It seems that the latest buzz word in program incentive planning is “outcome-based”. Many companies are adopting outcome-based strategies to improve the health and productivity of their employees. This type of strategy usually involves the use of easily quantified metrics such as smoking status, blood pressure or cholesterol levels. In its simplest form, an outcome-based incentive program would then use these metrics to determine which employees will be rewarded for good health and which employees will be “punished” for poor health. The logic to this approach seems simple enough from the employer's point of view- “If you can keep your cholesterol under 200 mg/dL then you must be healthy. Around here we appreciate healthy employees because they are less expensive to insure and research has shown they are more productive.” However, in the complex space between our ears, this simple logic has a number of flaws. Here are 4 to watch out for as you design your incentive program.
A far too narrow view of “healthy”.
As our elected officials grapple with the problem of insuring all Americans to treat diagnosed illness and disease, our culture's definition of healthy becomes more and more skewed. It is vital that we all remember the role and capability of medicine. Our medical system has been built with the primary goal of diagnosing and treating illness. Therefore, our current medical system is not very adept at supporting, much less defining, a “healthy” individual. Unfortunately, the vast majority of Americans view their health through the lens of our medical system and develop the mindset that if they aren't ill then they must be healthy. Now take this same mindset and apply it to an outcome-based wellness program where the goal that employees are asked to reach is as low as, “Don't be ill.” Is this really what you want your employees to aspire to?
A far too narrow view of the numbers.
One of the tools we use to help companies develop a healthy workforce is our Awareness Health Screenings. Like most biometric screenings, we provide employees a snapshot of their current levels of cholesterol, glucose or A1c, blood pressure, BMI and body fat. At the end of their 15 minute appointment, each employee walks away with their “numbers”. It is at this point that outcome-based programs can negatively affect not only the health of your employees, but also the health of your organization. Consider two different scenarios.
Yolanda has just completed her health screening and received her numbers. She learns that aside from being a little overweight, all of her numbers “pass” and she is eligible to receive the well thought-out incentive reward. She is excited to know that she will continue to receive a premium discount which will really come in handy because at 27, she is a young professional still concerned with paying the rent and childcare. Yolanda now knows that she has “earned” a reward from her company for her good health. The problem is, like many Americans, Yolanda is sedentary, makes nutrition choices based on marketing and convenience and is adding to her definition of stress each day as she works her way up your organization's corporate ladder
Jason also just completed his Awareness Health Screening but the results were not as great as Yolanda's. In fact, Jason has now realized that his current numbers mean that he won't receive the full incentive reward and, unless he finds a way to lower his blood pressure and glucose in the next 6 months, he will actually be penalized for his poor results. But Jason isn't willing to give up yet. He does some research and learns that lowering blood pressure can be as simple as skipping the 3 cups of coffee before his next screening. He also learned that by fasting for a couple of hours before the screening, he can see his glucose numbers drop significantly as well. Jason now has his personal “wellness plan” and he's confident that in 6 months he can get his numbers down to where they need to be to “earn” his reward, just like Yolanda.
So, where does the problem lie in these two scenarios? Is it Yolanda's ignorance about the fact that lifestyle habits are the leading cause of preventable disease? She must need more access to health education materials, right? Is Jason “cheating” your incentive system? Your organization just needs to figure out a way to make your incentive system fool-proof, right? As difficult as it can be to accept, the problem in these scenarios lies in the incentive plan itself. Programs where rewards or punishments are based on biometric outcomes actually teach participants to focus on numbers instead of being healthy.
A far too narrow view of what motivates us.
From what I've been told, the one thing that sets humans apart from animals is our ability for higher reasoning. There are times, though, when I think our family's cat has a better grasp on what life is all about than I do. When incentive plans try to make direct connection between biometric outcomes and dollars, they leave out the most human element- a higher reason. If you have ever trained an animal to do a trick, you've probably used the outcome-based approach to get Sparky to role over. It's as simple as, show the treat, take Sparky and role him over and then give him the treat. Do that enough times and you won't even have to show Sparky the treat before he rolls over for you all on his own. However, forget to give Sparky his treat after the trick too many times and he'll stop rolling over. That's because Sparky is after the treat. He has no real interest in rolling over.
However, there is more to Sparky than just chasing treats. You may have also heard of examples where a dog has run into a burning house to try and wake his master. There are no treats being offered, so what would make Sparky risk his own life to save his master? The answer is a higher reason. Over a period of time, Sparky developed a relationship with his master to the point where he tapped into something more than just his current desire for a treat. Sparky had an internal motivation to save that person and accept additional risk. The last thing you want to do is leave something this powerful out of your incentive plan. You don't buy healthy, you cultivate it. Watch a great talk by Daniel Pink on the power of incentives on creativity.
A far too narrow view of your organization's influence.
What happened to Yolanda and Jason is just a small example of how your organization exerts influence on the people that keep you in business. An incentive plan that is not fully thought out can quickly backfire and set your health and wellness strategy back years. I see this happen far too often in companies all over New York State and the consequences are real and costly.