Data from a large employer that offered financial incentives to encourage participation in its wellness program are analyzed in this paper. It examines how the characteristics of first-time, wellness-program participants changed with the enhancement of financial incentives for health-risk assessments (HRA) and biometric screenings. Those who completed an HRA or biometric screening in the two years prior to the change in financial incentives (i.e., pre-incentive) are compared to those who completed an HRA or biometric screening in the two years (for HRA) or three years (for biometric screening) after the change in the financial incentives. Findings from this study paint a vivid picture of the type of individual who favorably responds to wellness-program financial incentives—a research contribution with important implementation and evaluation implications.
Demographics—Among employees who first completed an HRA post-incentive, 82.4 percent were male versus 70.2 percent who first completed an HRA pre-incentive. For biometric screenings, the gender comparison was similar. Late adopters also tended to be older. Among those first completing an HRA post-incentive, average age was 50.0 compared to 45.0 among the pre-incentive group. For biometric screenings, average age was 48.7 versus 46.4 for the post- and pre-incentive cohorts, respectively.
Health Status—In general, individuals who first completed the wellness programs during the post-incentive period were less healthy than early adopters. Moreover, prevalence rates of diabetes, high blood pressure and high cholesterol were all higher in the post-incentive groups than in the pre-incentive groups.
Health-Services Utilization—Visits to specialists were higher for the post-incentive cohorts. Prescription drug utilization was higher as well among post-incentive HRA completers (17.0 fills per year) compared to pre-incentive HRA completers (14.2 fills per year), and also greater for post-incentive biometric screening completers (18.7 fills per year) compared to pre-incentive completers (13.3 fills per year). In large part, individuals who first completed HRA and biometric screenings after the financial incentives were introduced were less likely to have consumed preventive care, and they were less likely to have visited a primary care provider.
Health Risks—Individuals who first completed the HRA post-incentive had greater health risk than those first completing it pre-incentive. Employees first completing the HRA post-incentive were more likely than those completing it pre-incentive to be at risk for blood pressure, exercise, glucose, nutrition, smoking, and weight.
Biometrics—Late adopters of biometric screening also had worse biometric values. Over one-third (35.2 percent) of post-incentive biometric screening completers was obese compared with about one-quarter (26.3 percent) of pre-incentive completers. Further, 50.3 percent of post-incentive biometric screening completers were pre-hypertensive, compared to 45.8 percent of early adopters.