Eric Zimmerman

Eric Zimmerman

By Eric Zimmerman, Chief Marketing Officer, RedBrick Health

A recent survey of employers with more than 500 employees confirmed what many of us expected to see—a continuing rise in outcomes-based incentives programs.1 Our own survey research shows a strikingly similar trend among employers with more than a thousand employees: Many are moving to outcomes-based designs.2

It seems like a logical assumption is being made here—outcomes-based models that tie rewards to key behavioral and biometric results are likely to produce better biometric outcomes.

But is there evidence to back up that assumption?

We recently reviewed the year-over-year program results of over 80 reward designs that reached nearly 500,000 individuals. We divided the sample into four reward design types:

  • Participation-based models that rewarded members with dollars or points for completing a health assessment, screening or other behavior, with no tie to a healthy result.
  • Partial outcomes-based models that rewarded points or credits for biometric measures within a healthy range (subject to the availability of reasonable alternative standards), and also for participation in healthy activities.
  • Outcomes-based models that penalized those whose biometrics were not within a healthy range and required them to “earn money back” through risk-matched reasonable alternative standard activities.
  • Programs where there was no incentive or punitive outcome.


Here’s what we found. Engagement levels were positively associated with improved biometric outcomes. So were reward levels. (In fact the two are highly correlated, so it’s likely the effect of rewards is really the lift they create in engagement.) However, we could find no statistical evidence that participants in outcomes-based models achieved better outcomes than those in other models.2 That’s not to say it isn’t there—we just didn’t see it in this large sample.

So the answer according to this analysis is no, outcomes-based designs do not produce better outcomes than participation-based designs. That may be a relief to those who’ve felt pressure to join the trend toward outcomes-based reward designs, but were concerned about backlash.

The takeaway: If you’re going to focus on one thing, focus on what gets you real engagement in your population, whatever that might be. It’s engagement that gets you results.



1Gene Baker, G., Dermer, M., & Wolfsen, Brad. (2015, April 29). 2015 bswift Benefits Study Preview: Wellness and Incentives [Webinar]. Retrieved from
2RedBrick Health, Analysis of results by reward design, 2013 to 2014.