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Pizza tastes better than salad: why we need health rewards

When I started IncentOne’s health business in 2003, it’s because I came across a startling fact – that less than 20 percent of women followed their pre-natal care. That blew me away. We were not talking about diabetes or heart disease in ten years. We were talking about a child in a few months. When I looked further, I found a common thread. Both short and long term, Americans were not doing the basics to care for their health. For example, today Medicare offers a free annual wellness visit. On a national level in 2011, about 6 percent of Medicare’s eligible participants had their wellness visit.

Unfortunately, in many cases, the “healthy” behavior we want people to take actually is less beneficial to them in the short term. We are fighting human nature and the desire for instant gratification. Pizza tastes better than salad. Sitting on the couch is easier and less taxing than a trip to the gym. Cigarettes are costly ($14 per pack in NYC) and deadly and consumers still buy them. When it comes to preventative behavior, the “costs” in the terms of financial cost and time out of the day and inconvenience often outweighs the benefits of preventative care that might not be felt until years later. Don’t get me wrong, I am not saying this is how it “should” be. Personally, I am a big believer in personal responsibility. Regardless, the reality is that people need to overcome this personal cost benefit analysis when making these decisions. While we all know or have experienced the longer-term benefits of being healthier, we also know the immediate benefits of another slice of pizza.

Given this reality, what is the solution? The solution is to reward consumers with financial incentives to engage in healthy behavior. If individuals were told, “be healthy and be rewarded”, we could improve the health of Americans and generate massive cost savings for America. It is widely accepted that many powerful health programs simply fail to drive engagement without incentives. The use of gamification, mobile technologies and social tools are making some progress, but hardly enough. I would suggest that we need to move past the “should” debate and focus on aligning incentives to the right behaviors.

The analysis could move to not whether we should give rewards, but how do we align them in the right amounts and to the right behaviors. A few examples:

  • Medicaid: if we gave everyone on Medicaid a $50 reward for going to primary care, could we prevent unnecessary emergency room visits? If we gave 10 Medicaid patients $50 at a cost of $500 and prevented one unnecessary visit at a cost of $1,500, we would save $1,000 and have an ROI of 2 to 1.
  • Pregnant Moms: in Florida, medical costs for a healthy baby are approximately $4,551 from birth (including labor & delivery) through the first year. For a preterm baby who needs intensive care, the costs average $49,033. 19.2 percent of women were getting proper pre-natal care. If we gave each woman $500 in incentives to follow their pre-natal care, and we prevented one incident at a cost of $49,033, the cost for 10 women of $5,000 would be well worth it.
  • MRI: the price of a lumbar spine MRI at a hospital in California can reach more than $3,000, while the price of the same test at an independent radiology facility can be as low as $400. A $50 incentive seems to make a lot of sense.

Of course Medicaid recipients should not unnecessarily visit the ER. Pregnant moms should certainly be following their pre-natal care. And why wouldn’t we take the time to go to the lower cost MRI facility. Plan design can help but in the end it is not happening at the rate needed to really address our healthcare burden.

Keep in mind that these examples are pretty straightforward. When it comes to areas like nutrition and exercise, it becomes even harder. If we all were stranded on a desert island, would the five foods we would bring be kale, asparagus, tofu, beans and non-fat Greek yogurt or pizza, steak, macaroni and cheese, chocolate cake and your favorite childhood cereal.

Let’s move beyond the “should” and start to ask the question, what are the right behaviors and the right reward amounts? When financial incentives are aligned to the behaviors that improve health or optimize utilization of health resources, everyone wins. It’s time to move beyond the way we want the world to be, acknowledge that pizza tastes better than salad, and create real world solutions.

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2 Responses so far.

  1. Niraj Jetly says:

    Michael,
    A thought provoking article and I must a say a very catchy title. Although I agree with you that health rewards play a significant role in creating motivation for individuals to take the desired action. However, rewards cannot and should not be the only carrot for individuals to take control of their health.
    If I were to take your example of pregnant moms in Florida and for the sake of discussion even if we provide a reward of $500 for follow up on pre-natal care. Then we would need to go to next level, i.e. prescription compliance, which we all know is very low. That would mean we would need to create reward for that as well. Then what about reward for healthy eating to ensure baby is getting a balanced diet. As you can see it becomes a never ending reward structure that is purely focused on transaction.
    In my opinion, the right motivators should be a solution that encompasses – education, affordability, and (positive and negative) incentives. Education must be hyper-targeted to increase its relevance for the individual, affordability of nutritious food and relevant prescriptions to lower barrier of adoption and of course positive and negative incentives.

    -Niraj

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