Bravo helps employers and health plans leverage wellness to strengthen their business and optimize healthcare investment.


Last month I shared what could be interpreted as a bit of a rant regarding the debates concerning the virtues and value of employee wellness programs. I agree that a person or organization expecting a simple and inexpensive 3-step process that will result in employees developing a passionate resolve to change how and what they eat, spending 30 minutes a day in the gym and making their health risks and medical claims disappear, will be very disappointed in the results they experience. It sounds too good to be true because it is. …….
Imagine if your auto insurance company decided to ignore your accident history and speeding tickets,
and instead just charged everyone a higher fixed amount for their coverage. How long could that go on? How long until the good drivers say “enough is enough” when their rate keeps going up because of you? Sure the insurance company could have a counselor call you and educate you on how you should slow down, wear a seatbelt and fix your broken mirrors. Maybe they’ll show you a video on the dangers of not brushing the snow off your windows before getting on the freeway. I believe that some people would appreciate the outreach and may take it upon themselves to change; some may already be following these guidelines. But the majority already knew these things and just didn’t believe that bad things would ever happen to them. It wasn’t personal, and if it’s not personal, people aren’t alwaysmotivated to change. Would people slow down for a “suggested speed limit” or just when they may befacing a $200 ticket? Premium increases following an accident and fees for traffic violations make it personal and challenge individuals to become accountable for their choices.

Of course, your health is different than your driving record though. Right? If we were penalizing people for a BMI over 25 or an elevated blood pressure, then yes, it would be a different scenario because unlike their driving habits they may not be able to control their risks as easily. Or they might not be a risk at all given the full set of their circumstances. Well-designed incentive programs may offer a reward if you achieve an “optimal” goal so that you don’t have to jump through numerous hoops like wearing a pedometer, having coaching sessions or logging your food intake. On the other hand, those who don’t achieve all of the goals may need tools and resources like these to help them improve. Compliant incentive plans will give you other ways to qualify for the full reward, such as some amount of incremental improvement. With medical benefits being the number 2 or 3 expense at the majority of U.S. companies, is that really too much to ask people to do?

Bravo has implemented hundreds of outcomes-based wellness incentive programs. Now going into our seventh year, we are seeing some unique and interesting data surface from our groups. We recently completed an analysis of 45 accounts that had an outcomes-based program with incentives for meeting blood pressure, cholesterol, tobacco use and obesity measures in place for three years. (See chart below.) The results for all 45 accounts (nearly 37,000 unique participants) were more favorable than anything we had previously heard of with participation-only incentives. Additionally, when comparing the 10 accounts with the greatest health improvement to the 10 accounts with the least improvement, we could clearly see that the 10 who experienced the greatest amount of health improvement had more aggressive health goals (such as a BMI of <27.5 versus 30) and much greater financial incentives tied to the plan (an average of $1,100 versus $500).

The top 10 experienced sustained improvement in cholesterol levels seeing the percentage of those with an LDL greater than 160 decrease by 38%, blood pressure levels – seeing the percentage with a blood pressure >140/90 decrease by 52.3% and tobacco use – decreasing by 7.7% while obesity levels improved only in cases where at least $50 per month was tied to the category, and the full reward was offered for modest improvements (such as 5% weight loss in a 12 month period). The percentage of the cohort population with a BMI over 30 decreased by 3% respectively. It’s also noteworthy to report that measures that were gathered and reported as a health risk but were not associated with an incentive did not improve. For example, the number of individuals with a fasting glucose score of 126 or higher actually increased by 4.7%. In other words, we told people that they might lose a leg, go blind or have to wear an insulin pump but, when this was just a risk of a future consequence versus a penalty in next week’s paycheck, they didn’t take action nearly as fast or as effectively.


I’ve met with organizations who say “we’re very paternal; we want to gently introduce this to employees and not increase the dollars or health goals until we’ve seen more people pass.” I’ve also met with organizations who say “we’re very paternal; we have to teach people that their health is their responsibility and equip them to make better choices.” As a father of four, I compare it to teaching my kids to ride a bike and my decision of when to let go. I love my children, and would be devastated if they suffered an injury, but realize that if I never let go they would never ride without my handholding. Be paternal. Teach, equip, empower, trust and then let go. Having a BMI goal of 27 instead of 32 and incenting with $100 per month versus $50 per year may feel aggressive – and people may complain – but the results speak for themselves and the complaints stop as soon as people realize how much better they feel after you provided them with an avenue to see their doctor and improve their high risk factors.

The evidence is exciting and encouraging. An incentive alone is not a wellness program. I’m taking it for granted that employers who head down this path will appreciate the need for a positive culture, leadership support and encouragement, health education and access to tools and resources to help people succeed. These have long been the staples of a reasonably designed wellness program but these programs have also struggled to show and positive results. Adding the “good driver discount” and making it reasonable to achieve, and financially meaningful to attain, is proving to be the missing ingredient in many strategies.