Money talks: Cold cash and other incentives

A way to launch, but worker must finish

It might seem like a "no-brainer" to you, but it's not always enough to simply ask workers to make changes for better health. You might need to offer other incentives to get them to take action, says Margie Weiss, PhD, CEO and community health advocate at the Weiss Health Group, a Neenah, WI-based consulting company that works with companies and communities on health and wellness.

"Many companies are using incentives to encourage healthy behaviors," says Weiss. "They are trying to control health care costs by encouraging healthy lifestyles."

Research from HCMS Group, a health IT and clinical services company based in Cheyenne, WY, has shown that investments in wellness have a higher likelihood of making a difference when other business practices already are aligned with wellness, says Nathan Kleinman, PhD, director of research services at HCMS. For example, a wellness or safety incentive might have less of an impact at a company at which employees have little or no opportunity to earn more for working harder.

"On the other hand, if employees can earn salary bonuses for improved performance, they are more likely to view maintaining good health as important," Kleinman says.

Incentives for participation in wellness activities and challenges range from prizes to money to significant decreases in healthcare premiums, says Weiss. "Companies usually move through a continuum of options," she says.

Initially, companies usually start with providing incentives for participation in wellness-related activities. Other financial incentives are based purely on utilization, such as co-pays for emergency department care versus outpatient or clinic care, Weiss says. Once companies initiate a health risk assessment, premium costs may be linked to employee participation, then spouse participation.

"The third step is to integrate biometrics in the equation," Weiss says. "These strategies have proven effective in minimizing health care cost premium increases."

Changing it up

Tracey L. Yap, RN, PhD, an assistant professor at the College of Nursing at University of Cincinnati (OH), says that an occupational health professional might use incentives as a way to "get people to launch," but Yap says you need to get creative after that.

"You can't do the same thing all the time, with repetitive stuff. You need to change it up," she says. "That takes a lot of upfront work and energy." Here are Yap's recommendations for use of incentives:

• Consider the "stage" of the person.

When Yap held focus groups with employees at manufacturing plants, she learned that individuals in the "preparation" stage of change really didn't care about the incentives being offered as much as they did about competition. "For them, it really was about gaming against their fellow workers in other plants," she says.

In that same study, incentives combined with health behavior change education moved employees that were in the "pre-contemplation" stage of change to the "action" stage, says Yap. "The incentive can get some people rolling. It can probably push somebody to get started, but obviously incentives are not a sustainable way for behavior change," she says.

• Ask what they want.

If you're wondering what would really jump-start an employee to make a lifestyle change, just ask him or her, says Yap.

"Always go to them first. Ask what would get them engaged," she says.

Yap once offered Starbucks gift cards to get employees at a manufacturing plant to complete a questionnaire, but she later learned the closest location for Starbucks was 45 minutes away. Later, those employees told her they would rather have had Wal-Mart gift cards, but supermarket gift cards are another practical choice, says Yap.

To learn this in advance instead of after the fact, Yap says to "just randomly grab a few people and ask them what would get them engaged. Always personalize whatever you do."

• Give the equivalent of at least an hour's pay.

While the amount of incentive needed "depends on the crowd," a good ballpark figure is at least an hour's pay, Yap says. "Depending on what you are doing, being too cheap may be considered insulting," she says.

• Offer a variety.

If you're offering items such as duffle bags, water bottles, or T-shirts, provide a variety of choices, says Yap. "Do people really want a T-shirt with the company logo on it? People know you bought them in bulk, and they don't feel important," she says. "I think a lot of people want gift cards, especially around holiday time."


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