Rewarding Bad Behavior
Why are we paying people for acting the wrong way?Although phrased more politely, this in essence was the question raised by a caller on a recent HCPro audioconference that I moderated. The conference was focused on ways to get members to abandon bad habits and to lead healthier lives, so it's little wonder that for the past 45 minutes we had been discussing the use of incentives to get smokers to kick the habit, or to encourage members who were overweight to lose some of the extra pounds.
I could hear his frustration, and he's not the first person I've heard raise the issue. Some of the most common incentives offered by employers and health plans these days are designed to get people to stop smoking or lose weight. Often these benefits take the form of cash rewards or discounts on the member's health insurance premiums.
But where's the benefit for the member who leads a smoke free life or already found the willpower to kick the habit? What's the benefit of a $10 a month discount on premiums for entering a weight loss program to the worker that has maintained a healthy body mass index? The money for these programs has to come from somewhere and many members feel it's coming out of their pockets.
Well, the benefit is in the form of lowered healthcare costs for everyone if we reduce the rate of smoking or other unhealthy behaviors. But that doesn't mean that all enrollees will see the big picture. Many will grumble that they should take up smoking just to quit for the incentive. . .and some may even try to game the system in this way.
But it doesn't have to be like this. The speakers for the audioconference--Robin Foust of Zoe Consulting and Sue Lewis of IncentOne--were quick to point out that there are tangible incentives available that can provide an immediate benefit to the entire workforce that participates, not just those with serious health risks. One such way is to create an incentive for all workers to undergo a Health Risk Assessment combined with biometric testing.
Those who participate and are within healthy ranges continue to receive the incentive throughout the benefit year. If the HRA identifies someone as a smoker, then that person would have to enter a cessation program and remain compliant to get the benefit.
If someone doesn't participate in the HRA or adhere to a recommended intervention, then the incentive is never provided or is revoked. Looking back, this is a lot like the allowance system that my sister and I enjoyed growing up. As long as were compliant with the program--cleaned our rooms, did the dishes after dinner, etc.--we received our allowance.
But if we engaged in risky behavior, such as fighting with each other or cutting class, then those actions had consequences. Now grounding an enrollee who drops out of a smoking cessation program might be difficult, but cutting their "allowance" is imminently doable.
Brad Cain is editor of California Healthfax and executive editor for managed care with HealthLeaders Media. He may be reached at firstname.lastname@example.org .
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