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LK 120
Promoting healthy behaviors: Five-year study on impact of incentives
LK 120
Promoting healthy behaviors: Five-year study on impact of incentives
Vice President of Clinical Solutions, ActiveHealth Management
BackgroundPayers, including government, employers, and now even individuals, seek to slow rising costs and improve outcomes by investing in health and wellness initiatives, aiming at engaging individuals... Read more



Payers, including government, employers, and now even individuals, seek to slow rising costs and improve outcomes by investing in health and wellness initiatives, aiming at engaging individuals and their families. Incentives are thought to increase engagement with programs that improve healthy lifestyles; and about 70 percent of employers currently offer some sort of wellness incentive. Studies have shown, however, the individual may not, and often does not, take actions that would result in improved health and wellness even when the knowledge is presented and readily available. As a result, behavioral economics has fueled development of the field of incentives for healthy behavior. Aside from the theory, the question of what works in real-world settings has remained elusive. Here we describe a study on actual incentives offered to two million persons across 25 organizations, compared with 1.5 million persons without incentives, over a five year period.

One area of particular interest, and debate, is whether rewards (“carrots”) or penalties (“sticks”) are more effective. The stick approach, once shunned, is gaining more traction. Across the country, 36% of employers report using them in 2014, more for tobacco use or refusal to participate in cessation programs (11% use premium surcharge). But carrots are still most popular, 61% of employers report a premium or benefit differential, 55% used cash, gift cards, or points; 27% used contributions to a benefit card (e.g., HSA/HRA/FSA).

Here we describe a research project into incentives for health and wellness, results from the research, and further areas of inquiry. The objective of this study was to support organizations in designing outcomes-focused incentive strategies, and to improve effectiveness of services provided by health plans. Most of the published research is focused on incentive impacts on certain behaviors, here we looked at the impact on population health and wellness outcome measures.


What we studied: Various types of incentives and their relationships to clinical outcomes, lifestyle risks and closure of gaps in clinical care. 

What we didn’t study: Impact of monetary value of incentives, organization culture, communication strategy and actual dollar savings – all important topics, mostly were not studied due to data or time limitations.

Methodology: pre-post cross sectional retrospective study of 2 million persons from 25 different organizations enrolled in a number of different health plans who received a variety of incentives during the study period. This was compared with 1.5 million persons, similarly enrolled in a number of different health plans, who did not receive any incentives related to their healthcare.


Carrot vs. Stick: The “stick” was proven to be 2.6 times more impactful in motivating program participation for chronic condition management

Health Profile: people with chronic conditions respond differently to incentives compare to those with only lifestyle risks: sticks are more effective for chronically ill persons, and carrots for those with only lifestyle risks.

Health Coaching: People who completed a “Health Risk Assessment” form only when incented present 4 times more opportunities for health coaching


Incenting sustained engagement is the key to improving health outcomes in a population; incenting only outcomes did not prove effective.

  • The five-year study of almost two million members is one of the largest industry studies on the impact of different types of health care incentives, and one of the only to link incenting engagement to improving health outcomes
  • This covers more than five years designing, managing and evaluating a variety of incentives, and represents an in-depth study of rewards and their impact on patient engagement, outcomes, and how this may ultimately impact health care costs
  • The findings offer insights into the way incentive design can be used to motivate healthier behaviors and improve health outcomes
  • Some key findings include:
  1. The strength of the stick: Using a disincentive to motivate engagement had a significant impact, particular with getting certain patients to participate in disease management programs
  2. Incenting data collection: Incentives around Health Risk Assessment and biometric completion can be key to identifying patients for engagement opportunities. Incenting HRA completion revealed up to 44 times more patients needing health coaching.
  3. The importance of incenting sustained engagement: To realize success in improving clinical outcomes, it is critical to focus on sustained engagement vs. incenting outcomes directly. Further, using a stick to as the lever can improve clinical outcomes up to 11%. Thus, not only is short-term behavior modified, but long-term improvements in outcomes were recorded.


Ken Yale is a senior executive with a track record of accomplishments in creating new products, establishing new markets, and growing innovative healthcare businesses through start-up, capital raising, mergers, acquisitions, and liquidity events. He has extensive prior and current work in care and disease management, and physician and patient engagement. He is a clinician and business professional with expertise in law, science, and medicine - and experience with government regulation, data science, and health care. Ken recently moved to San Francisco Bay area to collaborate with data science colleagues. He is currently focused on advanced clinical decision support, clinical and financial analytics, and patient engagement.

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