Employers recognize that incentives can be powerful tools to nudge their employees to participate in health promotion programming. However, finding the right incentive can be challenging. The incentive debate whirls in questions: How much? How often? When? For what?
The answers to these questions lie within the local and company culture, the socioeconomic strata and the company's ability to sustain the incentive.
It has been assumed that cash is the best and most universal motivator. While cash may be effective in motivating someone to take the initial step toward risk modification, data now suggest behavior change and risk modification degrades when the incentive is removed. Further, ongoing cash rewards for health are just not financially sustainable.
To be a catalyst for healthy behavior change, employers need to adopt bold, creative participation strategies that foster intrinsic motives in employees for managing their own health, which in turn can reduce costs and boost productivity.
Low participation
Like many employers, Advocate Health Care, a faith-based integrated health care system, relied on traditional recruitment methods such as mailings, flyers, health fairs and specially timed campaigns, like open enrollment, to encourage participation in wellness initiatives.
They also offered a modest incentive during open enrollment for completing the health risk assessment. Although these methods were a good foundation, Advocate Health Care was faced with low participation in the online health programs. They needed an affordable, scalable solution to drive participation and bring greater value.
Technological advancements such as interactive voice recognition, SMS text messaging, targeted and tailored e-mails, social-networking Web sites and other Internet tools have expanded the capacity of traditional recruitment channels, reaching more people where they are in their daily lives. Although some of these solutions can be costly, many are offered at little to no additional charge.
Advocate Health Care found a solution that worked for them without bottoming out their budget. Their own media services team created a video that demonstrated the benefits of the wellness program offerings and how to access the programs.
Additionally, the company implemented a tool that uses data from the health risk assessment to identify participants with an epidemiological need and who are ready to change. The system sends a tailored message based on their stage of change, motivation, self-confidence, perceived barriers and demographics. The message can be delivered using e-mail, direct mail or IVR to recruit individuals into appropriate behavior-change interventions at the right time.
Results
When Advocate Health Care executives examined the participation rates for the new engagement tools, they found a 127% increase in participation using the video over their standard recruitment period. The standard recruitment period involved a complete set of traditional promotional materials, including table tents, posters, instructions for accessing programs, FAQs, intranet communications, newsletters, voice mail and e-mail broadcasts continued from open enrollment, with a specific focus on biometrics for the "Know Your Numbers" campaign.
Interventions
Some health interventions' success are attributed to attracting healthy, already motivated participants. Surprisingly, Advocate found the opposite to be true. People who took the program during the standard recruitment period had the lowest prevalence of obesity, chronic conditions and diabetes, and the highest lifestyle score.
Even when factoring in other possible limitations that could have affected the relationship between exposure to the recruitment method and actual participation, like delayed participation, the results were still stunning - and achieved without utilizing a monetary incentive.
Employers must also think about what they are promoting. Employers should implement participation strategies that endorse meaningful, sustainable behavior change to get more bang for their buck. Many incentive campaigns focus on increasing participation in a health risk assessment.
Although the assessment is imperative to identifying the populations' health risks, it alone is not intended to change behaviors or modify health risks. Employers can no longer afford to focus only on the health risk assessment, but rather must also incent the behaviors that lead to reduced health care costs and increased productivity.
Building a meaningful connection does not demand expensive incentive campaigns. Rather, understanding the workplace culture, tying health to other values, making risk modification meaningful to employees with strategic and effective messaging can drive sustained participation without breaking the bank.
Danielle L. Giuseffi, MPH, is a health researcher and participation specialist for HealthMedia, Inc. Steven M. Schwartz, PhD, is the director of corporate research for HealthMedia, Inc.
