Behavioral Perspective

Transcription

1 Click to edit Master text styles Incentive-Based Wellness Programs: Understanding the Rules of the Road Second level Behavioral Perspective Third level Fourth level» Fifth level David Anderson, PhD LP Innovations in Workplace and Community Wellness April 7, 2014

2 David R. Anderson, PhD LP HERO Chairman, Research Committee Member, Board of Directors Founding member StayWell Health Management EVP & Chief Health Officer Co-founder

3 What Drives Behavior? Psychology 101 Animal Drives Drive 1: biological drives like food, water, sex Drive 2: reward/punishment, i.e. extrinsic motivation Psychology 201 Human Needs Drive 3: intrinsic motivation Highest levels in Maslow s hierarchy of needs Autonomy, competence, relatedness Self-determination theory Deci & Ryan State of absorption in an activity for its own sake Sense of engagement, happiness, fulfillment, timelessness Optimal level called flow by Mihaly Csikszentmihalyi

4 Extrinsic vs. Intrinsic Why Care? Controlled vs. Autonomous Motivation Controlled: Seduced, coerced, pressured Autonomous: Volition, endorsement, interest, deeply valued Some even choose to die for valued beliefs Limits of wellness incentives Controlled motivation buys compliance Compliance depends on incentive

5 What s the Evidence on Incentives? Incentives increase short-term compliance HA, activity participation, simple short-term actions Long-term change requires intrinsic motivation or large ongoing incentive Large external incentives may decrease intrinsic motivation People work long and hard for valued goals Health is not a passion motivating most people until it s gone Large outcome-based financial incentive may increase perceived value of employer s health goals but little evidence yet exists Initial compliance may become intrinsic over time Requires strong cultural alignment, e.g. seat belt use, smoking

6 Smoking Trends Among U.S. Adults 45% 42.4% 37.4% 37.1% 35% 33.2% 30.1% 25% 25.5% 24.7% 22.8% 20.8% 19.3% 18.0% 15% Source: National Health Interview Surveys,

7 HA Participation Rate (%) Supportive Environment Matters Impact of Culture and Communications 100% Weaker Strong 80% 65% 69% 60% 40% 27% 44% 33% 41% 33% 51% 37% 51% 41% 53% 20% 0% Comm. Culture Comm. Culture Comm. Culture Non-Cash Incentives Cash Incentives Benefits-Integrated Incentives n=4 n=16 n=16 Reference: Seaverson ELD, Grossmeier J, Miller TM, Anderson DR. The role of incentive design, communications strategy and worksite culture on health assessment participation. American Journal of Health Promotion, 2009;23:

8 The Three Pillars of Engagement

9 ACA Regulations and Wellness Incentives are NOT a wellness program Large incentives are health plan design feature ACA driving rapid growth in incentives Usage, amounts, requirements Trend toward outcome-based designs Behavioral and policy issues Limited evidence of long-term behavioral impact Concerns: fairness, trust, extrinsic motivation

10 Reasonably Designed Wellness Program Guidance for a reasonably designed employer-sponsored wellness program using outcomes-based incentives: Consensus statement of the Health Enhancement Research Organization (HERO), American College of Occupational & Environmental Medicine (ACOEM), American Cancer Society and American Cancer Society Action Network, American Diabetes Association, and American Heart Association. Journal of Occupational and Environmental Medicine. 2012;54(7):