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Insurance savings incentive spurred walking among obese enrollees
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An Internet-based incentive program implemented by a large insurance company in the Midwest had positive effects on physical activity among obese enrollees, according to data from a mixed-methods evaluation of the program. Members who chose to commit to healthy lifestyles were eligible for improved benefits, such as lower deductibles and co-payments.
Acceptance levels were high, as determined by enrollment levels, and about two-thirds of those who participated said they appreciated the health benefits the program offered. Additionally, participants walked an average of 6,523 steps per day, and some experienced weight loss.
Incentive to walk
The Web-based walking initiative (Walkingspree), part of the Healthy Blue Living program, included Blue Care Network of Michigan enrollees who agreed to either participate in the program or meet targets for BMI, blood pressure and no tobacco use. The program required enrollees to walk an average of 5,000 steps per day to gain eligibility for the improved benefits: an estimated 20% cost savings for out-of-pocket expenses.
According to data, 6,548 of 15,397 Blue Care Network enrollees (43%) chose to participate in the walking program and walked an average of 6,523 steps per day, as calculated by a pedometer. Those who uploaded step counts for 75% of days for a full year (n=2,885) walked an average of 7,500 steps per day, the researchers wrote.
“There are ethical debates around the idea of forcing someone to be personally responsible for health care costs related to not exercising, but we expect to see more of these approaches to financially motivate healthier behaviors,” researcher Caroline R. Richardson, MD, from the Health Services Research and Development Center for Clinical Management Research at the Ann Arbor VA Medical Center and the department of family medicine at the University of Michigan Medical School in Ann Arbor, Mich., said in a press release. “Our evaluation of Blue Care’s incentivized program showed a surprisingly high rate of people who enrolled in the Internet-mediated walking program and stuck with it — even among those who were initially hostile to the idea. Wellness interventions like this clearly hold significant promise for encouraging physical activity among adults who are obese.”
Richardson, MD
Data from an optional survey of the program revealed that close to one-third of participants disliked the program and some described it as coercive.
“Nevertheless, given the mounting costs associated with sedentary behavior, approaches to financially incentivize healthy behaviors are likely to expand and gain political support, as has occurred with cigarette taxes and more recently with discussions about taxes on high-sugar beverages,” Richardson and colleagues wrote.
Program implementation
Aside from physical effects of the program, the researchers examined the factors that influenced Blue Care Network to implement such a program. These included forces from both outer and inner settings such as federal policies and rising obesity costs and organizational culture and support from leadership. Moreover, factors associated with the intervention and the implementation process also were influences, the researchers wrote.
“In addition, there were three cross-cutting themes that highlight some challenges that are specific to the implementation of an incentivized wellness program,” they wrote.
These included: 1) state and federal policies affecting program structure; 2) privacy and data security requirements for incentive eligibility; and 3) tension between personalized goals and simplicity of incentive structure.
According to the researchers, “A longer-term and more comprehensive evaluation to fully understand the program’s impact on clinical outcomes and health care utilization and costs” is warranted.
Disclosure: Richardson is a scientific adviser to Walkingspree and an unpaid consultant to Blue Care Network.
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