay period ($240 for the year) than those who got the screening.

Full disclosure: I’m in the procrastination group, although I won’t join the pumpkin group. I’ve got my screening scheduled. But as is true every year, I’m asking myself why I do this. The short answer is I’d rather get $10 knocked off my premium than not, but without sneezing at that savings – might as well use a health care metaphor – I don’t kid myself that an extra Alexander Hamilton every two weeks is going to change my life.

However, I don’t take lightly the investment UCHealth makes in these screenings. I understand the rationale for gathering data on our height, weight, waist circumference, blood pressure, cholesterol, triglyceride and blood sugar levels, and so. How else to gauge the overall health of employees and identify the risk factors – obesity, diabetes, and heart disease, to name three of the usual suspects – that drive health care costs and premiums ever higher?

With that in mind, I do my bit to help my employer get a better idea of how it’s spending its health care dollar and perhaps figure out new ways it can help me and my fellow employees get healthier or stay healthy.

All things being equal, I prefer to work for an employer who values health and wellness, and offers options aimed at encouraging employees and family members to exercise, eat healthier diets, and reduce stress. But even the truest believer in the concept must admit that improving the health of a workforce ultimately relies in large part on individual motivation. You can lead a horse to the salad bar but you can’t make him stop drinking soda.

What’s my motivation?

Still, a recent podcast of a “Freakonomics Radio” broadcast reminded me that as long as an individual has at least some motivation to change a behavior, there are strategies for doing so. The episode, “When Willpower Isn’t Enough” centered on a study by Katy Milkman, a professor who studies behavioral economics at the University of Pennsylvania’s Wharton School. Milkman’s primary area of study is how people make choices.

In the broadcast interview, Milkman explained a study she designed to examine the effects of a concept she calls “temptation bundling.” Simply put, the idea is that people might be more willing to do something that’s good for them that they also consider boring or unpleasant – like exercise – if they pair it with something they like, like listening to music or watching television. The twist is that temptation bundling requires that you allow yourself to do the easy and pleasant thing only if you bundle it with something you’d rather avoid. By getting beyond willpower, you get yourself off the couch.

It’s an intuitive idea, but being a researcher, Milkman tested it by creating a study with three exercise groups. The first got an iPod loaded with four novels they chose that millions have found compelling, even addictive, reads, including “The Hunger Games.” They were allowed to listen to their audiobooks only while at the gym exercising, after which the iPods were taken away. If they wanted to get to the next phase of the story, they had to come back and exercise more. Group two also got iPods pre-loaded with the books of their choice, but their reading wasn’t confined to coming to the gym. The third, a control group, got only a gift card and words of encouragement to work out. They could follow their own instincts as to whether to exercise or not.

The initial results of the nine-week program offered encouragement for the temptation-bundling concept. After seven weeks, the first group had exercised significantly more than the other two. But a holiday break preceded the final two weeks, and after that the first group sank back in the exercise pack with the others. Gym attendance sagged for all three groups. Call it everything new is old again.

Starting over

That didn’t mean the study was a flop, though. It led Milkman to consider the so-called fresh start effect familiar to anyone who has made a New Year’s resolution. I can say from experience that those brave promises often fade, but Milkman expanded the fresh-start concept, wondering if people are more open to change at, say, the beginning of a week or month or in a season like spring that is redolent with the scent of budding trees and blooming flowers and filled with the spirit of rebirth.

Milkman examined Google searches on “diet” – perhaps the most common code word for behavioral change – and found that the numbers were, well, heavily weighted toward the beginning of the week. She tested “placebo” terms, like “weather,” and didn’t find the same patterns.

It’s an interesting concept in terms of health care marketing, as Milkman pointed out. Think of how important screenings for breast, colon and prostate cancer are for our hospitals and how heavily we invest in reminding people of their importance. Would it make a difference if patients receive the notices on a Monday rather than a Friday or on a day in early May rather than a mid-month Wednesday in February?

Looking out for number one

It all brought me back to the question of choice, not only in the decisions we make each day but in who we decide to be. Our employer can and will nudge us in the direction of health and well-being and will urge us to achieve the elusive work-life balance. As in all things, though, it will be our decision to seek a fresh start or trod old and often barren ground.

As for me, I will consult my muse, Monday Morning Man. Far from dreading the start of the week, Monday Morning Man gets up early, savors a cup of coffee, takes an appreciative look at the sunrise and prepares for a day graced by The Working Man’s Blessing: It will not be boring. Monday Morning Man looks ahead, knowing the day will always hold something new. Monday Morning Man knows there are paths he can take that circle back to where he started or where he has been, but that he will choose to follow the one that leads toward the horizon – destination unknown, but not to be feared.

Monday Morning Man will pivot toward becoming healthier, wiser, and wealthier, at least in spirit. He will do so not because he was told but because he is in touch with the one voice that finally matters: his own.


About the author

Tyler Smith has been a health care writer, with a focus on hospitals, since 1996. He served as a writer and editor for the Marketing and Communications team at University of Colorado Hospital and UCHealth from 2007 to 2017. More recently, he has reported for and contributed stories to the University of Colorado School of Medicine, the Colorado School of Public Health and the Colorado Bioscience Association.