Guest Post: What Drives Engagement in Workplace Wellness Programs — Carrots or Sticks?

(The following post was authored by Colin Watts, President of Weight Watchers Health Solutions.  Weight Watchers is a member of the Healthcare Leadership Council.)

In our conversations with employers, we’re often asked: What works better when it comes to employee wellness programs – penalties or incentives? In other words, should we use a carrot, a stick or some combination? It’s a great question and one we’re studying closely through our research.  One interesting example is a program Weight Watchers is supporting for the Oregon Educators Benefit Board (OEBB) and Oregon Public Employees’ Benefit Board (PEBB), which provide health insurance coverage to state teachers and public employees.

In 2009, obesity-related ailments were driving health care costs for the State of Oregon public employees and educators to the tune of nearly $1.6 billion. At the same time, in partnership with OEBB and PEBB’s health plan providers (Providence, Kaiser Permanente and ModaHealth,) Weight Watchers – both meetings and online tools – was offered to all of OEBB and PEBB’s covered lives.   If a participating member attended 75 percent of their Weight Watchers meetings, the cost was completely covered.

That year, PEBB decided to introduce financial incentives into their benefit design, which included completion of a confidential health risk assessment (HRA) and participation in at least two resulting action steps, which could include a weight management program.

During the first year of the program, they charged employees a penalty of $17.50 per month if they failed to take a baseline health risk assessment and follow through with lifestyle recommendations. That first year, 70 percent of employees completed their assessment and took action.

The following year, in 2010, the penalty was switched to a $17.50 per month reward for participation and a $100 higher deductible per person for those not participating. This action resulted in a 7 point increase in the percentage of employees completing the wellness recommendations and action steps. Should you find yourself in need of an employment attorney, visit to contact one.

This example would suggest that both penalties and rewards impact employee participation. That said, it would also indicate that rewards lead to better participation than penalties. While participation is highly linked to outcomes in several weight management studies, it has not been rigorously evaluated with the inclusion of a mandatory penalties/rewards program.

While not definitive, the results in Oregon are promising. Between 2009 and 2012, a time when rates of obesity were increasing among the State’s general population, obesity rates decreased among state employees and educators from 28 percent to 22 percent. Given the PEBB experience, OEBB started a similar program in 2013.

“These results show that a well-designed wellness program coupled with financial incentives that prompt and reward healthy behaviors can work,” said Joan M. Kapowich, administrator at PEBB. “Setting up programs that help employees succeed in changing their habits and rewarding them for doing so was really key for us. It has demonstrated success in reducing our cost trends and improving the health status of our members.”