Key to achieving wellness goals may require combination of carrots and sticks

by Bruce Shutan

It’s easy for employees to fall short when it comes to achieving fitness, weight loss or smoking cessation goals if they become complacent about maintaining behavior change. This complacency can stem from their employer falling into the same trap by not adequately promoting their wellness program with fresh communications, relying solely on an incentive to create an impact.

Incentives can be effective in improving participation and behavior change, but are not sufficient to improve long-term outcomes on their own. To have the greatest impact, a well-designed health and wellness program should have an effective communications strategy and an emphasis on creating a culture of health in the workplace.

An effective communications campaign can shape an employee’s view of the incentive program and has the potential to impact the size of incentive necessary to generate the desired outcomes. A recent article on incentives by Healthways’ Center for Health Research cited evidence that employers that advertised their wellness programs more frequently and through multiple mediums could use much lower incentives to achieve the same results compared with employers that were less committed to promotion.

Employers also can improve outcomes by creating a culture of health in the workplace through stocking the corporate cafeteria or vending machines with healthier selections, sponsoring employee walking clubs and yoga classes, providing gym membership discounts or declaring a smoke-free workplace.
“If the culture is in place, then people feel more inclined to develop healthy behaviors,” explains Elizabeth Rula, Ph.D., manager of clinical research at Healthways Inc. “A lot of the research shows that employer commitment to the program is really a huge driver of success.”

Reward and punishment
One of the first things an organization must do is to carefully consider whether to adopt a “carrot or stick” approach to incentives, based on their objectives, comfort level and tolerance for controversial measures when determining the most effective means of achieving results.

Incentives are used to reward individuals for taking certain actions or for achieving desired results such as enrolling in a program, changing health behaviors or making measurable improvements to their health. Alternatively, disincentives penalize those who do not take an action or have a successful outcome.

A combination disincentive/incentive approach is often employed by increasing the cost of health insurance coverage for all employees, then providing a discount for program involvement. This strategy, if communicated properly, may avoid the stigma of a disincentive yet minimize the costs associated with incentivizing a program.
The key to success is how resources are deployed. Rula noted the success of the incentive program used in the SilverSneakers Fitness Program for seniors, even though the program is limited to using incentives that align with Centers of Medicare and Medicaid Services guidelines and generally involve small gifts, such as t-shirts.

Despite the fact that small tangible gifts are not typically effective at driving healthy behaviors, these gifts were promoted with great fanfare and rewards were given for discreet, time-limited actions such as visiting a fitness center a certain amount of times. Gifts also were emblazoned with the SilverSneakers logo, which helped create a powerful brand and fostered a sense of community among participants who greatly valued the program. Also, the demographic group targeted may have an impact.

Realistic goals
One challenge is to ensure that each incentive or disincentive reflects the perceived difficulty of the required action. Rula says some companies use focus groups to pin down these details and also need to be mindful that goals must be achievable. This may require the establishment of incremental rewards for ongoing participation or progress toward a goal.

In discussing how organizations monetize incentives, Rula cited a study by Great-West Healthcare that examined the minimum dollar amount that would encourage the adoption of healthy behaviors. The decision on where to spend those dollars ultimately hinges on the behaviors that are driving up health care costs within any given employee population.

“It’s not very difficult for someone to take an HRA or floss their teeth everyday, but to implement an exercise program, lose weight, eat healthier or stop smoking are big changes in one’s lifestyle that require larger dollar amounts,” she notes.
Healthways has found that in a health coaching program, people are more likely to take calls at off-peak times when it’s not so convenient if there’s a greater incentive involved.

“Incentives help to overcome perceived barriers to participation. The success of almost any program can be further enhanced through the appropriate use of incentives,” Rula says.

About the author
Bruce Shutan, former managing editor of Employee Benefit News, is a freelance writer based in Los Angeles.