A new study that flew under the radar of most wellness professionals may have major implications for our understanding of how to influence health behavior and the role of outcomes-based incentives.
The study, published in the Annals of Internal Medicine, compared HbA1c improvements in three groups of diabetic patients:
- A group provided with telephonic coaching (a “buddy system”) delivered by a peer who received training in motivational interviewing.
- A second group offered a $100 incentive reward if their HbA1c dropped by one point after six months and $200 if their HbA1c dropped by two points or to 6.5%.
- A control group.
All three groups received their usual medical care.
The study subjects were not typical workforce members. In fact, some may not have been workers at all. The study included 118 African Americans ages 50-70, with poor glucose control, being treated by the Veterans Administration. They were randomly assigned to one of three study groups and had their HbA1c drawn at enrollment and at the end of the six month study period.
For more specific information about the protocols and findings, see the reader-friendly Issue Brief or try this link for a pdf of the full Annals article.
This was not an employee wellness study, per se, but it is relevant because one of the interventions tested — an “outcomes-based” incentive in which participants earn an incentive for achieving a specific biometric value — is fast growing in popularity among employers, despite the scarcity of evidence to support it. And the main intervention offered, peer coaching, may prove to have benefit for employee populations.
It would be ideal to have more worksite-specific research, but we are better off paying attention to non-worksite evidence compared to the usual wellness approach: flying by the seat of our pants.
In this study, the peer-mentoring approach was more effective than the incentive-based approach. As stated in a patient summary developed by the Annals of Internal Medicine:
“Patients with diabetes who talked with a peer mentor on a regular basis achieved the greatest decreases in HbA1c level. Patients with diabetes who received a small monetary incentive for good control had smaller decreases in HbA1c level that were not considered clinically important.”
This can’t be considered a breakthrough study for benefits and wellness managers, but we should certainly sit up and take notice that, in one of the few studies of its kind, the intervention that honored the individual, fostered social connection, and elicited intrinsic motivation trumped the intervention that relied on cold hard cash.
In an upcoming blog post: More about this study’s co-authors, George Loewenstein and Kevin Volpp, MD, leading behavioral economists upon whose work many employers’ have premised their so-called outcomes-based approach.
