Summary of key findings across all survey efforts:

  • Use of Incentives: is growing and have been associated with companies considered “top performers” in the are of managing healthcare costs.
  • Cash and Premium reductions seem to be the most popular type of incentives used across all of the studies.
    4 of the 7 studies found that Gift Cards were the most popular incentive used (Hay, ERIC-NAM, WatsonWyatt, SHPS).
    One study (SHPS) concluded that Cash-based incentives (which include Reduction in Plan Premium, Direct cash, HRA or HAS Contribution) versus non-monetary (merchandise, gift cards) have the greatest impact on reduced healthcare costs.
    15.6% average cost per employee decrease or $1,165 per benefit eligible employee.
  • Disincentives and non-voluntary incentives (i.e. requiring an activity to earn something) are not popular among both employers and employees and seem to be used by less than 25% of all who use Incentives. Rather, the “Carrot” approach seems to preferred.
  • When evaluated, the majority of incentive programs reward for program participation in health management programs versus achievement of outcomes or behavior change
  • While Health Assessments remain one of the most popular programs to use incentives, lifestyle behavior change programs are growing in popularity, specifically, weight management, smoking cessation and fitness.

Hewitt 2008

Two Roads Diverged:Annual Health Care Survey 2008

  • Sample Size: 448 Employers /HR Benefit Leaders (represents 8M employees); AND, 30,000 Employees were surveyed to gather employee perspectives on health and health care (The Road Ahead: Employee Views on Health (2008) Survey)
  • Survey Focus: Survey Focuses on healthcare benefit trends. (includes data on Use of Incentives: , targeted areas for incentives, employee perspectives on incentives for health improvement, types of incentives employees prefer/support.
  • Use of Incentives: 65% of those respondents are offering financial incentives to motivate employee healthcare behavior as part of their overall healthcare strategy
  • Types of Incentives Offered:
    Employers and Employees prefer “carrots” over sticks, and incentives that reward versus are required.
    7 out of 10 employees Support the use of lower premiums for practicing healthy behaviors
    76% agree with higher premiums for smokers
    64% of employees disagree with the stick approach when it comes to Health Asssessments. Feel it should not be required for health coverage.
  • Change from previous year: 48% either offered or were considering financial incentives in 2007 (17% increase in 2008 over 2007)
  • Other Key Data Points:
    The top 3 health priorities for employers over the next 5 years are weight management (77%), physical fitness (62%) and smoking cessation (49%)
    These may be emerging areas for tailored incentive programs
Download Hewitt Survey

Watson Wyatt 2008

2008 13th Annual National Business Group on Health/Watson Wyatt Employer Survey on Purchasing Value in Health Car

  • Sample Size: 453 employers that collectively employ 8.4 million employees
  • Survey Focus: This report identifies the actions of best performers as well as current trends in the health care benefit programs of U.S. employers.

    “Best-performing Companies” have realized significantly lower medical cost trends. Specifically, have a median two-year trend of only 1 percent (average of all respondents was 6.2% increase and “Poor Performers” had a cost trend of 10%.
  • Use of Incentives:
    More than half of all employers use financial incentives to encourage employees to participate in one or more types of health improvement activities and 24 percent more plan to do so in 2009
    42% of the best performing companies Offer financial incentives for participation in health improvement or disease management programs
  • Types of Incentives Offered:
    32% offer cash or cash equivalent to complete a Health Risk Appraisal
    22% offer cash or cash equivalent to participate in health improvement or Disease Management programs.
    Coverage differentials are most common for use of preventive services. (37%)
    Premium differentials: Only 12% use to drive HRA Participation. Only 4 – 6% use these types of incentives for health management program participation.
  • Other Key Data Points/Findings:
    The best-performing companies are getting results by incorporating programs and initiatives in five key areas
    1. Appropriate financial incentives
    2. Effective information delivery
    3. Metrics and evidence
    4. Quality care
    5. Maximizing health and productivity
    Companies with CDHP Plans are more likely to offer incentives to participate in health and disease management programs than non-CDH Employers.
Download Watson Wyatt Survey
 

ERIC-NAM/IncentOne 2007/2008

The use of Incentives with employee Health and Wellness and Disease Management programs

  • Sample Size: 281 Employers representing 7.6M
  • Survey Focus:
    Determine employer adoption of health and disease management programs.
    Assess types of incentives used with health and disease management programs; ways in which incentives are applied to activities or behaviors and determine the average amount paid.
  • Use of Incentives:
    78% offer wellness programs and 71% of those with wellness programs offer incentives.
    1. 64% offer Health Assessment programs and 62% of those with the HRA Program offer Incentives
    2. Safety, Smoking Cessation and Fitness programs are the next most popular programs using incentives.
    48% offer Disease Management programs but Only 15% offer in support of DSM programs
    1. 97% offer diabetes Programs but only 18% of these programs offer incentives
    48% using incentives to drive program participation
    38% using to reward for completing a program
    Only 16% use incentives to reward for outcomes.
  • Types of Incentives Offered:
    Gift cards: The use of “gift cards” increased from 17 percent in 2007 to 28 percent in 2008. (11% increase and most popular incentive)
    Premium reductions and cash bonuses as an incentive show a decline in use from 2007 (from 42% to 26%)
    Cash/Bonuses third most popular incentives remains the same (25%)
    Merchandise and health spending account contributions also remained unchanged (18% and 15% respectively)
  • Change from previous year: 52% in 2007 offered incentives in support of their H and W programs; (Decrease) 23% offered in support of their DSM programs.
  • Other Key Data Points:
    Avg Per participant per program ranging from approximately $100 to $300
    1. $143 = Fitness
    2. $140 = Smoking
    3. 123 = HRA
    4. $116 = Weight Management
    Wellness Programs are popular and on the rise: 77 percent of employers offer formal health & wellness programs, up slightly from 2007
    48 percent of employers offer formal disease management programs, approximately the same percentage as in 2007
    Most common incentives used with Disease Management Programs are Cash Bonuses, Health Account Contributions and Premium Reductions (versus gift cards)
    The proportion of those companies successfully measuring ROI increased dramatically between 2007 and 2008 from 14 percent to 26 percent of employers with programs.
Download ERIC-NAM/IncentOne Survey

Forrester 2007

The Employee Benefit News/Forrester Research 2007 Benefits Decisions’ Impact Study

  • Sample Size: 703 U.S Benefit Administrators
  • Survey Focus: Wellness and DM Program Trends among Employers (included data on use of Incentives, type of incentives, Consumer perspective towards incentives)
  • Use of Incentives: Approx 50% of the 639 who offer wellness or DSM offer incentives
    52% large employers
    43% medium sized employers
    46% small employers
  • Types of Incentives Offered:
    36% use Cash
    31% reimburse for cost of memberships (ie: Health clubs)
    28% use raffles
    27% use reduced employee health benefits contributions
    22% use Gift Cards
    6% use PTO

    Most Popular Incentive with LARGE Employers: Cash Incentives followed by health benefit reductions, then raffles.

    Most Popular with Medium Sized Employers: Raffles, health benefit reductions, gift cards

    Most popular with Small Employers: Cost reimbursement, Cash, Gift Certificates
Download Forrester Research

IBI July 2007

Incentives for Healthy Behavior and Workforce Productivity

  • Sample Size: 500 Employers (represents 5M employees)
  • Survey Focus: Survey on incentive trends among employers. ( Focused on incentives vs disincentive trends/preferences, Use of Incentives: and type)
  • Use of Incentives:
    73% of employers in the IBI sample of 500 employers provide at least one incentive program
    Only 19% use disincentives
    Medium sized employers (500 – 4,999) more likely to offer incentives than small or large.
  • Types of Incentives Offered:
    63% Use discounts
    62% use non-monetary gifts
    53% use benefits during a transitional return-to-work (RTW) period
    43% use lottery/sweepstakes Points for purchases and additional paid time off are the least-used incentives—at 17% and 12% of employers, respectively.
Download IBI Survey

SHPS Study 2007

2007 SHPS Health Practices Study

  • Sample Size: 2007 SHPS Health Practices Study
  • Survey Focus: The survey focused on numerous health care cost management strategies and evaluated which practices have a positive or negative impact on healthcare costs. Use of Incentives was one practice included in the survey and analysis.
  • Use of Incentives: Cash-based incentives (which include Reduction in Plan Premium, Direct cash, HRA or HAS Contribution) versus non-monetary (merchandise, gift cards) have the greatest impact on reduced healthcare costs.
    15.6% average cost per employee decrease or $1,165 per benefit eligible employee.
  • Types of Incentives Offered:
    Gift Cards/Merchandise (13.9%)
    Reduced Premiums (13.9%)
    Cash Payment (11.3%)
    Contribution to HAS/HRA (7.9%)
    Change in deductible/co-pay (5.2%)
    Free or discounted generic drugs 4.3%
    Other (2.6%)
  • Other Key Data Points/Findings: The study found a high correlation of those who used cash incentives and care management programs
Download SHPS Study

Hay Group/Wellness Advisor Survey 2006

2006 Hay Group Benefits Survey & Wellness Program Manager Advisor Survey

  • Sample Size: 750 Employers (large and Mid-Sized). 70% of those surveyed by WPM managed wellness programs.
  • Survey Focus: This report combines two survey efforts, both focused on trends with wellness programs, and the use and type of wellness incentives used at the worksite.
  • Use of Incentives: 69 percent of the WPM survey participants had some sort of formal incentive program
  • Types of Incentives Offered:
    Most Popular: Cash-Based Incentives (66% offer Cash-Based Incentives (defined as gift cards, merchandise, debit cards, cash);
    Health Assessments: 17.7 % of the companies that offered a wellness program had a cash, flex credit or other financial incentive to complete a health risk appraisal.
    Comprehensive wellness program: 17.2 percent had a financial incentive to participate in the comprehensive wellness program.
  • Change from previous year: 32.3 percent increase in the number of organizations offering cash bonus incentives since last survey in 2003
  • Other Key Data Points:
    34% of incentive programs focus on “attendance” of programs
    67% focus on program participation
    27% focused on outcomes
    40% focused on HRA participation only
    33% focus on behavior change.
Download Hay Group/Wellness Advisor Survey
  • Forrester Study: Large Employers defined as >1000; Medium = 250 – 999; small = fewer than 250
  • Survey participants include Wellness Program Management Advisor subscribers, subscribers to the e-mail Wellness Junction Professional Update and members of the Wellness Manager Discussion Forum. Over 70 percent of those who participated in the survey are directly responsible for the management or the administration of their wellness programs. The others who participated in the survey include: director of finance, financial manager, human resources (HR) assistant, human resources administrators, etc.