The Well-Being Journal

Do Incentives Really Work?

Jennifer Rudloff

Over the years we’ve learned that there are a number of virtues and pitfalls to using incentives to encourage people to live healthy lifestyles. By definition, an incentive is an extrinsic reward that is provided to a person until such time that the value to the recipient is internalized. When it comes to health, many employers use incentives in the hopes that their employees will internalize the need to be healthy and achieve lasting behavior change, which ultimately creates a healthier, and more productive work force with lower healthcare costs. While our experience tells us that incentives do indeed drive participation in health promotion activities, many organizations are struggling to translate that participation into lasting behavior change – and THAT can get expensive fast.

Take this scenario for example: Let’s say Company X offers an incentive to their people for taking a health risk assessment (HRA), and an additional incentive for those who participate in coaching programs to work on health risks identified through the HRA. Of their 10,000 employees 8,000 participate (up from only 3,000 last year). 7,000 of the 8,0000 HRA takers enroll in coaching, up from 1,000 last year. So far so good…but what if only half of the participants really take advantage of the opportunity and work to change their health behaviors? Company X has then invested in incentives for a lot of people who have no real intention to change their behaviors. In this scenario Company X’s participation could skyrocket but the achievement of outcomes could be totally unproductive, throwing the balance between the cost of incentives and health cost savings out of whack. Bummer. Tricky, huh?

When you step back and look at it, it’s easy to see why incentives have become a source of lively debate amongst wellness professionals. Some professionals believe that the practice of taking healthcare premiums from people who take care of themselves to subsidize those who don’t has gone far enough. They would advocate “stick” type incentives to penalize people who do not take care of themselves to offset this balance. To the other extreme, some professionals believe that laws and regulations should be put in place to ban or restrict the use of incentives all together. Others are not opposed to incentives but are concerned that the wide spread use of them is causing employees to feel a sense of entitlement for doing what is already in their best interest. There is merit in all of these positions, and all of them deserve to be heard. While I doubt the industry needs any additional laws or regulations, I do believe that more education is in order.

Employers need to be more aware of the pro’s and con’s of incentive programs so they can make smart decisions about what will work best for their people and their organization – it’s not a one-size-fit’s-all kind of thing. A consultative partner can help carefully craft an incentive plan to fit the needs of an individual organization. You must take into consideration company culture, needs, stage of well-being program development, the communications strategy, and the style of doing business. For instance, studies have shown that the better the culture and communication effort, the smaller the incentive required to drive participation.

If you want to learn more or join the debate on incentives, the Health Enhancement Research Organization (HERO) has an ad hoc incentives group that has been meeting to explore the best ways to leverage the value of incentives. This group is reaching out across the industry to get opinions from experts nationwide. I expect this group will provide leadership in the industry around incentives, so this might be a great time to join the HERO Think Tank if you have a vested interest in being part of the industry-wide incentive discussion. Please feel free to reach out if you would like more information on this effort, or if you have an opinion and want your voice to be heard.

I could say a lot more about incentives, but for now let’s leave it at that. What do you think about incentives? What incentives have been most successful for your organization? Have you been creative with the incentives you offer? Please share!

Topics: Well-Being HERO Workplace Well-Being Engagement Health Wellness Wellness Program Incentive Programs

Reflections from The HERO

Jennifer Rudloff

A couple of weeks ago the Health Enhancement Research Organization, also known as HERO held its bi-annual Think Tank meeting and Forum (the HERO version of a conference) in Phoenix Arizona. After having some time to reflect on both of those meetings, I would like to share some of my reactions with you. Let me start with the Think Tank.

The Think Tank brings employee health management (EHM) experts together bi-annually to exchange ideas, expertise, and recommendations in an effort to solve problems and react to opportunities. Members of the think tank have a major role in the creation and dissemination of national EHM policy, strategy, leadership and infrastructure. During the most recent session we addressed three subjects: (1) the role of consumer directed initiatives and personal responsibility in health care, (2) the impact of an aging workforce and actions that must be taken both domestically and internationally, and (3) the role of financial incentives in the health management industry. As you might imagine, the use of incentives drew significant debate so let me expound upon that discussion.

Overall the field is fairly supportive of the use of financial incentives to drive participation in health management programs. However, we also agree that while financial incentives can drive participation, little evidence exists to show that financial incentives alone change behavior. The lightning rod seems to be the use of incentives to reward “health outcomes” as it is defined in The Patient Protection and Affordable Care Act. Such incentives reward people for keeping biometrics such as cholesterol, blood pressure, and body fat within reasonable limits. The opinions on this issue varied widely at the HERO Think Tank.

From my experience I know that all employers are different. As the result, I believe America’s employers need the latitude to put in place the incentive programs that work best for them, based on their cultures and their business environments. We do not need further regulation regarding incentives. Instead, the pros and cons of various incentive programs should be evaluated so that employers can make discriminating choices that support the needs of their people and culture. Others may disagree with my perspective. For instance, American Heart Association has distributed position statements taking the view that outcomes-based incentives tied to health plan or self-insured company premium costs are unfair and discriminatory, instead advocating for ‘‘participation-based’’ incentives. Their fear appears to be that such incentives could lead to the mistreatment (including greater cost burden) of people with existing disease. While an understanding view points, current law already provides many safeguards and people who take good care of themselves already pay a disproportionate amount of the health care cost burden.

Regardless of our individual views, the one thing that the think tank fully agrees on is that as an industry, we must speak with a united voice. Articles by Michael O’Donnell, and by Paul Terry and David Anderson have done a nice job of advocating for the “one voice” approach.

The HERO Forum was also an enlightening experience. Highlights were the following:

  • Many companies are going back to the basics. Part of the format at the HERO Forum is to have “How To Do It” workshops where best-practice health management programs are highlighted. This year many of the professionals guiding these programs described how they were getting back to the basics of superior program planning, setting clear objectives, communicating their programs effectively, generating engagement through creative approaches, and measuring outcomes effectively.
  • People were networking and discussing some of the most timely topics in health management. Many good ideas were discussed in areas like the broader view of well-being, program integration, and the impact of work culture on health management success.
  • The research showing the efficacy of health management is continuing to advance and HERO is leading the way.
  • There are many breakthroughs in the area of participant engagement that involve superior communications, incentives, program positioning, and the ability to use new media and technology in the effort.
  • The use of small actions and social media in effectively advancing behavior change was addressed by Chris Cartter, General Manager of MeYou Health, in the closing keynote. Chris provided deep insights into this topic.

Both the HERO Think Tank and the Forum were well attended and the sessions and debate were provocative. If you are not a member of HERO, I urge you to consider getting involved. If you were there, what were your impressions and biggest takeaways?What are your thoughts on the incentive debate? Please share.

Topics: HERO Think Tank Workplace Well-Being Healthcare Engagement Business Performance Health Financial Incentives for Health Management Program Events Health Enhancement Research Organization

Cooking & Company: Creating Heroes at Home

Jennifer Rudloff

When you think about corporate wellness programs, it's unlikely that the first thing that comes to mind is cooking. However, there are others who advocate that cooking should be a cornerstone to your workplace wellness programs. Jamie Oliver and the Food Revolution team partnered with IDEO and came up with Cooking & Company -- a revolution for the workplace which aims to keep cooking alive and change the way people eat where they spend the most time - at work. In this short video series, Chris Waugh, Practice Lead at IDEO, talks with us about the hows and whys of cooking at work. You'll learn more about how cooking can improve engagement in workplace wellness programs, build stronger sense of community, foster creativity, and help employers make employees heroes at home.

To see Chris's full presentation, Designing Workplace Wellness, from the Healthways Well-Being Summit click here.

Interested in learning more and joining the food revolution? Click here to download the toolkit.

Topics: Well-Being HERO Cooking & Company Workplace Well-Being Jamie Oliver Engagement IDEO Community Cook at Work Food Revolution

Lincoln Industries: A Case for Well-Being

Jennifer Rudloff

Recently, CFO magazine published a story on Lincoln Industries inspired by the findings of a new study done by Lincoln Industries in conjunction with Healthways and the Health Enhancement Research Organization (HERO). This study, featured in the Journal of Occupational and Environmental Medicine, is among the first peer- reviewed research evaluating the effectiveness of worksite health and wellness programs offered by a small employer. Findings support the premise that high-quality employee wellness programs in small businesses improve employee health and well-being, which drives organizational outcomes such as absenteeism, healthcare costs and disability claims.

The study shows a phenomenal corporate culture of health at Lincoln Industries, adopted by the company years ago. Lincoln adopted a culture of health years ago. Its leadership realized that to take its wellness program to the next level, there needed to be a stronger emphasis on well-being, focusing on the whole person, not just physical health. To gain a better understanding of the needs of their population and identify areas of opportunity, they began using the Healthways Well-Being Assessment™ (WBA). The WBA assesses physical health, emotional health, healthy behavior, work environment, life evaluation, and basic access to food, shelter, healthcare and other necessities, and provides management with a comprehensive, holistic view of the health and well-being of their employees.

The study marks an important step toward broadening the workplace well-being impact beyond just large businesses. Small businesses, which stand to benefit from financial incentives provided by healthcare reform legislation, are in need of guidance regarding their investment in programs that deliver results.

Lincoln is a great example of how to do it right. They make well-being a part of individual objectives, and as a the result, they’ve seen a 5 to 1 ROI in wellness programs. They achieved an 87 percent response rate on the Well-Being Assessment (without incentives). Additionally, approximately 99 percent of employees complete regular health screenings with the majority of the workforce participating in wellness programs throughout the year. They’ve successfully reduced tobacco use, significantly reduced workers compensation costs, and have consistently managed to beat the national average on health insurance rates by $3000 per employee.

So how do they do it? Watch the interviews below where their Director of Wellness, Safety and Life Enhancement, Tonya Vyhildal talks with us in about the well-being improvement programs at Lincoln Industries. For a more detailed dive into their successes, watch her complete presentation from the Healthways Well-Being Summit here.

As a leader in well-being, how do you promote well-being internally?

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How do you tie well-being into individual objectives?

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What impact have well-being programs had on your organization?

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Why do you include well-being as a performance measure?

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Talk about the HERO paper published in the Journal of Occupational & Environmental Medicine,

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What's the one thing you'd tell an employer looking to move to well-being?

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Topics: Return on Investment Well-Being HERO Tonya Vyhildal Nebraska Workplace Well-Being Business Performance Competitive Advantage Prevention wellbeing and health Wellness Lincoln Industries Healthways Wellness Program Well-being Assessment