Workforce Health + Benefits

How To Use Wellness Incentives To Improve Participation and Employee Health

Creating an employee wellness program requires effort, patience, and trial and error to find what works for your people and your budget. But it’s not enough to have an employee wellness program—participation in the program is just as important. Which is why many organizations turn to financial incentives to spark participation.

Some consider them a core component of workplace wellness initiatives, as 78% of large employers offer them in their program, and most find them useful in motivating people to participate.

But wellness incentives are a hot topic of debate and study, as many people want to ensure that their investment will produce results. In this article, we’re diving into new research about the influence of incentives on wellness program participation and population health improvement. We’ll answer the following questions:

  • What are the different kinds of wellness incentive designs?
  • Can incentives influence health outcomes?
  • What makes a workplace wellness program successful?

New research suggests incentives, combined with a supportive workplace health culture, can achieve favorable outcomes in wellness participation and health outcomes.

In October 2020, the Health Enhancement Research Organization (HERO) published a study titled, “Influence of Incentive Design and Organizational Characteristics on Wellness Participation and Health Outcomes.”

While prior research indicates that incentive design and incentive amount influences program effectiveness, little research examines how incentive designs, combined with other organizational factors, influence population-level health outcomes. HERO launched this study to address that gap in the research.

Bravo supplied aggregated, de-identified data to HERO, alongside two other national suppliers of health and well-being incentive administration services to conduct the study, published in the Journal of Occupational and Environmental Medicine.

Researchers identified four common patterns in incentive designs with varying levels of success in participation and outcomes.

What are the different kinds of wellness incentive designs?

Since companies continue to provide financial incentives in their health and well-being programs, understanding how to incorporate them into the program is essential.

Across the 174 organizations in the study, researchers identified four common patterns in incentive designs: “participation-focused,” “outcomes-focused,” “combination,” and “participation-to-outcomes.”

Participation-Focused Incentives

These reward individuals for participating in a biometric screening, health risk assessment, health intervention, or completing a health intervention.

16% of organizations in the study favored a participation-focused incentive design.

Outcomes-Focused Incentives

These designs reward individuals for achieving targets or improving health-related outcomes including BMI, weight, blood pressure, cholesterol, tobacco use and glucose.

44% of organizations in the study favored an outcomes-focused incentive design.

Combination (Participation and Outcomes-Focused Incentives)

In this type of plan, rewards were available for participating in or completing an activity and/or achieving targets or making improvements in health-related outcomes.

17% of organizations in the study favored a combination approach to their incentive design.


24% of organizations began with a participation-focused incentive design and shifted the program to include rewards for achieving targets or making improvements in health-related outcomes.

Can wellness incentives influence health outcomes?

The short answer, based on this study, is yes! The combination approach showed the most promising outcomes in terms of participation and population-level health improvements.

But the incentive design isn’t the only influencing factor in participation and health outcomes.

Study author Jessica Grossmeier said of these findings, “There is an indication, a leaning, that a combination approach may be more desirable when it comes to the kind of outcomes you’re looking at. Now, I want to say ‘may’ because there were those other factors at play like the health and well-being support index.”

Combination Incentive Design Results

Companies with a combination incentive design had the second-highest participation in health assessment and screenings (which improved over time). They also recorded second-highest participation in health behavior change interventions (which decreased over time). These companies also scored the highest on the health and well-being support index and averaged the second-highest incentive value of $753.

In terms of health outcomes, companies that combined participation and outcomes-focused incentives saw:

  • The most improvement in blood pressure risk
  • The most improvement in cholesterol risk
  • A significant improvement in glucose risk
  • A non-significant increase in obesity risk

Want to see the participation and population-level health outcomes for each type of incentive design? Download the results infographic.

What makes a wellness program successful?

5 Takeaways For HR and Workplace Wellness Practitioners

To better interpret this study’s findings, you have to understand that it’s not just the incentive design that led to these outcomes. Organizational planning and support for the program, plus the incentive amount, also play a role.

So, what are those other support elements?

The health and well-being index from this study identified five essential elements that lead to participation and health outcomes:

1. Strategic Planning

Talk with your leadership team and poll employees about what is most important to them to build a one-, three- and five-year vision for what employee wellness could look like at your organization.

Review available data from and about your employees, including aggregated medical, Rx, workers’ compensation and disability claims, and any past health risk assessment and biometric screening data to create a comprehensive view of risks and opportunities.

Work with your well-being vendors to create measurable goals that will guide your evaluation process throughout the year, and make sure everyone’s on the same page.

2. Organizational Support

Strong organizational and leadership support practices are the strongest predictor of participation and health and medical cost impact. That’s why it’s important to get leadership involved in the program and seek out wellness champions to garner grassroots support at all levels of the organization.

Encourage leaders to play a role by publicly recognizing employees for healthy actions and becoming a role model for prioritizing their health and work-life balance. Involve wellness champions in day-to-day promotion activities and empower them to organize and host wellness-related events.

3. Participation Strategies

What good is a program if employees don’t know what it is, how to participate, or how it might benefit them? Our top tips for promoting your program effectively include:

  • Communicating via a variety of touchpoints, including digital, in-person, in-home and in-environment.
  • Incorporating programs that employees care about by polling them in advance about their health goals.
  • Simplifying registration and participation steps and providing clear and consistent messaging about how to participate.
  • Being transparent about your intentions for the program to establish trust with employees instead of skepticism.

4. Evaluation Activities

Like many company initiatives, employee wellness is not a “set it and forget it” type of investment. There can be a bit of trial and error to find out what works best for your people. By measuring progress along the way, you can make real-time adjustments to your promotion strategy to increase participation.

Read our blog post, Evaluating Your Wellness Program: Are You Focusing on the Right Metrics? for more tips on what to measure and adjust for optimal success.

5. Evidence-Based Interventions

When it comes to your wellness program’s core tenants, the proper support and referrals are key, especially for people with elevated risks.

This study highlighted the importance of:

  • A follow-up and referral process for employees with abnormal biometric values
  • Offering behavior change programs to ALL individuals, regardless of health status
  • Providing individually-targeted lifestyle behavior change programs based on elevated risk

For more on evidence-based interventions, check out Cleveland Clinic Coaching – a high-touch, multi-channel, coaching solution for everyone in your population.

Download the Results Infographic for More Information

Learn how each incentive design structures performed and determine what wellness incentives will work best for your organization by downloading the results infographic.

Download Infographic

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