Premium-Based Financial Incentives Did Not Promote Workplace Weight Loss In A 2013–15 Study

Abstract

Employers commonly use adjustments to health insurance premiums as incentives to encourage healthy behavior, but the effectiveness of those adjustments is controversial. We gave 197 obese participants in a workplace wellness program a weight loss goal equivalent to 5 percent of their baseline weight. They were randomly assigned to a control arm, with no financial incentive for achieving the goal, or to one of three intervention arms offering an incentive valued at $550. Two intervention arms used health insurance premium adjustments, beginning the following year (delayed) or in the first pay period after achieving the goal (immediate). A third arm used a daily lottery incentive separate from premiums. At twelve months there were no statistically significant differences in mean weight change either between the control group (whose members had a mean gain of 0.1 pound) and any of the incentive groups (delayed premium adjustment, -1.2 pound; immediate premium adjustment, -1.4 pound; daily lottery incentive, -1.0 pound) or among the intervention groups. The apparent failure of the incentives to promote weight loss suggests that employers that encourage weight reduction through workplace wellness programs should test alternatives to the conventional premium adjustment approach by using alternative incentive designs, larger incentives, or both.

Developing a Patient-Centered mHealth App: A Tool for Adolescents With Type 1 Diabetes and Their Parents

“…Some research has shown that financial incentives are key motivators in weight loss and smoking cessation [46]. Ethical issues remain related to incentivizing individuals in this manner and what this practice might mean particularly for disadvantaged populations [47].…”

Uptake of an Incentive-Based mHealth App: Process Evaluation of the Carrot Rewards App

“…In the United States, the Patient Protection and Affordable Care Act (2010) allows employers (as of the year 2014) to reimburse their employees up to US $1500 per year for engaging in healthy behaviors or reaching health targets [23]. An often-cited limitation of these programs and policies, however, is the notorious delay between (1) behavior or outcome achievement and (2) reward [15,23,24]. Generally speaking, this lag has been too long (and the incentives not large or meaningful enough) to elicit the desired behavioral responses or health outcomes [23,24].…”

“…An often-cited limitation of these programs and policies, however, is the notorious delay between (1) behavior or outcome achievement and (2) reward [15,23,24]. Generally speaking, this lag has been too long (and the incentives not large or meaningful enough) to elicit the desired behavioral responses or health outcomes [23,24]. …”

A Response to Proposed Equal Employment Opportunity Commission Regulations on Employer-Sponsored Health, Safety, and Well-Being Initiatives

“…Yet, recent research indicates that incentive design using only modest premium adjustment associated with personal improvement in challenging health issues such as obesity may not be adequate for changing behavior, especially in a sustained way, and that other approaches should be explored. 25 According to Kevin Volpp, a leading scientist in the study of use of behavioral economics in health and wellness programs, many cases of how financial incentives are used in wellness programs and recent legislation represents a relatively uncommon example where ''policy has run ahead of science'' because the policies put in place go beyond what has been adequately tested (e-mail communication between Kevin Volpp and Paul Terry, January 3, 2016). Although it may be true that policy has run ahead of science, the health care community is committed to use of financial incentives as one of the key levers that needs to be pulled to drive behavior change.…”