Team lotteries motivate employees to participate in wellness programs

Corporate wellness programs are one way that employers can help improve the health of their employees and decrease spiraling health care costs. However, getting employees to participate in such programs can be challenging. Now a new study in the American Journal of Health Promotion suggests that group lotteries might increase employee participation in one component of wellness programs—filling out health risk assessment questionnaires.

Health risk assessments, or HRAs, are screening questionnaires that ask about a patient’s health risk factors, such as smoking, weight, exercise and other health behaviors.

“The HRA is an important first step of a wellness program in that it’s a screening tool,” explained Ha Tu, a senior researcher at the Center for Studying Health System Change, a nonpartisan think tank in Washington, D.C., who was not associated with the study. “It’s not a stand-alone initiative, but can be followed up by health coaching and by wellness activities,” she said.

Unfortunately, many employees don’t fill out HRAs. “As a result, there’s been a real shift toward employers offering some sort of monetary incentive for employees to fill out HRAs,” Kevin Volpp, MD, co-author of the study, said. Such incentives often include cash payments, gift cards or reductions in insurance premiums.

However, the most cost-effective way to implement an incentive program isn’t known. Volpp and his colleagues at the University of Pennsylvania and Carnegie Mellon University enrolled nearly 1300 employees from a large health care management company in the study and investigated the effectiveness of three different incentive approaches.

The first approach offered $25 cash to any employee completing an HRA. The second approach offered $25 cash plus a $25 grocery gift card upon completion of an HRA. The third approach assigned employees to lottery teams of four to eight people. Each week, one team would be selected and each team member who had filled out an HRA would win $100. As an additional incentive, if at least 80 percent of the team members had filled out an HRA, the prize increased to $125. The cumulative cost of the lottery was designed to be equivalent to the gift card offering.

About 65 percent of the employees in the lottery groups completed HRAs, compared to 42 percent in the cash-plus-gift-card group, and 40 percent in the cash-only group.

“The most important finding in the study is that how you design an incentive program makes a really big difference in how effective it is,” Volpp said. “There is often this assumption if we just give people ‘x’ amount of dollars, the bigger ‘x’ is, the more effective it will be.  One can argue that lotteries take advantage of the fact that people don’t understand probabilities very well.  The goal here was to think about ways to use a lottery to help people rather than as a way to take advantage of them.”

One limitation of the study, the authors note, was the inability to determine the degree to which the elements of the lottery?assignment to a team, the team participation bonus or the lottery, itself?contributed to its success.

Cash incentives are not the only way to increase employee participation in wellness programs. “Some companies have been extremely successful in designing wellness programs that have real impact but don’t offer financial incentives,” Tu said. Typically, these programs work because they meld their wellness strategy with the company’s overall business strategy, Tu explained, offering employee recognition from both peers and company management.