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Workplace wellness programs should focus on improvement, not participation

Paying employees to participate in a health assessment program may not be enough for employers who want to bring down their health insurance costs, says a new white paper from StayWell Health Management.

In the white paper, “The role of incentives in improving engagement and outcomes in population health management: An evidence-based perspective,” St. Paul, Minn.-based StayWell says employees often participate in the “pay-to-play” model for the money and not out of a commitment to their health.

“Paying people to complete a health assessment does result in higher participation rates but does not necessarily get them truly engaged in the process of improving their health,” said David Anderson, PhD, StayWell’s senior vice president and chief health officer and co-author of the white paper.

“Research shows that incentives do have a role in workplace health management programs, but that sweet spot may not be where many incentives programs currently reside,” said Anderson.

StayWell advocates a progress-based model that rewards participation and outcomes and includes opportunities to earn incentives for making reasonable improvements.

“Based on available research and our direct experience working with employers and individual participants, we believe there is a middle ground where incentives can be implemented in a way that is safe and fair for all employees without compromising the effectiveness and relevance for either employers or individual employees,” he said.

Rather than just rewarding specific outcomes, a progress-based approach offers all employees an opportunity to earn incentives regardless of where they are on the health continuum. For instance, an employee who is at risk for obesity could earn an incentive for actively participating in programs that address nutrition and physical activity rather than being incented for achieving a specific body mass index.

StayWell believes employers can also encourage participation by providing financial incentives that are built into their health plan's cost and benefit structure. For example, there could be a surcharge on health insurance premiums for employees with unheathy lifestyles or non-smoking employees could be eligible for a higher life insurance payout.

Although Anderson says it’s too early to know the true return on investment of a progress-based model, his gut feeling is an incentive in the form of direct payment for participation, not improvement, is doomed to failure.

“Integration into the health plan powerfully tells employees that their behavior has an impact on healthcare costs. If you can create that shift in people’s mindset and have them see it as shared accountability, it makes a difference. That is the move you need to make,” said Anderson.

He also says that employers who take this approach can roll out a wellness plan in a cost neutral way, rather that taking on all the expense of a pay-for-participation model.

“You need a supportive culture, strong messaging and a sense of shared responsibility to get improvement in health. It translates to the bottom line because healthcare costs are directly related to lifestyle risks,” he said.