offered increased health care costs or increased exercise, employees choose action

May 16, 2013

in behavior change,communication,design,incentives,wellness

a study conducted by the university of michigan health system and stanford university found that employees offered the choice to pay more or exercise more chose to get a move on.

according to the university of michigan health system’s website:

“Blue Care Network created a buzz when it implemented one of the largest-scaled financial incentive programs in the country by requiring adults who were obese and in the Healthy Blue Living program to enroll in a fitness program to qualify for lower out-of-pocket health care costs. Enrollees could choose between several programs, including Weight Watchers and WalkingSpree, which uses a digital pedometer to upload walking data on a wellness tracking web site.

“For some families, the out-of-pocket cost of failing to meet the new criteria in one of the wellness programs was nearly $2,000 more per year. Those with medical conditions were exempt if they had waivers from their doctors.”

5,000 steps per day required

the program was actually a little broader than described here. to save the $2,000 in reduced copayments and deductibles, BCN required participants to meet certain health metrics or enroll in a program that helped them move closer to doing so. participants with a BMI equal to or greater than 30 were invited to enroll in a weight management program or walkingspree’s internet-empowered walking program. they could also opt out or obtain a medical waiver. the study looked only at the experience of those who enrolled in the walkingspree program, roughly 50% of the final eligible population.

these participants were issued a pedometer and given access to walkingspree’s website, which includes community forums and other support. to meet the requirements, they needed to maintain an average of 5,000 steps per day in each three-month period. the pedometer, like other trackers, auto-uploaded user data so the data was not self-reported.

some people will take the lumps, some the sugar

when employers roll out these programs, employees have a choice. they can take the lump (the increased costs) or they can take the sugar (the financial incentive). with BCN, 17% opted out of the program and another 5% had a medical waiver and were legally excused from the penalty. a survey administered to those who completed the program found good results and mixed feelings:

  • 97% of enrolled participants met the daily steps requirement
  • 51% appreciated the program’s financial and health benefits
  • 17% initially joined to save money but were ultimately satisfied with the program benefits
  • 31% did not like the program and many noted feeling coerced to join

these are extremely positive figures. and if sustained over time, that’s real change. for those who have worried about the negative consequences of these results-based wellness programs, the authors recognize, “the program’s effect came at a cost of ill-will from some individuals who felt coerced to participate. while most of these members later appreciated the benefits of the program, nearly a third of them did not like the program, even in retrospect.” the authors seem to suggest that the disliking of the program came from the feelings of coercion, but it might also be that the feelings of coercion came from the disliking of the program. seventeen percent also joined to save money despite not really wanting to participate, but they were ultimately pleased with the program, too.

based on the available information, it doesn’t appear the study authors asked any questions before or after the program to see if there were any changes in feelings of loyalty or engagement. that’s too bad. more employers are rolling out these results-based programs that tie results to an incentive. this report gives them food for thought about planning for the possible ill-will. information on its possible impact on engagement and job satisfaction would also be valuable.

it’s important to note as well that one of the study authors is a scientific adviser to walkingspree and a an unpaid consultant to blue care network.


p.s. the study contains insights on program design and communication worth the $39.95 download fee.

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