The Role of Incentive Design, Incentive Value, Communications Strategy, and Worksite Culture on Health Risk Assessment Participation

Research Findings Journalists Cannot Resist: A Tale of Three Mental Health and Well-Being Studies

Addressing employee mental health needs and fostering organizations that enable thriving has become a priority for most workplace health and well-being initiatives. While mental health issues for the nation were of growing concern before COVID-19, the pandemic amplified concerns about loneliness, burnout and deaths of despair. A recent study that garnered attention from the popular press found that participants of individual-level mental health interventions were no better off than non-participants. This editorial reviews that study, summarizes limitations and beneficial learnings from the research, and argues that organizational factors have been shown to mitigate or amplify the effectiveness of mental health services. Tenets of 'patient-centered care' and the principles behind Total Worker Health® will need to be more broadly embraced so that the voice of employees can better inform workplace well-being strategies and strategic plans.

Building the Worksite Wellness Foundation Infrastructure: A Critical Component of the WorkWell KS Strategic Framework

OBJECTIVE

Workplace health programs can be ineffective, and changes are likely to be temporary without first establishing a wellness infrastructure. This study sought to determine whether attending a WorkWell KS Building the Worksite Wellness Foundation (Foundation) workshop enabled worksites to develop this infrastructure.

METHODS

Survey data were collected from worksites before attending a workshop and approximately 1 year later. Survey items were designed to assess whether the worksite was implementing best practices.

RESULTS

In total, 212 worksites participated in a workshop and completed both a baseline and follow-up assessments. At follow-up, more worksites reported having a wellness committee (89.6% vs 59.7%, P < 0.001) and having wellness committee duties included in position descriptions (26.2% vs 6.4%, P < 0.001).

CONCLUSIONS

This study suggests that Foundation workshops can support worksites' implementation of best practices to establish worksite wellness infrastructure.

Is It Time to Re-Shift the Research Agenda? A Scoping Review of Participation Rates in Workplace Health Promotion Programs

Workplace health promotion programmes (WHPPs) are among the most important measures to improve the health and motivation of the ageing workforce. However, they are accompanied with certain challenges, such as low participation rates and higher participation levels of the more health-conscious workers, often failing to engage those who need such interventions the most. Following the PRISMA guidelines, this scoping review examined participation rates reported in articles on WHPPs to identify potential knowledge gaps. The results are worrying: participation rates are not only infrequently reported, but also low. Of the 58 articles, 37 report participation rates, with the majority (20) reporting an average participation rate of less than 50%. Reported participation rates refer either to different target groups, the type of intervention, or to single points in time, which makes it difficult to establish consistent criteria for comparison. We argue that despite the importance of WHPP efficacy, research focus should shift to the determinants of participation, as well as the issue of standardising the reporting of participation rates, alongside the potential problem of reporting bias.

Influence of Incentive Design and Organizational Characteristics on Wellness Participation and Health Outcomes

OBJECTIVE

To explore how changing incentive designs influence wellness participation and health outcomes.

METHODS

Aggregated retrospective data were evaluated using cluster analysis to group 174 companies into incentive design types. Numerous statistical models assessed between-group differences in wellness participation, earning incentives, and over-time differences in health outcomes.

RESULTS

Four incentive design groups based on requirements for earning incentives were identified. The groups varied in support for and participation in wellness initiatives within each company. All four design types were associated with improved low density lipoprotein (LDL) (P < 0.01), three with improved blood pressure (P < 0.001), and two with improved fasting glucose (P < 0.03). No incentive plan types were associated with improved body mass index (BMI), but designs predominantly focused on health outcomes (eg, Outcomes-Focused) exhibited a significant increase over time in BMI risk.

CONCLUSION

Incentive design and organizational characteristics impact population-level participation and health outcomes.

Effect of Behavioral Economic Incentives for Colorectal Cancer Screening in a Randomized Trial

BACKGROUND & AIMS

Financial incentives might increase participation in prevention such as screening colonoscopy. We studied whether incentives informed by behavioral economics increase participation in risk assessment for colorectal cancer (CRC) and completion of colonoscopy for eligible adults.

METHODS

Employees of a large academic health system (50-64 y old; n = 1977) were randomly assigned to groups that underwent risk assessment for CRC screening and direct access colonoscopy scheduling (control), or risk assessment, direct access colonoscopy scheduling, a $10 loss-framed incentive to complete risk assessment, and a $25 unconditional incentive for colonoscopy completion (incentive). The primary outcome was the percentage of participants who completed screening colonoscopy within 3 months of initial outreach. Secondary outcomes included the percentage of participants who scheduled colonoscopy and the percentage who completed the risk assessment.

RESULTS

At 3 months, risk assessment was completed by 19.5% of participants in the control group (95% CI, 17.0-21.9%) and 31.9% of participants in the incentive group (95% CI, 29.0-34.8%) (P < .001). At 3 months, 0.7% of controls had completed a colonoscopy (95% CI, .2%-1.2%) compared with 1.2% of subjects in the incentive group (95% CI, .5%-1.9%) (P = .25).

CONCLUSIONS

In a randomized trial of participants who underwent risk assessment for CRC with vs without financial incentive, the financial incentive increased CRC risk assessment completion but did not result in a greater completion of screening colonoscopy. Clinicaltrials.gov no: NCT03068052.

Association of organizational factors with knowledge of effectiveness indicators and participation in corporate health and productivity management programs

OBJECTIVES

The working-age population is rapidly declining in Japan, so the government has adopted "health and productivity management" (HPM). This policy initiative aims to encourage corporations to view health promotion activities as an investment in their employees' health. The objective of this study was to examine the association between organizational factors and knowledge of the organization's effectiveness and program participation levels, and to understand the factors that affect effectiveness of corporations' activities.

METHODS

We used data from all corporations that completed the HPM Survey Sheets in 2018 (n = 1800). The explanatory variables were organizational factors: written company-wide policy, agenda item at management-level meetings, regular education for managers, and full-time occupational health staff. The outcome variables were knowledge of the corporation's status on the effectiveness indicators (employees' exercise habits, risk for high blood pressure, visiting hospital after a health examination, and long-term sickness absences) and rates of participation in four areas (health education, exercise program, dietary program, and influenza vaccination). The associations between organizational factors and knowledge on effectiveness indicators and rates of program participation were analyzed using multiple logistic regression analysis.

RESULTS

All the organizational factors were related to knowledge of effectiveness indicators, but only some were associated with the program participation indicators in the model, including all explanatory variables.

CONCLUSION

Enhancing organizational factors may lead to improvement of HPM programs and higher program participation among employees in corporations.

Financial Incentives and Employer-Sponsored Health Activities

OBJECTIVE

To understand how employer-sponsored incentives and participant-level characteristics drive health activity engagement.

METHODS

Multivariable hierarchical logistic regression models evaluated 283,365 individuals eligible for incentives through health savings accounts, health reimbursement accounts, health incentive accounts, gift cards, and other means, and estimated log odds of (1) completing a health survey; (2) participating in a biometric screening; (3) attaining a biometric target; (4) participating in a weight loss program; undergoing (5) breast, (6) colorectal, or (7) cervical cancer screening.

RESULTS

Larger incentives were associated with higher odds of participating in biometric screenings only (2% higher for every $25). Obesity, tobacco use, and lack of primary care were associated with lower odds.

CONCLUSION

Employers may wish to tailor incentive plans to the unique characteristics and needs of their populations to better drive participation in sponsored health activities.

Health Risk Assessments in Michigan's Medicaid Expansion: Early Experiences in Primary Care

INTRODUCTION

Michigan is one of 3 states that have implemented health risk assessments for enrollees as a feature of its Medicaid expansion, the Healthy Michigan Plan. This study describes primary care providers' early experiences with completing health risk assessments with enrollees and examines provider- and practice-level factors that affect health risk assessment completion.

METHODS

All primary care providers caring for ≥12 Healthy Michigan Plan enrollees (n=4,322) were surveyed from June to November 2015, with 2,104 respondents (55.5%). Analyses in 2016-2017 described provider knowledge, attitudes, and experiences with the health risk assessment early in Healthy Michigan Plan implementation; multivariable analyses examined relationships of provider- and practice-level characteristics with health risk assessment completion, as recorded in state data.

RESULTS

Of the primary care provider respondents, 73% found health risk assessments very or somewhat useful for identifying and discussing health risks, although less than half (47.2%) found them very or somewhat useful for getting patients to change health behaviors. Most primary care provider respondents (65.3%) were unaware of financial incentives for their practices to complete health risk assessments. Nearly all primary care providers had completed at least 1 health risk assessment. The mean health risk assessment completion rate (completed health risk assessments/number of Healthy Michigan Plan enrollees assigned to that primary care provider) was 19.6%; those who lacked familiarity with the health risk assessment had lower completion rates.

CONCLUSIONS

Early in program implementation, health risk assessment completion rates by primary care providers were low and awareness of financial incentives limited. Most primary care provider respondents perceived health risk assessments to be very or somewhat useful in identifying health risks, and about half of primary care providers viewed health risk assessments as very or somewhat useful in helping patients to change health behaviors.

Workplace Well-Being Factors That Predict Employee Participation, Health and Medical Cost Impact, and Perceived Support

Purpose:

This study tested relationships between health and well-being best practices and 3 types of outcomes.

Design:

A cross-sectional design used data from the HERO Scorecard Benchmark Database.

Setting:

Data were voluntarily provided by employers who submitted web-based survey responses.

Sample:

Analyses were limited to 812 organizations that completed the HERO Scorecard between January 12, 2015 and October 2, 2017.

Measures:

Independent variables included organizational and leadership support, program comprehensiveness, program integration, and incentives. Dependent variables included participation rates, health and medical cost impact, and perceptions of organizational support.

Analysis:

Three structural equation models were developed to investigate the relationships among study variables.

Results:

Model sample size varied based on organizationally reported outcomes. All models fit the data well (comparative fit index > 0.96). Organizational and leadership support was the strongest predictor ( P < .05) of participation (n = 276 organizations), impact (n = 160 organizations), and perceived organizational support (n = 143 organizations). Incentives predicted participation in health assessment and biometric screening ( P < .05). Program comprehensiveness and program integration were not significant predictors ( P > .05) in any of the models.

Conclusion:

Organizational and leadership support practices are essential to produce participation, health and medical cost impact, and perceptions of organizational support. While incentives influence participation, they are likely insufficient to yield downstream outcomes. The overall study design limits the ability to make causal inferences from the data.

The impact of organizational support for employees’ health on organizational commitment, intent to remain and job performance

Purpose

The purpose of this paper is to examine the relationship between employees’ perceptions of organizational support for employee health (OSEH) and employees’ turnover intention and job performance, with a focus on the possible mediating roles of affective commitment and wellness program participation in these relationships.

Design/methodology/approach

Data were collected from surveys of employees at a public university that provides employees with a variety of wellness program options. Conditional procedural analysis was conducted to test the model.

Findings

Results showed that employees’ perceptions of OSEH positively related to both turnover intention and job performance and that affective commitment fully mediated the relationships between OSEH perceptions and both dependent variables.

Research limitations/implications

Cross-sectional data were collected on OSEH, affective commitment, employees’ intent to remain in the organization and job performance. Future studies based on panel data would be helpful to establish the causal relationships in the model.

Practical implications

Our findings show that employees’ perceptions of OSEH are likely to affect behavioral outcomes through affective commitment, suggesting that managers should ensure that employees are aware of organizational support for health promotion. Our findings also suggest that organizations move beyond a focus on design of wellness programs to include an emphasis on the overall OSEH.

Originality/value

This research study is the first empirical examination on the two possible channels through which organizational health support may influence employees’ intent to remain and job performance – participation in wellness programs and affective organizational commitment. The results are of value to researchers, human resource management managers, employees and executives who are seeking to develop practices that promote employee health at the workplace.

The Sustainability of a Workplace Wellness Program That Incorporates Gamification Principles: Participant Engagement and Health Benefits After 2 Years

Purpose:

To evaluate the results of a workplace wellness program that incorporates gamification principles.

Design:

In this prospective cohort study, the participation rate and observed health outcomes were evaluated after approximately 2 years.

Setting and participants:

All permanent employees (n = 775) of a national company located in Canada were eligible to participate.

Intervention:

The wellness program included web-based challenges (team or individual) incorporating gamification strategies to improve exercise, nutrition, weight reduction, and mental health management behaviors.

Measures and analysis:

The primary outcomes were employee participation rates. The secondary pre-specified outcomes were the sustained benefits of the program on physical and mental health measures.

Results:

Participation rates in the health screenings were 78% (baseline), 54% (year 1), and 56% (year 2). Participation in the 4 team web-based challenges ranged from 33% to 68% with 76% to 86% of participants tracking their activity on at least half of the days. After 2 years, there were significant clinical improvements in systolic blood pressure (−1.3mm Hg), total cholesterol/high-density lipoprotein (HDL) ratio (−0.14), glycated haemoglobin (HbA1c; −0.1%), weekly physical activity (+264 Metabolic Equivalents [METs]), perceived stress score (−17%), insomnia severity index (−16%), general fatigue (−10%), and reductions in the cardiovascular age gap (−0.3 years). Greater benefits occurred among employees at higher risk.

Conclusions:

Workplace wellness programs that evolve over time and focus primarily on fun and competitive challenges may support long-term participation, behavior change, and sustained improvements in clinical outcomes.

Is More Always Better in Designing Workplace Wellness Programs?: A Comparison of Wellness Program Components Versus Outcomes

OBJECTIVE

Assess whether adding more components to a workplace wellness program is associated with better outcomes by measuring the relationship of program components to one another and to employee participation and perceptions of program effectiveness.

METHODS

Data came from a 2014 survey of 24,393 employees of 81 employers about services offered, leadership, incentives, and promotion. Logistic regressions were used to model the relationship between program characteristics and outcomes.

RESULTS

Components individually are related to better outcomes, but this relationship is weaker in the presence of other components and non-significant for incentives. Within components, a moderate level of services and work time participation opportunities are associated with higher participation and effectiveness.

CONCLUSIONS

The "more of everything" approach does not appear to be advisable for all programs. Programs should focus on providing ample opportunities for employees to participate and initiatives like results-based incentives.

Incentives and Big E Engagement

The kind of engagement industrial psychologists have shown can produce optimal performance relates more to a state of mind than to increasing participation in programs or motivating a workforce with financial incentives. In the context of quality improvement methodologies, the health promotion profession has yet to discover when, where and how large financial incentives should be and how they best fit in our processes. That is, there is no “standard work” for the use of extrinsic motivators. Yet, to argue against incentives given evidence to date has more to do with polemics than science.

An Incentivized, Workplace Physical Activity Intervention Preferentially Increases Daily Steps in Inactive Employees

Although physical activity (PA) is associated with decreased risk of chronic diseases, fewer than half of American adults meet the recommendations for daily PA, in part, due to large amounts of sedentary time in the workplace.

PURPOSE

To determine the efficacy of an incentivized workplace PA intervention.

DESIGN

Retrospective cohort design.

SETTING

Large southeastern university.

PARTICIPANTS

Of the 16 588 eligible employees working ≥8 h/wk, 6246 (37.6%) participated and 2206 (13.3%) were included in data analysis.

INTERVENTION

Six-week PA intervention with tiered incentives (value: $10.50-$29.00).

MEASURES

Steps/day measured via consumer-grade PA monitors for 1-week pre-, 6-weeks during, and 1-week postintervention.

ANALYSIS

Participants were grouped by preintervention PA into 4 groups: <6000 (I); 6000 to 7999 (II); 8000 to 9999 (III); and ≥10 000 (IV) steps/d ( n = 481, 540, 485, and 700, respectively) in accordance with the tiered incentive schedule. Statistical comparisons were made by repeated-measures analysis of variance.

RESULTS

During the intervention, participants achieving ≥10 000 steps/d increased by 60%. Groups I, II, and III significantly increased steps/day during the intervention (46%, 24%, and 11%, respectively), which was partially maintained in groups I and II 1-week postintervention. Group IV did not increase steps/day during the intervention and significantly decreased steps/day 1-week postintervention. The estimated cost per participant of this intervention increased with from group I ($55.41) to IV ($71.90).

CONCLUSION

An incentivized, workplace PA intervention preferentially increases PA and is most cost-effective among university employees with low initial PA who may benefit substantially from increased levels of PA.

Outcome-based and Participation-based Wellness Incentives: Impacts on Program Participation and Achievement of Health Improvement Targets

OBJECTIVE

This study examined whether worksite wellness program participation or achievement of health improvement targets differed according to four incentive types (participation-based, hybrid, outcome-based, and no incentive).

METHODS

The study included individuals who completed biometric health screenings in both 2013 and 2014 and had elevated metrics in 2013 (baseline year). Multivariate logistic regression modeling tested for differences in odds of participation and achievement of health improvement targets between incentive groups; controlling for demographics, employer characteristics, incentive amounts, and other factors.

RESULTS

No statistically significant differences between incentive groups occurred for odds of participation or achievement of health improvement target related to body mass index, blood pressure, or nonhigh-density lipoprotein cholesterol.

CONCLUSIONS

Given the null findings of this study, employers cannot assume that outcome-based incentives will result in either increased program participation or greater achievement of health improvement targets than participation-based incentives.

The Role of Leadership Support for Health Promotion in Employee Wellness Program Participation, Perceived Job Stress, and Health Behaviors

Purpose:

The purpose of the study was to explore the relationship between leadership support for health promotion and job stress, wellness program participation, and health behaviors.

Design:

A cross-sectional survey design was used.

Setting:

Four worksites with a range of wellness programs were selected for this study.

Participants:

Participants in this study were employees (n = 618) at 4 organizations (bank, private university, wholesale supplier, and public university) in the southeastern United States, each offering an employee wellness program. Response rates in each organization ranged from 3% to 34%.

Measures:

Leadership support for health promotion was measured with the Leading by Example instrument. Employee participation in wellness activities, job stress, and health behaviors were measured with multi-item scales.

Analysis:

Correlation/regression analysis and descriptive statistics were used to analyze the relationships among the scaled variables.

Results:

Employees reporting higher levels of leadership support for health promotion also reported higher levels of wellness activity participation, lower job stress, and greater levels of health behavior ( P = .001). To ascertain the amount of variance in health behaviors accounted for by the other variables in the study, a hierarchical regression analysis revealed a statistically significant model (model F7,523 = 27.28; P = .001), with leadership support for health promotion (β = .19, t = 4.39, P = .001), wellness activity participation (β = .28, t = 6.95, P < .001), and job stress (β = −.27, t = −6.75, P ≤ .001) found to be significant predictors of health behaviors in the model. Exploratory regression analyses by organization revealed the focal variables as significant model predictors for only the 2 larger organizations with well-established wellness programs.

Conclusion:

Results from the study suggest that employees’ perceptions of organizational leadership support for health promotion are related to their participation in wellness activities, perceived job stress levels, and health behaviors.

Promoting Healthy Workplaces by Building Cultures of Health and Applying Strategic Communications

OBJECTIVE

The aim of the study was to identify key success elements of employer-sponsored health promotion (wellness) programs.

METHODS

We conducted an updated literature review, held discussions with subject matter experts, and visited nine companies with exemplary programs to examine current best and promising practices in workplace health promotion programs.

RESULTS

Best practices include establishing a culture of health and using strategic communications. Key elements that contribute to a culture of health are leadership commitment, social and physical environmental support, and employee involvement. Strategic communications are designed to educate, motivate, market offerings, and build trust. They are tailored and targeted, multichanneled, bidirectional, with optimum timing, frequency, and placement.

CONCLUSIONS

Increased efforts are needed to disseminate lessons learned from employers who have built cultures of health and excellent communications strategies and apply these insights more broadly in workplace settings.

My Last Lecture

In celebration of my final comments as editor in chief of the American Journal of Health Promotion, I offer reflections on the importance of workplace health promotion, the impact of financial incentives on program effectiveness and financial sustainability, return on investment (ROI) analysis, reducing the federal debt by improving health, balancing high technology approaches with human touch, focusing on passions and sense of purpose, and nurturing a loving and caring community of professionals.

Incentives, Program Configuration, and Employee Uptake of Workplace Wellness Programs

OBJECTIVES

The aim of this study was to determine the effect of wellness program configurations and financial incentives on employee participation rate.

METHODS

We analyze a nationally representative survey on workplace wellness programs from 407 employers using cluster analysis and multivariable regression analysis.

RESULTS

Employers who offer incentives and provide a comprehensive set of program offerings have higher participation rates. The effect of incentives differs by program configuration, with the strongest effect found for comprehensive and prevention-focused programs. Among intervention-focused programs, incentives are not associated with higher participation.

CONCLUSIONS

Wellness programs can be grouped into distinct configurations, which have different workplace health focuses. Although monetary incentives can be effective in improving employee participation, the magnitude and significance of the effect is greater for some program configurations than others.

Outcomes Across the Value Chain for a Comprehensive Employee Health and Wellness Intervention: A Cohort Study by Degrees of Health Engagement

OBJECTIVE

Evaluate a large employer's wellness intervention by studying outcomes across the value chain, and testing Health Engagement's (HE) dose-response relationship to outcomes.

METHODS

Evaluation included 37 measures across eight outcomes domains (OD) using repeated measures, analysis of variance and logistic regression.

RESULTS

Participants with higher HE had better pre-post percent changes than control: 1.7% higher for Motivation (OD1), 3.4% for Behavior (OD2), 1.0% for Emotion (OD3), 5.8% for Biometrics (OD4), 6.3% for Compliance (OD5), and 5.2% for Claims (OD6). They also had 0.5% less Productivity loss (OD7), and odds of Turnover (OD8) one-quarter to one-half that of control. A dose-response relationship with degrees of HE was also shown.

CONCLUSIONS

Three outcomes domains (OD6 to OD8) can be monetized for cost-benefit analysis. Authors recommend, however, staying focused on driving HE and using metrics from all OD to assess value.

Does workplace health promotion contribute to job stress reduction? Three-year findings from Partnering Healthy@Work

BACKGROUND

Workplace health promotion (WHP) has been proposed as a preventive intervention for job stress, possibly operating by promoting positive organizational culture or via programs promoting healthy lifestyles. The aim of this study was to investigate whether job stress changed over time in association with the availability of, and/or participation in a comprehensive WHP program (Healthy@Work).

METHOD

This observational study was conducted in a diverse public sector organization (~28,000 employees). Using a repeated cross-sectional design with models corroborated using a cohort of repeat responders, self-report survey data were collected via a 40 % employee population random sample in 2010 (N = 3406) and 2013 (N = 3228). Outcomes assessed were effort and reward (self-esteem) components of the effort-reward imbalance (ERI) measure of job stress. Exposures were availability of, and participation in, comprehensive WHP. Linear mixed models and Poisson regression were used, with analyses stratified by sex and weighted for non-response.

RESULTS

Higher WHP availability was positively associated with higher perceived self-esteem among women. Women's mean reward scores increased over time but were not statistically different (p > 0.05) after 3 years. For men, higher WHP participation was associated with lower perceived effort. Men's mean ERI increased over time. Results were supported in the cohort group.

CONCLUSIONS

For women, comprehensive WHP availability contributed to a sense of organizational support, potentially impacting the esteem component of reward. Men with higher WHP participation also benefitted but gains were modest over time and may have been hindered by other work environment factors.

Development and Implementation of Worksite Health and Wellness Programs: A Focus on Non-Communicable Disease

The development and implementation of worksite health and wellness programs (WHWPs) in the United States (US) hold promise as a means to improve population health and reverse current trends in non-communicable disease incidence and prevalence. However, WHWPs face organizational, economic, systematic, legal, and logistical challenges which have combined to impact program availability and expansion. Even so, there is a burgeoning body of evidence indicating WHWPs can significantly improve the health profile of participating employees in a cost effective manner. This foundation of scientific knowledge justifies further research inquiry to elucidate optimal WHWP models. It is clear that the development, implementation and operation of WHWPs require a strong commitment from organizational leadership, a pervasive culture of health and availability of necessary resources and infrastructure. Since organizations vary significantly, there is a need to have flexibility in creating a customized, effective health and wellness program. Furthermore, several key legal issues must be addressed to facilitate employer and employee needs and responsibilities; the US Affordable Care Act will play a major role moving forward. The purposes of this review are to: 1) examine currently available health and wellness program models and considerations for the future; 2) highlight key legal issues associated with WHWP development and implementation; and 3) identify challenges and solutions for the development and implementation of as well as adherence to WHWPs.

Huge "wellness incentives" are more about health plan benefit design than health promotion

Regulations governing employers' use of financial incentives for employees who participate in health promotion programs or are successful in achieving health goals go into effect today (January 1, 2014). It is important to recognize that huge incentives have more to do with health plan design and less to do with effective strategies to improve health. Comprehensive health promotion programs need to increase awareness of the link between lifestyle and health, enhance motivation to improve health, build the skills important for a healthy lifestyle, and provide an abundance of opportunities to practice a healthy lifestyle.

Four lenses through which to develop wellness incentive policies

Employers had to scramble to develop policies for their Wellness Incentives in time for their Fall, 2013 Open Enrollment deadlines, and are already refining policies for the 2014 Open Enrollment period. Employers are encouraged to consider six policy elements and to view all of them through four lenses. The policy elements are: (1) Number and Types of Behaviors and Outcomes to Target. (2) Cost-Positive, Neutral, or Savings Approach. (3) Maximum Incentive Value and Allocation of Incentives. (4) Ratio of Types of Incentive Structure for Reasonable Alternative Standards. (5) Numbers of Cycles of RASs. (6) Access and Allocations for Family Members. The lenses are: (1) What drives healthy behavior? (2) What is equitable? (3) What is sustainable? and (4) What enhances employee morale?

The impact of an incentive on the use of an online self-directed wellness and self-management program

Background

Those who pay for health care are increasingly looking for strategies to influence individuals to take a more active role in managing their health. Incenting health plan members and/or employees to participate in wellness programs is a widely used approach.

Objective

In this study, we examine financial incentives to health plan members to participate in an online self-management/wellness program—US $20 for completing the patient activation measure (PAM) and an additional US $40 for completing 8 learning modules. We examined whether the characteristics of plan members differed by the degree to which they responded to the incentives. Further, we examined whether participation in the wellness program was associated with improvements in PAM scores and changes in health care utilization.

Methods

This retrospective study compared demographic characteristics and change in PAM scores and health utilization for 144,625 health plan members in 2011. Four groups were compared: (1) those who were offered the incentives but chose not to participate (n=128,634), (2) those who received the initial incentive (PAM only) but did not complete 8 topics (n=7099), (3) those who received both incentives (completing 8 topics but no more) (n=2693), and (4) those who received both incentives and continued using the online program beyond what was required by the incentives (n=6249).

Results

The vast majority of health plan members did not participate in the program (88.91%, 128,634/144,675). Of those who participated, only 7099 of 16,041 (44.25%) completed the PAM for the first incentive, 2693 (16.79%) completed 8 topics for the second incentive, and 6249 (38.96%) received both incentives and continued using the program beyond the incentive requirements. Nonparticipants were more likely to be men and to have lower health risk scores on average than the other three groups of participants (P<.001). In multivariate regression models, those who used the online program (8 topics or beyond) increased their PAM score by approximately 1 point more than those who only took the PAM and did not use the wellness program (P<.03). In addition, emergency department visits were lower for all groups who responded to any level of the incentive as compared to those who did not (P<.01). No differences were found in other types of utilization.

Conclusions

The incentive was not sufficient to spark most health plan members to use the wellness program. However, the fact that many program participants went beyond the incentive in their use of the online wellness program suggests that the users of the online program found value in using it, and it was their own internal motivation that stimulated this additional use. Providing an incentive for program participation may be an effective pathway for working with less activated patients, particularly if the program is tailored to the needs of the less activated.

A focus group assessment to determine motivations, barriers and effectiveness of a university-based worksite wellness program

BACKGROUND

This study explores university employee perceptions and under-standing about its Worksite Health Promotion Program (WHPP). The WHPP included a Health Risk Appraisal (HRA), biometric screening, publicity for on-campus health programs and facilities, and health coaching.

METHODS

A qualitative design was used based on a grounded theory ap-proach. Four 90 minutes focus groups with 6-8 participants in each were conducted within a two 2 week period among employees, representing fac-ulty/participants, fac-ulty/nonparticipants, staff/participants, and staff/nonparticipants. Responses to questions about motivations, barriers, and perceived health benefits that impacted participation in the WHPP were digi-tally recorded, transcribed and coded for themes.

RESULTS

Incentives effectively motivated participation. Biometric screening had the largest impact on behavior change, followed by the information learned from the HRA. However, despite two-thirds of the employees partici-pating in the pro-gram, lack of a full understanding of WHPP benefits and services lowered partici-pation in follow-up services and supplemental pro-grams.

CONCLUSIONS

Biometric screening and HRAs effectively motivate program par-ticipation. Communication of benefits and services are important when providing WHPPs.

Determinants of participation in a web-based health risk assessment and consequences for health promotion programs

Background

The health risk assessment (HRA) is a type of health promotion program frequently offered at the workplace. Insight into the underlying determinants of participation is needed to evaluate and implement these interventions.

Objective

To analyze whether individual characteristics including demographics, health behavior, self-rated health, and work-related factors are associated with participation and nonparticipation in a Web-based HRA.

Methods

Determinants of participation and nonparticipation were investigated in a cross-sectional study among individuals employed at five Dutch organizations. Multivariate logistic regression was performed to identify determinants of participation and nonparticipation in the HRA after controlling for organization and all other variables.

Results

Of the 8431 employees who were invited, 31.9% (2686/8431) enrolled in the HRA. The online questionnaire was completed by 27.2% (1564/5745) of the nonparticipants. Determinants of participation were some periods of stress at home or work in the preceding year (OR 1.62, 95% CI 1.08-2.42), a decreasing number of weekdays on which at least 30 minutes were spent on moderate to vigorous physical activity (OR_dayPA0.84, 95% CI 0.79-0.90), and increasing alcohol consumption. Determinants of nonparticipation were less-than-positive self-rated health (poor/very poor vs very good, OR 0.25, 95% CI 0.08-0.81) and tobacco use (at least weekly vs none, OR 0.65, 95% CI 0.46-0.90).

Conclusions

This study showed that with regard to isolated health behaviors (insufficient physical activity, excess alcohol consumption, and stress), those who could benefit most from the HRA were more likely to participate. However, tobacco users and those who rated their overall health as less than positive were less likely to participate. A strong communication strategy, with recruitment messages that take reasons for nonparticipation into account, could prove to be an essential tool for organizations trying to reach employees who are less likely to participate.

Promoting health and wellness in the workplace: a unique opportunity to establish primary and extended secondary cardiovascular risk reduction programs

Given the burden of cardiovascular disease (CVD), increasing the prevalence of healthy lifestyle choices is a global imperative. Currently, cardiac rehabilitation programs are a primary way that modifiable risk factors are addressed in the secondary prevention setting after a cardiovascular (CV) event/diagnosis. Even so, there is wide consensus that primary prevention of CVD is an effective and worthwhile pursuit. Moreover, continual engagement with individuals who have already been diagnosed as having CVD would be beneficial. Implementing health and wellness programs in the workplace allows for the opportunity to continually engage a group of individuals with the intent of effecting a positive and sustainable change in lifestyle choices. Current evidence indicates that health and wellness programs in the workplace provide numerous benefits with respect to altering CV risk factor profiles in apparently healthy individuals and in those at high risk for or already diagnosed as having CVD. This review presents the current body of evidence demonstrating the efficacy of worksite health and wellness programs and discusses key considerations for the development and implementation of such programs, whose primary intent is to reduce the incidence and prevalence of CVD and to prevent subsequent CV events. Supporting evidence for this review was obtained from PubMed, with no date limitations, using the following search terms: worksite health and wellness, employee health and wellness, employee health risk assessments, and return on investment. The choice of references to include in this review was based on study quality and relevance.

The Influence of Worksite and Employee Variables on Employee Engagement in Telephonic Health Coaching Programs: A Retrospective Multivariate Analysis

Purpose.

This study assessed 11 determinants of health coaching program participation.

Design.

A cross-sectional study design used secondary data to assess the role of six employee-level and five worksite-level variables on telephone-based coaching enrollment, active participation, and completion.

Setting.

Data was provided by a national provider of worksite health promotion program services for employers.

Subjects.

A random sample of 34,291 employees from 52 companies was selected for inclusion in the study.

Measures.

Survey-based measures included age, gender, job type, health risk status, tobacco risk, social support, financial incentives, comprehensive communications, senior leadership support, cultural support, and comprehensive program design.

Analysis.

Gender-stratified multivariate logistic regression models were applied using backwards elimination procedures to yield parsimonious prediction models for each of the dependent variables.

Results.

Employees were more likely to enroll in coaching programs if they were older, female, and in poorer health, and if they were at worksites with fewer environmental supports for health, clear financial incentives for participation in coaching, more comprehensive communications, and more comprehensive programs. Once employees were enrolled, program completion was greater among those who were older, did not use tobacco, worked at a company with strong communications, and had fewer environmental supports for health.

Conclusion.

Both worksite-level and employee-level factors have significant influences on health coaching engagement, and there are gender differences in the strength of these predictors.

Impact of Financial Incentives on Behavior Change Program Participation and Risk Reduction in Worksite Health Promotion

Purpose.

To examine the impact of financial incentives on behavior change program registration, completion, and risk improvement rates.

Design.

Retrospective cohort study conducted to observe the relationship between financial incentives and behavior change program registration, completion, and risk improvement rates.

Setting.

Large public- or private-sector employers.

Subjects.

Twenty-four organizations (n = 511,060 eligible employees) that offered comprehensive worksite health promotion (WHP) programs.

Intervention.

Financial incentives offered for completion of a behavior change program as part of a WHP program.

Measures.

Behavior change program registration and completion data were obtained from standard reports. Company-level risk change was calculated from the average per-person number of risks on baseline and follow-up health risk assessments. Incentive design was determined from questionnaires completed by WHP program managers.

Analysis.

Average registration rates, program completion rates, and risk improvement rates were compared using t-tests for companies that did versus did not offer incentives. Comparisons were also made between companies with incentives of less than $100 and those with incentives of $100 or more. Correlations between incentive value and outcome variables were assessed using Pearson correlations.

Results.

Companies that offered incentives had significantly higher health coaching completion rates than companies not offering an incentive (82.9% vs. 76.4%, respectively, p = .017) but there was no significant association with registration (p = .384) or risk improvement rates (p = .242). Incentive values were not significantly associated with risk improvement rates (p = .240).

Conclusion.

Offering incentives for completing behavior change programs may increase completion rates, but increased health improvement does not necessarily follow.

The importance of employee participation and perceptions of changes in procedures in a teamworking intervention

The powerful positive results of implementing teamwork are not always achieved. It has been suggested that attempts to implement theories regarding teamwork do not always lead to those theories being put into practice, and as a result positive outcomes are not always found. The participation of employees in the development and implementation of an intervention may help to ensure that changes take place. In this longitudinal study (N = 583) of teamwork implementation in Denmark we examined the links between pre-intervention working conditions and well-being, levels of participation in planning and implementation, employees’ reports of changes in procedures, and intervention outcomes. Pre-intervention levels of autonomy and job satisfaction predicted the degree of employee participation in the planning and implementation of the intervention. Pre-intervention well-being and social support were linked directly to the degree to which employees reported changes in existing work practices concerning teamwork. In addition, participation and changes in work procedures were significantly associated with post-intervention autonomy, social support and well-being. The results indicate that employee participation in intervention processes is crucial in what appears to be an important association with perceived changes in procedures and, therefore, in intervention outcomes.