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Executive Summary
Between January and June this year, 127 Cognizant employees could
have walked halfway to the moon. Their cumulative footsteps covered
half of the 238,000-mile distance and theyre still walking.
This group has taken nearly 200 million steps as part of iCommit2Fit,
an innovative wellness improvement program that we designed and
piloted for our associates in five U.S. locations. The voluntary program
combines personal commitment, technology, incentives and coaching.
At the close of the six-month pilot, virtually all of our participants have
substantially increased and sustained their physical activity levels while
losing weight and seeing significant improvements in their Body Mass
Index (BMI) ratios.
What sets iCommit2Fit apart is the personalized, one-to-one coaching
deployed to help associates outfitted with Fitbit wearable smart
bands to monitor their physical activity, with the goal of improving
their wellness. While wearable smart bands like Fitbit are all the rage,
they are no wellness elixir.1 The reason? While great at automating data
collection without any human intervention, the current generation of
devices cant instruct users on ways to increase their physical activity
today or tomorrow, much less next week or month. The bottom line: to
iCommit2Fit in Action
When designing iCommit2Fit, we hypothesized that proactive, personalized and
technologically savvy support was necessary to help individuals embrace and
sustain behaviors that improve health and prevent or alleviate chronic health
conditions. The healthcare industry is already measuring patient activation rates
as a way of predicting which individuals will consume more healthcare services and/
or succeed in managing their existing health conditions.3
We solicited voluntary applications for iCommit2Fit from five Cognizant facilities
across the U.S., located in the South, Southwest, Midwest and Southeast. Applicants
were reviewed for any pre-existing health conditions that could preclude their participation; those selected were equipped with a Fitbit activity tracker.
From an iCommit2Fit participants perspective, the requirements were simple: wear
the activity tracker to capture daily steps walked; log food intake in a daily digital
diary; upload data on a weekly basis; and participate in weekly coaching sessions
via telephone (see Figure 1). On the back-end, we used the data capture and personalized coaching capabilities of our HealthActivate patient engagement platform to
administer the program (see sidebar, page 7).
Periodic
webinars
Weekly nutrition
e-mails
Portal/
Personal Coach
Weekly step
count upload
via activity monitor
Weekly virtual
meeting with coach
Figure 1
All participants reported their pre-program daily step baseline. Based on
that measure, each participants coach set a daily step goal for the first
month of the program. If a participant easily met or exceeded that goal, the coach
would increase it.
Devices were synchronized with participants smartphones or laptop dongles, then
uploaded directly from Fitbit to the Cognizant HealthActivate portal. Laptops
equipped with the Fitbit software were available at several office locations for use
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October 2014
Comparison
iCommit2Fit
Average
70K
60K
50K
Fitbit Average
40K
U.S. Average
Cognizant Baseline
30K
JAN.
FEB.
MARCH
APRIL
MAY
JUNE
Figure 2
80K
70K
OVERWEIGHT
OBESE 1
76
72
OBESE 2
72
70
60K
50K
40K
44
36
30K
34
31
20K
10K
0
Figure 3
OVERWEIGHT
OBESE 1
= BASE STEPS
250
OBESE 2
(lbs.)
200
150
100
50
0
= STARTING WEIGHT
Figure 4
In other words, participants with 95% compliance rates missed only two of 23
meetings, yet lost only half the weight and took slightly more than half the steps
of those who made it to all their coaching sessions. Similarly, the group with the
lowest compliance rates missed about three meetings, lost only about a quarter of
the weight and took only about 30% of the steps of those in the 100% group (see
Figure 9, page 10).
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October 2014
Improvement by BMI
Weight Category
50
NORMAL
OVERWEIGHT
OBESE 1
40
41
Healthy Optimism
Our initial pilot program was not long enough in duration or large enough
in participant numbers to draw conclusions about the impact of increased
activity and weight loss on employee productivity or health claim costs.
However, we are optimistic about achieving positive results. For instance,
greater activity and improved BMI should contribute to reduced healthcare
costs. It is estimated that obesity-related productivity losses cost employers
$225.9 billion per year, with an obese employee costing employers an
additional $460 to $2,500 in medical care and sick days over the average
annual individual healthcare cost of $3,000 per person.5
32.4
30
28.2 27.2
20
OBESE 2
38.3
30.5
23.5 22.8
10
0
= BASE BMI
Figure 5
Quick Take
Cognizants Connected Health Solution
The HealthActivate platform combines bring your own health device (BYOhD) data
collection capabilities with analytics and virtual and live coaching to offer a nextgeneration care management platform. The platform accepts data from virtually
any BYOhD that an individual might use, from an activity tracker to an in-home
blood sugar testing device to a wireless scale.
Our analytics engine reviews this data and alerts coaches to any anomalies
requiring intervention. Some interventions are automatic and virtual, such as an
instant message or e-mail; at other times, coaches (who are trained nurses) will
call the individual to find out why a medicine dosage was missed or to determine
whether a sudden weight gain indicates a serious problem. The platform helps individuals on the cusp of chronic conditions to become healthier and enables participants who are managing diabetes, heart conditions, etc. to do so more effectively
and avoid acute care episodes.
JUNE
JAN.
JUNE
19
13
Moved to
Obese 2
Moved to
Overweight
Moved to
Obese 1
Obese 1
23
Remained
Obese 1
43
Obese 2
43
30
Remained
Obese 2
Figure 6
Device details. It is critical to use a reliable activity tracker that also largely
automates the data upload process. We selected the Fitbit, both for these capabilities and its name recognition. It is important to have extra devices on hand:
When a tracker was lost or stopped working for any reason, participant activity
quickly dropped.
As iCommit2Fit grows, we will watch for more advanced devices that can track
a wider range of physical activities and convert them to a meaningful measure.
Potential exercise movement to capture includes swimming, weight-lifting, yoga,
etc. As participants become more fit, they might be more likely to participate in
activities that our activity tracker cannot capture.
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October 2014
Quick Take
The Criticality of BMI-based Weight Categories
The Body Mass Index (BMI) is a mathematical formula that uses an individuals height and
weight to evaluate whether he or she is at a healthy weight. A BMI of 18.5 to 24.9 is
considered healthy, while a reading of 25 to 29.9 is considered overweight. Researchers and clinicians divide obesity into three categories: Class I (3034.9), Class
II (3539.9) and Class III (40). Class III is further divided into super-obesity
(BMI 5059) and super-super obesity (BMI 60+).10
What we found in our pilot program is that as participants lose weight
and begin to transfer from one BMI category to the next, it is crucial
for them to realize that meeting their goal is not enough; they must
sustain it. One way that we work to ensure goal maintenance is through
high-intensity interval training. We believe that when coaches encourage
individuals to increase the intensity of their workouts, it poses a new and
different challenge to the participants and results in a sustainable loss.
Research has found that people on diets typically lose 5% to 10% of their starting weight
in the first six months. However, at least one- to two-thirds of people on diets regain more
weight than they lost within four or five years, and the true number may well be significantly
higher.11 This is why we extended our pilot from three to six months and hope to extend the
program indefinitely in the future.
25
iCommit2Fit
Performance Rankings
20
Average Weight Loss (lbs.)
= TOP 15%
20.2
= MIDDLE 70%
15
= BOTTOM 15%
10
10.8
5.4
MISSED 3
MISSED 2
MISSED NONE
iCommit2Fit
Performance
Rankings
Worksite challenges involved seeing which site teams recorded the highest
compliance rates in terms of step counts, food logging and coaching. Winners
were treated to a lunch during program-related webinars.
Finally, several weeks into the program, we randomly selected participants
to form teams across the five pilot locations. To score points for their teams,
members had to complete their daily food log, meet their weekly step goals and
complete their weekly coach meeting. Missing even one of these activities would
reduce the teams overall score.
= TOP 15%
= MIDDLE 70%
= BOTTOM 15%
120K
125.2K
Certain teams proved especially competitive, so members would drop out rather
than hurt the team by leaving an activity incomplete. We will examine our scoring
procedures and communication to ensure that the formation of teams enhances
the iCommit2Fit support system.
90K
60K
68.1K
30K
38.4K
MISSED 3
MISSED 2
MISSED NONE
Figure 8
Impact of Coach
on Weight Loss
25
87%
Meeting
participation
20
95%
Meeting
participation
Meeting
participation
20.2%
15
10
10.8%
5
5.4%
0
BOTTOM 15%
MIDDLE 70%
Figure 9
10
KEEP CHALLENGING
October 2014
TOP 15%
Quick Take
Empowering Employees for Personal Wellness
Five little lights changed my life, says Jacqui
Bennion, one of the 150 participants in our iCommit2Fit wellness pilot program. After six months
of watching her Fitbit wristband display the
signal that she had reached her daily goal of
12,000 steps, Bennion feels more fit, has gained
better control over her diabetes and has made a
complete change in her lifestyle. The program
is about so much more than weight loss; its about
getting healthy, she said.
Getting healthy similarly was the driver behind
Kathy Martins participation in the program. I
have six grandkids and two more on the way,
Martin said. I want to be there for them but
I have a tendency to give up in an instant. With
iCommit2Fit, I had a support team, goals to make
and motivation.
The accountability the program offered was most
important to me, says Scott Seeliger. Seeing
that information the activity and food log on
a daily basis was a big motivator to reaching
my goals.
an indoor trampoline rebounder and a local airconditioned Walmart to beat the 113 F heat, and
Martin walked around her kitchen island to avoid
subzero wind chills.
Committed to Wellness
All three report much improved health and
energy. Martin is no longer winded by walking
up a short flight of steps in her house; Bennion
has improved blood sugar numbers; and Seeliger
dropped 45 pounds. Each said they expect their
education about healthier food choices to have
a lasting effect on their wellness. Logging the
value of everything you put in your mouth makes
a big difference, Bennion said. I was not going
to log French fries.
Family members of participants also saw side
benefits. Martins husband lost 20 pounds
because of the changes to her cooking style, and
Seeligers familys diet has also changed. I have
8-year-old twins, and it was just so important
for them to be exposed to healthier behavior,
Seeliger said.
Although the pilot ended in June, Bennion, Martin
and Seeliger have all continued their daily steps
and more. I have so much more energy than I
did eight months ago, Bennion said. With her
improved endurance, she is starting to move
into more intense interval training and planking
exercises. Seeliger has started the Couch-to-5K
running program.
We dont just sit on the couch anymore:
we find other things to do, said Martin,
who estimates her familys television-viewing went from as
much as eight hours a day to
just two hours a week. The
other things include yard
chores, fixing old cars and
remodeling a property.
Its been fabulous, she said. I
know Im in a better place because
of iCommit2Fit.
11
Offer high-quality, clinically trained coaches who can tailor advice and recommendations to participants.
Studies show that employees increasingly will pay for larger shares of their health
costs, whether as co-pays in employer-sponsored coverage or when selecting their
own health plans through employer-defined benefits contributions.8 Programs such
as iCommit2Fit potentially can help employees reduce their need for expensive
healthcare services. This development could benefit employers, too.
One way to determine whether to invest in a program like iCommit2Fit is to look at
aggregate, non-personal employee health data and calculate what percentage of
health claims are arising from lifestyle conditions, from diabetes to heart disease.
It is also worth noting that one review of more than a dozen employer wellness
programs indicated average savings of $358 through reduced health costs per
employee per year, while costing the employer $144 per employee per year. For
every dollar an employer spent on its program, it saved $3.37.9
Our expansion of iCommit2Fit this coming fall is not just about good health for our
employees; it is also about ensuring that our business is fit and productive, too. We
are proud of our iCommit2Fit participants and their hard work and look forward to
logging many more steps from them.
Footnotes
12
KEEP CHALLENGING
October 2014
Matt Clinch, Wearable Smart Bands Set for 350% Growth in 2014, CNBC, Feb. 12,
2014, http://www.cnbc.com/id/101410507#.
Obesity Accounts for 21 percent of U.S. Health Care Costs, Study Finds, ScienceDaily, April 9, 2012, http://www.sciencedaily.com/releases/2012/04/120409103247.
htm.
Julia James, Patient Engagement, Health Affairs, Feb. 14, 2013, http://www.
healthaffairs.org/healthpolicybriefs/brief.php?brief_id=86.
Workplace Health Promotion, Centers for Disease Control and Prevention, http://
www.cdc.gov/workplacehealthpromotion/implementation/topics/physical-activity.
html.
Katherine Baicker, David Cutler, Zirui Song, Workplace Wellness Programs Can
Generate Savings, Health Affairs, February 2010, Vol. 29, No. 2, pp 304-311, http://
content.healthaffairs.org/content/29/2/304.full#ref-22.
10
11
Stuart Wolpert, Dieting Does Not Work, UCLA Researchers Report, UCLA, April 3,
2007, http://newsroom.ucla.edu/releases/Dieting-Does-Not-Work-UCLA-Researchers-7832.
Dr. Anthony Nguyen is Cognizants Chief Medical Officer. He led the development of
the coaching protocols and oversaw all clinical aspects of the pilot. Anthony is part
of the Global Clinical Services teams and is responsible for furthering Cognizants
role in helping our clinical partners run better and run different. Anthony graduated
magna cum laude from University of CA, Irvine, and received his M.D. at Tufts School
of Medicine. He is board-certified in internal medicine. Anthonys passion in wellness
stems from his medical education, as well as his dedication to surfing at a high
level. Anthony can be reached at Anthony.Nguyen@cognizant.com | LinkedIn: www.
linkedin.com/in/anguyenmd
Acknowledgments
The authors would like to acknowledge Gajen Kandiah, Executive Vice-President of
Cognizants Business Process Services Business Unit, for his vision and contributions to this white paper.
13
About Cognizant
Cognizant (NASDAQ: CTSH) is a leading provider of information technology, consulting, and business process outsourcing
services, dedicated to helping the worlds leading companies
build stronger businesses. Headquartered in Teaneck, New Jersey (U.S.), Cognizant combines a passion for client satisfaction,
technology innovation, deep industry and business process
expertise, and a global, collaborative workforce that embodies the future of work. With over 75 development and delivery
centers worldwide and approximately 187,400 employees as
of June 30, 2014, Cognizant is a member of the NASDAQ-100,
the S&P 500, the Forbes Global 2000, and the Fortune 500
and is ranked among the top performing and fastest growing
companies in the world. Visit us online at www.cognizant.com
or follow us on Twitter: Cognizant.
World Headquarters
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Phone: +1 201 801 0233
Fax: +1 201 801 0243
Toll Free: +1 888 937 3277
inquiry@cognizant.com
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Paddington Central
London W2 6BD
Phone: +44 (0) 207 297 7600
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infouk@cognizant.com
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