Motivating Employees to
Make Lifestyle Changes
by
Elaine Frank, M.Ed., RD
Vice President
American Institute for Preventive Medicine
Total Employee/Employer
Health Care Costs: 2003 - 2008
Average Amount of Time (in Hours) Consumers
Spend Thinking About Various Purchase Decisions
Car
6.8
Holiday Gifts
4.4
Furniture
4.3
Computer
4.1
Television
3.3
Washer/Dryer
2.8
Birthday Present
2.7
Stereo
2.3
Shoes
Employee Benefits
1.3
0.8
Source: MetLife, 2007
Determinants of Health
60%
50%
50%
40%
30%
20%
10%
20%
20%
Genetics
Environment
10%
0%
Access to Care
Behavior
Actual Causes of Death in U.S.
435,000
T obacco*
400,000
Poor diet/physical inactivity*
85,000
Alcohol consumption*
Microbial agents
T oxic agents
Motor vehicle accidents*
Firearms*
75,000
55,000
43,000
29,000
Sexual behavior*
20,000
Illicit drug use*
17,000
* Indicates lifestyle related
The Cost of an
Unhealthy Lifestyle
 87.5%
of health care claims costs are
due to an individual’s lifestyle.
Source: Indiana University-Purdue University, Fort Wayne (IPFW) Study, 2006
Higher Premiums for
Unhealthy Lifestyle?

Is it fair to charge those who live
unhealthy lives to pay higher
insurance premiums?
Year
2007
Fair
37%
Unfair
42%
Not Sure
20%
2006
53%
32%
14%
2003
37%
46%
17%
Source: Wall Street Journal Online/Harris Interactive Poll, 2007
How Companies Are Responding
to Increased Health Care Costs
66%
59%
56%
58%
55%
31%
% of
companies
Increased
copays
Increased
participant
cost
Increased
deductibles
Participants Switched
pay more for providers
prescription
drugs
Source: Society for Human Resource Management, 2008
Offer
wellness
program
Association of Risk Levels with
Several Corporate Cost Measures
Outcome
Measure
Low Risk
(N-671)
Medium Risk
(N=504)
High Risk
(N=396)
Short term
disability
$120
$216
$333
Worker’s
compensation
$228
$244
$496
Absence
$245
$341
$527
Medical &
pharmacy
$1,158
$1,487
$3,696
Total
$1,751
$2,288
$5,052
Source: Wright, Beard, Edington, JOEM 44(12): 1126-1134, 2002
Issues Most Affecting
Employee/Member Productivity
80
72%
70
59%
60
58%
57%
49%
50
49%
40
30
20
10
0
Stress
Personal/
Family
Chronic
medical
conditions
Unscheduled Presenteeism
absences
Source: Watson Wyatt, 2005
Lifestyle
medical
conditions
Characteristics of Low Health
Care Cost Companies





Understand the current state
Are decisive and take action
Don’t simply shift costs to employees
Create a “culture of health”
Solutions target underlying causes
–
–
Invest in programs that encourage employees to
manage their health risks and conditions
Require employee to be more accountable for their
decisions and provide info and resources to help
Source: Towers, Perrin, 2007
Prevalence of Wellness Programs
Do
Plan to
Source: SHRM 2008 Benefits Survey Reports
How to Offer Wellness Programs

Make activities/programs
accessible
 Make activities/programs
affordable
 Involve dependents
–
Responsible for 70% of costs
– Women make 80% of decisions
Maximize Employee Participation

Create a culture of health
 Multi-component methods
 Saturation effect
 Incentives
What Determines
Employee Motivation

Relative ease and ability to
achieve an outcome or earn a
prize/reward
 Extent to which the reward is
worthwhile and the goal is
achievable
 Short term versus long term
consequences of behavior
The Strategic Use of Incentives
Identify the behavior(s) you’re trying to
change
 Understand what will motivate your
employees/members
 Identify the incentives to be used
 Communicate the incentive program
 Evaluate the impact

Incentives Can Increase








Participation
Compliance
Behavior change
Productivity
Learning
Achievement
Awareness
Performance
What Consumer Behaviors
Earn Incentives
Use of Incentives
American Institute for Preventive Medicine
Dollars Being Spent Per Person
Per Year on Incentives
American Institute for Preventive Medicine
Types of Incentives, NAM / ERIC 2008
American Institute for Preventive Medicine
Types of Incentives, WELCOA 2006
Cash Awards
279
respondents
30.4%
Prizes
74.0%
Special Recognition
38.8%
Company-Paid Programs
Co-Payment/Reimbursement
23.6%
Flex Time to Participate
16.0%
Other
None
356
respondents
216
respondents
147
respondents
Company Time to Participate
Premium Reduction
424
respondents
46.2%
47.0%
12.9%
10.3%
118
respondents
94
respondents
6.2% 57
respondents
Source: Wellness Councils of America, 2006
431
respondents
679
respondent
Cash vs Merchandise

Merchandise has residual value
 65% say cash is remembered shortest
time period
 60% see cash as part of compensation
package
 Cash is taxable
Source: Incentive Federation Study, 2005
Effect of Incentives
on Participation
Participation
100%
No Incentives
With Incentives
80%
60%
40%
20%
0%
Time
Source: Larry Chapman, Summex WebMD
Impact of Incentive on HR Participation
90%
80%
80%
70%
60%
Participation
60%
50%
50%
40%
30%
25%
20%
15%
10%
0%
$0
$25
$50
$ Incentive
$75
$100
Linking Wellness to
Benefit Plan Design

Offer reduced health premiums
 Provide preventive medical benefit
coverage
 Add wellness to the health plan coverage
 Provide a rebate of a portion of the
savings
Advantages of Incentives

Can increase motivation and change
behavior
 Easy to implement
 Can be very powerful
Potential Pitfalls of Incentives

May only reach healthy employees
 Confidentiality concerns
 May not be offered equitably
 Unintended artifacts
 May create a dependency
 May not yield desired results
 Can be costly
HIPAA Issues

Latest guidelines
 Effect on incentives
– A limited value
– Designed to improve the participant’s health
– Available to all employees in the same
circumstances
Health Belief Model
(Becker)

Recognize existence of risks
 Identify with risk
 Think behavior change reduces risk
 Think behavior change is worth effort
Source: American Journal of Health, 64:205-216, 1974
Stages of Change Model
(DiClemente and Prochaska)

Pre-contemplation
 Contemplation
 Preparation
 Action
 Maintenance
Source: Health Psychology, 13:39-46, 1994
BEMEM Model of
Behavior Change (Powell)
Behavioral
 Educational
 Motivational
 Enjoyable
 Maintainable

Source – American Institute for Preventive Medicine, 2008
Multiple Treatment Approach


Stimulus control
Thought control
 Behavioral rehearsal
 Cognitive restructuring
 Assertiveness training
 Incompatible behavior
 Goal setting
 Successive approximations
 Positive reinforcement
 Data collection
 Contracting
Methods for Increasing
Motivation/Compliance

Make materials easy to use
 Use feedback system
 Model and practice techniques
 Provide materials for techniques
 Dramatize the concept
 Make activities enjoyable
 Make materials easy to read
Appropriate Program Materials

Attractiveness
 Reading level
 White space
 Culturally diverse illustrations
 Fast food education
Multi-Component Program

Assessment activities
 Communication materials
 Self-help programs
 Group programs
 Coaching
Quit Rates for White-Collar and Blue-Collar
Employees Combined 12-Month Follow-Up
Category
Total# of
Employees
# of
Nonsmokers
% Who
Quit
All employees
622
138
22%*
Employees able to
be contacted
397
138
35%
Employees who used
kits
308
138
45%
*Assumes all employees who could not be contacted are smokers
Source: American Journal of Health Promotion
Programming with
Short Term Benefits

Seat belt usage
 Consumer education
 Prenatal care
 Medical self-care
Unnecessary Utilization
 Doctor visits – 25%
 Average cost -- $101
 E.R. visits – 55%
 Average cost -- $383
Source: National Ambulatory Medical Care Survey, 2006
Employee/Member
Co-Pay Costs
Activity
Amount
Doctor Visit
$20
ER Visit
$50
Prescription
$20
Total $90
“The Lowe’s Health at
Home® book was the reason I
went to see my doctor and it
saved my life.”
Jeff Bilbrey
Sales Specialist,
Bloomfield Hills, MI
“If it weren’t for Health at
Home®, I wouldn’t have
discovered I had ovarian
cancer in an early stage.
After radiation and chemo,
my prognosis is excellent.”
Registered Nurse
Fairview Health System
Minneapolis, MN
Understand How Your
Employees/Members Learn
Printed material
 Telephonically
 Online

Thank you for your attention.
Questions?
Contact:
Elaine Frank efrank@HealthyLife.com , or
Don Powell dpowell@HealthyLife.com
800-345-2476, ext. 221
Fax: 248-539-1808
Web Site: www.HealthyLife.com