behavior change, down to a science. › wp...behavior change, down to a science. author: liina...

©2017 The StayWell Company, LLC. All rights reserved.

David R. Anderson, PhD LP

Co-founder & Adviser

Wellness Incentives:Can they work? Are they worth it?

Art & Science of Health Promotion, 2017


Conflict of interest statement

2

The presenter was employed by and continues to have a

consulting relationship with StayWell, a national provider of

worksite health management solutions.

Some of the information in this presentation is based on the

presenter’s experiences with this provider but is used solely for

educational or illustrative purposes and does not promote the

use of specific products or services.


What we’ll talk about today

• The science of motivating behavior change

• Do incentives “work?”

• Are incentives “worth it?”

3


The science of motivating

behavior change

4


Power of patience, payoffs and praise

5

Thank you, Skinner! Thank you, Pavlov!


What drives human behavior?

6

Psychology 101 – It’s just the “animal drives”

– Drive 1: biological factors like hunger, thirst, sex, pain

– Drive 2: reward/punishment, i.e. extrinsic motivation

Then those pesky primates came along...

…with Drive 3:


What drives human behavior?

7

Psychology 201 – Power of “human needs”

– Drive 3: intrinsic motivation

• Maslow’s hierarchy – esteem, self-actualization

• Autonomy, competence, relatedness

– Self-determination theory – Deci & Ryan

• Deep absorption in an activity for its own sake

– Sense of engagement, happiness, timelessness

– Optimal state called “flow” (see Mihaly Csikszentmihalyi)

– Motivated by mastery of things we care deeply about – our passions!

• Aligning actions with purpose linked to fulfillment, mental & physical health


Purpose, alignment and well-being

8


Do wellness incentives “work?”

9


Do financial incentives change behavior?

10

Review criteria• First comprehensive review

• Incentive was only intervention

• Adults in real-world settings in US

• Cash/equivalent for behavior change

• Only randomized, controlled studies

Studies reviewed• 350 studies assessed

• Only 15 studies met criteria

• 10 smoking; 4 vaccination or

screening attendance; 1 exercise

Results• Smoking impact 2.48 odds ratio up to

6 months; 1.50 over 6 months

• Vaccination/screen attendance 1.92

• Total combined odds ratio = 1.62

Limitations• Maintenance when incentive ends

• No evaluation of cost-effectiveness


Intrinsic vs. extrinsic – It matters a lot!

11

Controlled vs. Autonomous Motivation– Controlled: Seduced, coerced, pressured

– Autonomous: Volition, endorsement, interest, deeply valued

– Cherished beliefs, purpose drive commitment, passion

Limits of “wellness incentives”– Controlled motivation buys compliance

– Compliance depends on incentive

– Often have “unintended consequences”

– May result in pushback

– BUT… may be a tool in a broader strategy???


Tom Sawyer knew intrinsic motivation!

12

Punishment or privilege?


“Psychological Reactance” in action

13


Wellness [incentives] in the news

14


Wellness [incentives] in the news

15


New research… more questions???

16

Objective• Compared participation-based, hybrid,

outcome-based & no incentive groups

• Impact on participation in activities

between screenings & on health risks

Methods• Wellness vendor book of business

• 122k screened in both 2013 & 2014

• Impact on those with high baseline

BMI, BP, or non-HDL cholesterol

Results• No significant differences in odds of

participating in activities or achieving

health targets

• Highest participation odds ratios –

1.46 – 2.07 – in no incentive group

Limitations• Sample criteria – at risk, multiple

screenings – limits generalizability

Journal of Occupational & Environmental Medicine, 2017.


Smoking trends among U.S. adults

17

Power of aligning environment, culture, taxes and surcharges(?)

10%

20%

30%

40%

50%

1965 1970 1974 1980 1985 1990 1995 2001 2006 2010 2013 2015

42.4%

37.4% 37.1%

33.2%

30.1%

25.5% 24.7%22.8%

20.8%19.3%

17.8%

15.1%

Source: CDC National Health Interview Surveys, 1965–2013.


Supportive environment matters

18

27%

33%

41%44%

51%

65%

33%37%

53%

41%

51%

69%

0%

20%

40%

60%

80%

100%Weaker Strong

HA

Pa

rtic

ipati

on

Ra

te (

%)

Reference: Seaverson ELD, Grossmeier J, Miller TM, Anderson DR. The role of incentive design, communications strategy and

worksite culture on health assessment participation. American Journal of Health Promotion, 2009;23:343-352.

Non-Cash

Incentives

Cash

Incentives

Benefits-Integrated

Incentives

N=4 N=16 N=16

Communication Culture Culture CultureCommunication Communication


19

Are wellness incentives “worth it?”


Are financial incentives worth the cost?

Health Assessment

Incentive

Participation

Rate

$ / Added

Participant

$0 20% -

$50 40% $100

$100 50% $167

$200 60% $300

Coaching

Incentive

Completion

Rate

$ / Added

Completer

$0 20% -

< $100 22% $550

$100+ 28% $350

20

vs. 98% for the cost of a haircut?

Source: Anderson et al. ACSM Health & Fitness Journal, 2008

… and risk reduction dropped…

“How many calls till I get paid?”

$7,000 per additional risk changed

Source: Gingerich et al. Amer Journal Health Promotion, 2012


Can we make incentives worth it???

Health plan integration can eliminate or reduce cost− Unintended consequences still need to be avoided

Incentive tactics may align with culture strategy

− Reduce resistance by creating with rather than doing to employees

− Long-term impact on population health is still unknown

Non-financial rewards can be intrinsically motivating

− Recognition, culturally relevant tokens, small tangible rewards

− Social engagement, games, lotteries, philanthropy

Potential to apply some behavioral economics principles

21


Thank you

22

Incentives do, in fact, “work” so…

use them carefully!

behavior change, down to a science. › wp...behavior change, down to a science. author: liina...

Documents