Rewarding Healthy Behaviors—Pay Patients for Performance

Joanne Wu

doi:10.1370/afm.1334

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Response to "Capitalize on Employer Advantages"
Joanne Wu

Published on: 31 May 2012
Capitalize on Employer Advantages
Leonard L. Berry, PhD

Published on: 30 May 2012

Published on: (31 May 2012)
Page navigation anchor for Response to "Capitalize on Employer Advantages"
Response to "Capitalize on Employer Advantages"
Joanne Wu, Family Medicine Physician
I would like to thank Dr. Berry for his perceptive comments on PP4P. In response: 1) I agree that focusing on two specific health problems like hypertension and diabetes is not as effective as trying to improve overall wellness, but they are two conditions that happen to have very measurable objective goals , so could be a good place to start. 2) People who are healthy will receive rewards for doing activities that mainta...
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I would like to thank Dr. Berry for his perceptive comments on PP4P. In response: 1) I agree that focusing on two specific health problems like hypertension and diabetes is not as effective as trying to improve overall wellness, but they are two conditions that happen to have very measurable objective goals , so could be a good place to start. 2) People who are healthy will receive rewards for doing activities that maintain their health (such as exercising, or getting preventive health exams done in a timely fashion- i.e. screening colonoscopy, pap smears, lipid screening). They can save up points to use for discounts on future office visits or on medications if they need them in the future. Hopefully this will make PP4P more acceptable to a wider audience, particularly since the rewards are not in the form of direct cash. 3) The incentives provide discounts for further medical care, so are meant to be ongoing and help perpetuate further healthy behaviors. There wouldn't be a specific end-date planned for the incentives. 4) I completely agree that a partnership among patients, employers, and doctors has the potential to be even more effective in improving health than just a partnership between doctors and patients. As you astutely pointed out, employers have more interaction daily with people, potentially allowing more influence over their long-term health behavior changes than physicians. In my article, I did include employers as one of the main group of financers for the PP4P program. Certainly, employers have a strong incentive to keep employees healthy, since they are often the ones who pay for health insurance. I also agree that a multi-pronged approach that includes nutrition counseling and gym memberships could be helpful in affecting long-term change.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (30 May 2012)
Page navigation anchor for Capitalize on Employer Advantages
Capitalize on Employer Advantages
Leonard L. Berry, PhD, Professor
Dr. Wu's proposal to pay patients for performance is a creative idea that contributes to the dialogue on a central challenge in healthcare: motivating patients to take more responsibility for behavior that influences their health. I doubt that Dr. Wu's approach will gain traction, but I do hope the pilot studies she recommends will be done. My doubts may be unfounded.
Here are my primary concerns about Dr. Wu...
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Dr. Wu's proposal to pay patients for performance is a creative idea that contributes to the dialogue on a central challenge in healthcare: motivating patients to take more responsibility for behavior that influences their health. I doubt that Dr. Wu's approach will gain traction, but I do hope the pilot studies she recommends will be done. My doubts may be unfounded.
Here are my primary concerns about Dr. Wu's proposal to pay patients for performance:
1. It is piecemeal. It focuses on a specific condition, such as diabetes or hypertension, rather than overall wellness.
2. Many patients will be missed by such a program, including those who do not have the targeted medical condition and those who are not responsive to an incentive. Some patients may be offended by the idea of a payoff and healthy patients may feel penalized for being well.
3. Once started, it is difficult to end an incentive program as the airlines have found out with frequent flyer programs. What happens if the health incentive is removed?
The best opportunity to effect sustainable behavior change in patients is to provide encouragement and resources that foster intrinsic motivation. At best, extrinsic motivators like incentives pave the way for behavioral change that becomes self-motivating over time. My colleagues and I have studied some of the most progressive employer health promotion programs in the U.S. (1-3) and we believe that employers have several important advantages over medical practices in fostering a sustainable commitment to wellness among individuals. First, employers have continuous access to employees. People do not eat or exercise at a doctor's office, but they may at work. Employers are well-positioned to offer employees nutritious food, opportunities for physical activity, and health screening and risk assessments (2). Second, employers have an incentive themselves, a big one, to engage and support employees in adopting behaviors that reduce their health risks, given fast-rising health benefit costs and documented productivity losses of unwell workers (4).
Dr. Wu's provocative paper is a welcome addition to the literature. It really makes you think. My view is that the more promising approach to foster sustainable wellness behavior is a multi-pronged approach that involves education on what people should do and accessibility to resources to help them actually do it, e.g., access to a fitness center, a physical trainer or dietician, healthful food, and medical personnel. We need to be thinking more about innovative employer-medical community partnerships that capitalize on the advantages of each.
REFERENCES
1. Berry LL, Mirabito AM, Baun WB. What's the hard return on employee wellness programs? Harv Bus Rev. 2010;88(12):105-112.
2. Berry LL, Mirabito AM. Partnering for prevention with workplace health promotion programs. Mayo Clin Proc. 2011;86(4):335-337.
3. Berry LL, Adcock G, Mirabito AM. "Do-it-yourself" employee health care. Sloan Mgmt Rev. 2012;53(2):15-16.
4. Loeppke R, Taitel M, Haufle V, Parry T, Kessler R, Jinnet K. Health and productivity as a business strategy: a multiemployer study. J Occup Environ Med. 2009;51(4):411-428.
Competing interests: None declared
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Competing Interests: None declared.