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3 problems with incentive based wellness programs

Will Harper, MD
Physician
September 28, 2013
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A recent story about Penn State’s new penalty-based approach to employee wellness is another reminder that programs relying on incentives aren’t going anywhere — even though incentive-based programs don’t work.

The traditional wellness model incentivizes people to participate in healthy behaviors—with the promise to employers of healthcare cost reductions—in exchange for discounts on their insurance premiums. However, the “carrot” is not working, to use the “carrot or stick” analogy. People aren’t changing their behaviors and costs are not coming down.

So what’s the next step? As suggested in a Wall Street Journal article that got a lot of attention last spring, use the stick. Yes, there are data that demonstrate that people are more likely to change in order to avoid a penalty than to get a reward. This is called loss aversion. However, there is no research that proves that wellness programs using this model are effective.

In fact, this “stick” approach leads to a whole host of new problems. First, people are going to be penalized unfairly. My business’ co-founder has a patient who lost 130 pounds—a full 40% of her body weight. Her employer is still penalizing her because her BMI is too high. Her employer should instead be rewarding her efforts.

The second problem is what people are going to do in order to hit the numbers. Backed into a corner, people will take unsafe short cuts to hit the expected numbers. I recently had a visit with a non-diabetic patient who got sick from taking a black market diabetes medication for weight loss. Magnify this choice in a population of thousands of people trying to lose weight in order to avoid a penalty. What harms will we unleash? It’s the law of unintended consequences.

A third drawback of the stick approach is the impact on employees’ perception of their employer. As an employer myself, I support a workforce that is committed to working hard to reach our collective mission. If I implemented a punishment-based system, I am sure it would adversely impact my employees’ commitment. This concern is voiced in the WSJ article as well, “At best, these programs are giving employers an enormous amount of control over our private lives.”

So, what to do instead? Let’s start by developing programs that value each individual’s role in making decisions about her health and well-being. People are not mules that respond to a carrot or a stick. In fact, we should stop using this idiom to describe behavior programs. People can reason and think for themselves. They have needs, desires, wishes and personal stories of success and failure — and these stories drive why people do what they do.

Let’s work with individuals to tap into their values, help them understand why they want to change and then give them the best tools to succeed in making lasting changes to their health and well-being — changes driven by their own desire to succeed, not by their employers’ desire to save a few dollars.

Will Harper is co-founder and co-CEO, Engaged Health Solutions and is the head team internist for the Chicago Blackhawks.

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