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Wellness incentives won't work if they target people in the wrong way
We are on the cusp of a new era in health care communication, believes Kevin Volpp, M.D., a pioneer in researching how people respond to efforts to engage them in achieving better health.
"We're at Engagement 2.0," Volpp said. "We now know a lot more about what motivates people and how that helps to get them engaged and stay engaged."
If Engagement 1.0 was the standard way companies would interact with employees by "maybe adjusting their benefits or premiums a bit as a way to engage them," there is now "a world of new possibilities that are extremely exciting, with a lot of yet-unrealized opportunity," noted Volpp, the director of the
Center for Health Incentives & Behavioral Economics at the University of Pennsylvania. One of his projects was an
intervention study on smoking cessation at General Electric (GE). The program structured incentives as follows:
Only those who quit smoking in the first six months were eligible for the $400 incentive.
At the same time, GE introduced a smoking-cessation program that consisted of education about the harmful effects of smoking and links to community programs. All employees, whether study participants or not, had a benefits package that covered tobacco-cessation pharmaceuticals.
The result of the study: Incentivized participants gave up smoking at three times the rate of their nonincentivized peers.
Incentivized participants gave up smoking at three times the rate of their nonincentivized peers.
Unlike many other incentive programs, GE paid out the incentive in increments over a full year, "requiring participants to modify their behavior over a relatively long period of time, so that restraining from smoking became routine," Volpp explained. Studies with quick payouts for short-term accomplishments have tended to show high rates of recidivism following the payout.
The GE program also reduced procrastination by only making employees eligible for the largest incentive—$400—if they quit smoking in the first six months following enrollment in the study.
Like Volpp's study on the GE program, new research into incentive designs is now "going live" in corporate wellness programs that stress personalized engagement and incentivizing employees to take greater responsibility for their health outcomes.
"We've learned a lot over the years about using incentives more judiciously to benefit both participants and employers," said David Anderson, co-founder and adviser at StayWell, a Yardley, Penn.-based wellness program provider.
According to the firm's recent report,
The Changing Tide of Health Care and Wellness Incentives, an alternative to incentives for participation or for goal-achievement is a progress-based incentive model that lets employees earn rewards in increments as they approach their health goals. "This provides an achievable alternative for individuals across the health continuum," Anderson said. As opposed to an outcomes-based model, progress-based incentives "may be viewed more positively by individuals for whom the ideal goal does not seem achievable."
Behavioral Economics a Linchpin
Matt Loper, co-founder and CEO of
Wellth, a new mobile platform that encourages people to take prescription drugs on time (i.e., medication adherence), explained the growing emphasis on behavioral economics when designing incentive programs.
"One of the basic assumptions of traditional economics is that people act rationally in their own interests," Loper said, "but 50 percent of people with chronic disease are nonadherent in their medication regimens."
"Present bias" contributes to behavior that does not jibe with beneficial self-interest, Loper explained.
"Our human psychology is only meant to be motivated by immediate-term gratification," he said. "In terms of medication adherence, people know they are supposed to take these meds, but they don't feel any different right now by
not taking it. Likewise, they know they shouldn't eat that candy bar sitting on the table, but eating it makes them feel good right now."
To encourage people to take their medications, companies use reminders or present employees with data about the long-term effects on their health, "but they don't solve the core issue of present bias," Loper said.
Wellth, currently in late-stage trial mode, gives patients a $150 credit (usually funded by an insurer) and a smartphone-based platform. It works this way:
Every time patients take their medication, they keep a small portion of the deposited money. "If you don't take the picture, you lose $2" out of the credited funds, Loper said. "We do that every day for 90 days so it forms a habit that sticks."
[SHRM members-only toolkit:
Designing and Managing Wellness Programs]
Beyond Health Warnings
Wellness promotion needs to go beyond sending diagnostic cautions to employees, agreed Joel Spoonheim, director of health promotion for HealthPartners, which runs a network of Minneapolis-based health clinics.
"We shouldn't be saying, 'Hey, you are on track for this condition'; we should be saying, 'What motivates you to be healthy and how can we support you?' " he said.
Technology can help support that dialogue, and HealthPartners' clinics have
partnered with Denver-based tech firm Welltok to create and deliver more-personalized patient engagement.
An example is the approach toward smoking cessation. "If a person who smokes is only told 'quit smoking' and they are not ready, you have alienated them," said Spoonheim. "But if you know they are not ready to quit smoking but have a high willingness to talk about stress, and put that up first, it's now a meaningful personalized relationship."
Added Ari Levy, M.D., founder of
SHIFT Sciences, a Chicago startup that offers integrated primary care and fitness-promotion services, "What the most successful technology platforms have done is less about any carrot or stick. It is more about making it easy for humans to just connect. Each one of our members signs a release agreeing to communicate by e-mail, text and phone [which are not secure communications under the Health Information Portability and Accountability Act] because they want to be connected" with the firm's health providers and coaches.
Health, Not Health Care, Is the Goal
In assessing new collaborative apps that foster interactive approaches, benefit managers should keep these tips in mind:
"Everybody has a story, and you have to spend time building a relationship to understand it," he said.
Greg Goth is a freelance health and technology writer based in Oakville, Conn.
Related SHRM Articles:
Best Practices for Using Wearable Devices in Wellness Programs, SHRM Online Benefits, May 2017
EEOC Settlement of Wellness Suit Leaves Unresolved Issues, SHRM Online Benefits, April 2017
Employee Loses Wellness Plan Challenge,
SHRM Online Employment Law, February 2017
IRS Reminds Employers: Wellness Incentives Are Taxable,
SHRM Online Benefits, July 2016
Incentives for Workplace Wellness Programs, RAND Research Brief, 2015
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