Large-scale, first-of-a-kind study finds that—contrary to conventional wisdom—incentive plans that reward biometric outcomes don’t produce better results than those that reward healthy activities
Minneapolis (February 21, 2017) – RedBrick Health, a leading provider of health and well-being solutions that deliver a better employee experience and a stronger Culture of Health, has published the results of a landmark study that finds outcome-based incentive designs that require participants to meet a standard for health measurements—like blood pressure, BMI and blood cholesterol—produce no better results than those programs that simply reward engagement in healthy activities.
The study addresses an important policy and program design consideration for the over 90% of employers with 100 or more employees that offer employee wellness programs as part of their benefits strategy. In recent years, despite a lack of research-backed evidence, a growing percentage of employers began requiring employees to meet a biometric standard (or to meet a Reasonable Alternative Standard, per EEOC regulations) to achieve their full wellness incentive. However, others held back due to concerns about employee perception, as well as potential legal concerns surrounding the use of such outcome-based incentive criteria.
Appearing online in The Journal of Occupational and Environmental Medicine, the RedBrick study, entitled “Outcome-based and Participation-based Wellness Incentives: Impacts on Program Participation and Achievement of Health Improvement Targets,” examined the impact of common incentive designs, incorporating data on 121,908 individuals across 48 employer organizations. It specifically traced the relationship between incentive design and the impact on individuals’ likelihood to participate in employer-based wellness programs, and the likelihood of those with elevated biometric risks to achieve clinically meaningful improvements in year-over-year measures.
“With the benefit of a large dataset including many different program designs, and a longitudinal view of objectively measured health indicators like blood pressure and BMI, we were able to address some important questions for policy makers and program designers,” said Nathan Barleen, lead investigator of the study and Director of Research at RedBrick Health.
The RedBrick study included 36,911 individuals with elevated Body Mass Index (BMI), 26,729 with elevated non-HDL cholesterol and 15,962 with elevated blood pressure. Wellness program participation rates were generally strong among these high-risk groups, with 53.4%, 54.5% and 51.8% participating in each group, respectively. Clinically meaningful improvement was seen in each group as well, with 18.4% of those with elevated BMI losing 5% or more of their body weight, 38.2% of those with elevated cholesterol reducing it by 10% or more, and 62.9% of those with high blood pressure reducing it to under 140/90 upon follow-up measurement one year later.
The RedBrick Health research team found that, despite conventional wisdom that paying for outcomes increases the likelihood of achieving those outcomes, there was no statistical advantage of this incentive design when looking at year-over-year measures. Those individuals with outcome-based incentive designs were no more likely to participate or to improve their measures than those with incentive designs that simply rewarded healthy activity.
“Outcome-based wellness incentives are conceptually similar to other performance-based incentives, in that both are designed to align incentives with a desired result,” noted Jeff Dobro, MD, co-author of the study and chief medical officer at RedBrick Health. “However, these research findings suggest that the thinking behind ‘pay for performance’ models may not apply when it comes to helping individuals achieve biometric health improvement. Focusing on direct actions within the individual’s control—such as engaging in healthy activities—appears to work equally well, without the baggage and complexity of outcome-based incentive designs.”
“Incentive design traditionally represents a fundamental building block of employer well-being programs,” noted Eric Zimmerman, co-author of the study and chief marketing officer at RedBrick Health. “Yet as an industry, we’ve operated in the data-free zone much of the time. RedBrick’s predictive models confirm that there is no magic bullet to achieving meaningful engagement and health improvement, but there is a success formula. That formula includes the creation of relevant choices that appeal to intrinsic motivations, unlocking the power of culture and social effects, and applying smart, segmented communication strategies. Incentives can clearly play a role in focusing attention, but require clear thinking to avoid unintended consequences. This research suggests that when it comes to wellness incentives, simpler is better.”
Read the complete research study, “Outcome-based and Participation-based Wellness Incentives: Impacts on Program Participation and Achievement of Health Improvement Targets,” at the Journal of Occupational and Environmental Medicine’swebsite here.
About RedBrick Health
RedBrick Health helps organizations improve population health and well-being. Because every consumer has unique needs, we combine our exclusive Behavior Change Framework™ with adaptive technology and live concierge services to drive greater engagement and more lasting results than industry norms. Over 100 leading employers, partners, health plans and healthcare
delivery organizations rely on RedBrick Health to measurably improve the health of their populations—while measurably improving their bottom line.