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  1. 1. Copyright © 2013 ShapeUp, Inc. All Rights Reserved. Proprietary & Confidential shapeup.comARE OUTCOMES-BASED PROGRAMSEFFECTIVE AND ETHICAL?
  2. 2. Towers Watson/NBGH Cost of Health Care Survey 2012• 68% of companies use incentives to promote participation• 32% plan to expand their incentives in 2013• Outcomes-based incentives are less popular:
  3. 3. Aon Hewitt 2012 Health Care Survey• 61% of employers offer incentivesor disincentives to motivatesustained healthcare behaviorchange• Of those who offer incentives, 50%tie them to wellness outcomes• 25% of employers who offerincentives tie them to healthyprogress
  4. 4. The Case For Rewarding Healthy Progress• People tend to place more weight on the present than the future, thusimmediate rewards are more motivating• Frequent, smaller, real-time rewards are more successful than promises oflarge, future rewards since they provide immediate gratification
  5. 5. “While more than 80% of employers provide an incentive to complete a healthquestionnaire, less than 10% provide an incentive to address the results ofthe questionnaire.More than 60% of employers provide an incentive to complete biometricscreening, yet again, less than 10% provide an incentive to take any action.Less than 20% of employers provide an incentive to employees who achievetargeted clinical results.This focus on participation and access to information rather than outcomesand results won’t move the needle when it comes to health improvement”– Aon Hewitt 2012 Health Care SurveyThe Case For Rewarding Health Outcomes
  6. 6. Are Outcomes-Based Incentives Effective?• “A review of 17 studies by researchers at Oxford University found nodifference in outcomes among participants in a smoking cessationprogram between those who received a financial reward and those who didnot. Another group of researchers in the UK reviewed 9 randomizedcontrolled trials of obesity treatment and found no significant effect of theuse of financial incentives on weight loss at 12 and 18 months.”• “On the other hand, a series of studies conducted at the University ofPennsylvania showed positive results associated with programs usingfinancial rewards. One study found that financial incentives were effective inproducing weight loss, but the results were not fully sustained seven monthsafter the program ended. In another study, financial rewards significantlyincreased rates of smoking cessation among 878 employees of a large”6Source:
  7. 7. Incentives: The Employer Argument• “In general, business groups want employers tohave maximum flexibility to design programswith rewards or penalties that will encourageemployees to not only participate but also toachieve and maintain measurable health statusgoals, such as quitting tobacco use or reducingbody mass index. They argue that individualsshould bear responsibility for their healthbehavior and lifestyle choices and that it isunfair to penalize an employers entire workforcewith the medical costs associated withpreventable health conditions as well as thecosts of reduced productivity.”Source:
  8. 8. Incentives: Consumer Advocate Argument• “Unions, consumer advocates, and voluntary organizations such as the AmericanHeart Association are generally wary of wellness initiatives that provide rewards orpenalties based on meeting health status goals. They are concerned that, ratherthan improving health, such approaches may simply shift heath care costs fromthe healthy to the sick, undermining health insurance reforms that prohibitconsideration of health status factors in determining insurance premium rates.”• “They argue that such incentives are unfair because an individuals health status is aresult of a complex set of factors, not all of which are completely under theindividuals control. For example, genetic predisposition plays a significant role indetermining many health status factors, including such attributes as excess weight,blood pressure, blood sugar, and cholesterol levels. Consumer advocates alsocaution that poorly designed and implemented wellness initiatives may haveunintended consequences, such as coercing an individual with a health conditionto participate in an activity without adequate medical supervision.
  9. 9. Copyright © 2013 ShapeUp, Inc. All Rights Reserved. Proprietary & Confidential shapeup.comPrepared