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Telephone wellness coaching used more when combined with financial incentives
Interest in telephone health coaching offered through a nonprofit health plan in New England grew when incentives were offered for the use of motivational services, according to research presented at Obesity Week 2014.
“Financial incentives offered to work with a health coach substantially increased coaching uptake as well as the amount of times that health plan members worked with a health coach,” Jason Block, MD, MPH, of the Harvard Pilgrim Health Care Institute, Harvard Medical School, told Endocrine Today. “Members who were black or older-aged were more likely to work with a coach.”
Jason Block
Launched in October 2010, the program provided the coaching opportunity to any member of the health plan. Employers then began offering incentives in 2011.
Based on records of health plan members, health coach encounters and employer incentives, Block and colleagues collected data from October 2010 to July 2013 on all adult members (n=991,743; mean age, 42.6; 52% female; 89% white) to examine the impact of incentives on coaching use, predictors of uptake and persistence with services.
The incentives offered differed slightly each year: in 2011, $50 incentives were offered to one employer; in 2012, four employers received incentives ranging from $25 to $500; in 2013, $25 incentives were offered to one employer and $500 to another.
The researchers compared uptake between 16,961 members who received incentives and 974,782 members who did not, with adjustments for demographics. Survival analysis was used to examine the association between receiving an incentive and coaching uptake, with first contact with a health coach serving as the outcome.
During a follow-up of nearly 3 years, 4,898 members had worked with a coach; 1,675 were among the 16,961 with incentives (10%) and 3,223 were among the 974,782 without (0.3%).
Receiving an incentive was strongly associated with time until uptake of health coaching in 2011 (HR=6.9; 95% CI, 5.7-8.4), 2012 (HR=80.8; 95% CI, 74-88) and 2013 (HR=7.1; 95% CI, 5-10.1).
Minority race proved to be an important predictor of uptake, with Hispanics taking advantage of services most (HR=2.2; 95% CI, 1.9-2.4), followed by races other than white (HR=1.5; 95% CI, 1.3-1.7) and blacks (HR=1.2; 95% CI, 1.1-1.4). Higher uptake was seen in people aged 40 to 59 years (HR=1.7; 95% CI, 1.6-1.8) vs. those older than 60 years (HR=1.4; 95% CI, 1.3-1.5).
Persistence was greater with incentives vs. no incentives (HR=0.6; 95% CI, 0.2-1) and highest with blacks (HR=1.8; 95% CI, 0.9-2.6) and people older than 60 years (HR=2.5; 95% CI, 1.9-3.1).
“Many employers and health plans are providing wellness incentives; however, there has still been relatively little evaluation of real-world programs,” Block said. “Our study demonstrates that incentives promote participation in wellness activities.”
Although very few health plan members participate in wellness activities without incentives, Block underscored that incentives appear to drive only modest participation. “This could lead to improvements in health; however, more research is needed to determine if that actually happens.” – by Allegra Tiver
For more information:
Block JP. Abstract T-3124-OR. Presented at: Obesity Week; Nov. 2-7, 2014; Boston.
Disclosure: This work was supported by a grant program through the Harvard Pilgrim Health Care Institute, with additional funding from the National Heart, Lung, and Blood Institute.