Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis

Misra‐Hebert, Anita D.; Hu, Bo; Taksler, Glen B.; Zimmerman, Robert S.; Rothberg, Michael B.

doi:10.1007/s11606-016-3686-2

Cited by 16 publications

(16 citation statements)

References 36 publications

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“…The studies were undertaken across a number of health insurance settings including private health insurance (19,(28)(29)(30)(31), employer-sponsored health plans (9,32-40), veteran's affairs (21,27,41) and public health insurance (20,22). The majority of the studies (14) were conducted in the USA (9,21,27,28,(32)(33)(34)(35)(36)(37)(38)(39)(40)(41), and the remainder were from South Africa (four) (19,(29)(30)(31), UK (one) (22) and Germany (one) (20). Studies incentivizing weight loss, increased physical activity and improved diets are discussed subsequently.…”

Section: Results Of Search Strategymentioning

confidence: 99%

“…Three of the studies included in the review were assessed as having strong methodological quality (20,36,40). Nine studies were assessed as having moderate methodological quality (21,27,28,30,31,34,35,37,41), and eight studies were assessed as having weak methodological quality (9,19,22,29,32,33,38,39).…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

“…Twelve studies evaluated programmes that incentivised weight loss (9,(20)(21)(22)27,28,32,(34)(35)(36)39,41). Two studies had a strong quality rating (20,36), six articles had a moderate rating (21,27,28,34,35,41) and four were assessed as being weak quality (9,22,32,39).…”

Section: Financial Incentives To Lose Weightmentioning

confidence: 99%

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Paying people to lose weight: the effectiveness of financial incentives provided by health insurers for the prevention and management of overweight and obesity – a systematic review

2017

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Curbing the obesity epidemic is likely to require a suite of interventions targeting the obesogenic environment as well as individual behaviour. Evidence suggests that the effectiveness of behaviour modification programmes can be enhanced by financial incentives that immediately reward weight loss behaviour. This systematic review investigated the effectiveness of incentives with a focus on assessing the relative effectiveness of incentives that target different behaviours as well as factors of importance when implementing these programmes in real-world settings (health insurer settings). A narrative review of the academic and grey literature including a variety of study designs was undertaken. Twenty studies met inclusion criteria and were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results suggest that incentivizing weight loss is effective in the short term while the incentives are in place. There are various incentive designs, and although the relative effectiveness of each of these on weight loss is not clear, it appears that positive incentives increase the uptake into programmes and may reduce dropouts. As with other weight loss initiatives, there is a need to explore ways to maintain weight loss in the longer term - incentives for weight maintenance could play a role.

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Section: Results Of Search Strategymentioning

confidence: 99%

Section: Quality Of Included Studiesmentioning

confidence: 99%

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Paying people to lose weight: the effectiveness of financial incentives provided by health insurers for the prevention and management of overweight and obesity – a systematic review

2017

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“…The first study was a retrospective cohort analysis of 2,103 employees with T2DM who received either a $100 incentive to participate in an employer-sponsored disease management program, a $300 incentive to participate in the disease management program, or a 30% health insurance premium discount that was tied to both disease management program participation and achievement of HbA1c, LDL-C, and blood pressure targets. [68] Overall these financial incentives led to modest declines in HbA1c levels, systolic blood pressure, LDL-C, and weight over five years compared to 2,672 commercially insured non-employee patients of the same primary care physicians. The other study was a three-arm randomized trial of 118 predominantly African American Veterans with T2DM and persistently poor glycemic control.…”

Section: Resultsmentioning

confidence: 99%

A Scoping Review of Behavioral Economic Interventions for Prevention and Treatment of Type 2 Diabetes Mellitus

et al. 2017

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Purpose of review To review studies of behavioral economic interventions (financial incentives, choice architecture modifications, or commitment devices) to prevent type 2 diabetes mellitus (T2DM) among at-risk patients or improve self-management among patients with T2DM. Recent findings We found 15 studies that used varied study designs and outcomes to test behavioral economic interventions in clinical, workplace, or health plan settings. Of four studies that focused on prevention of T2DM, two found that financial incentives increased weight loss and completion of a fasting blood glucose test, and two choice architecture modifications had mixed effects in encouraging completion of tests to screen for T2DM. Of 11 studies that focused on improving self-management of T2DM, four of six tests of financial incentives demonstrated increased engagement in recommended care processes or improved biometric measures, and three of five tests of choice architecture modifications found improvements in self-management behaviors. Summary Though few studies have tested behavioral economic interventions for prevention or treatment of T2DM, those that have suggest such approaches have potential to improve patient behaviors and should be tested more broadly.

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“…The authors found that incentives increased wellness program participation amongst employees (7 to 50 %), although those with poorer glycemic control (HbA1c >9 %) were less likely to participate. 2 The authors suggest that more immediate rewards (not delayed insurance reimbursements) may have stimulated greater participation, and suggest that in the future these could take the form of Bwaived^copayments. The literature, however, suggests that monetary rewards contingent on health behaviors are more effective than subsidies alone.…”

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confidence: 99%

Capsule Commentary on Misra-Hebert et al., Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis

Mitchell

2016

J GEN INTERN MED

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A dearth of randomized trials testing incentives for chronic disease self-management 1 makes this retrospective analysis of propensity-matched diabetic employees and nonemployees particularly valuable. The authors found that incentives increased wellness program participation amongst employees (7 to 50 %), although those with poorer glycemic control (HbA1c >9 %) were less likely to participate. 2 The authors suggest that more immediate rewards (not delayed insurance reimbursements) may have stimulated greater participation, and suggest that in the future these could take the form of Bwaived^copayments. The literature, however, suggests that monetary rewards contingent on health behaviors are more effective than subsidies alone. 3 In addition, more information about the incentive program would have provided greater design insight. For instance, it was not clear how employees were being rewarded, and for what exactly. Did employees receive lump-sum cash payments, or were rewards rolled into paychecks? Did program Bparticipationm ean enrollment only, 50 % attendance? Fuller reporting of incentive program features using published checklists 4 would have helped identify specific areas for improvement.At the population level, incentives stimulated a clinically meaningful 0.33-point reduction in HbA1c, though this took 5 years to achieve. We suggest that, in the context of an already engaged patient population with near optimal glycemic control at baseline (7.38 %), larger incentives worth $5 to $10 per week ($260 to $520 per year), that are dispensed more regularly (every 3 or 6 months, not just once a year), and are tied to regular program participation and meeting incremental and agreed-upon HbA1c targets (not unrealistic standardized targets) may yield larger effects.These design enhancements (and others-chance-based, loss-framed rewards that leverage behavioral economics principles) 5 may increase the proportion of employees, especially higher-risk employees, who sign up for and complete wellness programs and reach HbA1c targets in the future. Making incentives contingent on small-group performance (e.g., all three in your group must meet targets for rewards to be dispensed), rather than just on individual-level achievements, may optimize the intervention as well. While it is effective, there is much room to improve upon the incentive design examined here.

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Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis

Cited by 16 publications

References 36 publications

Paying people to lose weight: the effectiveness of financial incentives provided by health insurers for the prevention and management of overweight and obesity – a systematic review

Paying people to lose weight: the effectiveness of financial incentives provided by health insurers for the prevention and management of overweight and obesity – a systematic review

A Scoping Review of Behavioral Economic Interventions for Prevention and Treatment of Type 2 Diabetes Mellitus

Capsule Commentary on Misra-Hebert et al., Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis

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