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Creating Successful Wellness Incentives: An Inside Job

By Jonathan Edelheit

Employers are getting in the business of keeping employees healthy. There are
still those employers who will encourage employees to use the stairs instead of an
elevator, position gym equipment in a hard-to-find old storage space or put posters
up that tout the advantages of eating fruits and vegetables. But, those measures are
considered tame by todays standards.
Companies are developing not only attractive wellness programs, but creative
incentives to engage employees to participate in them. Just how far will employers
go to keep their employees healthy? Well, that all depends upon what those workers
or the programs that have been designed for them return on the companys
investment.
For employers who choose to go the route of incentives even those that include
deterrents the question then becomes not only which rewards or penalties, but
which behavior or outcomes to target and influence employees.

Shape Up: Sign of Times

Most companies use incentives. Others go so far as to threaten employees who
dont shape up with penalties. Cash, gift cards, even discounts on health insurance
premiums are some of the rewards employers are dangling in front of workers who
are on the fence or about to fall off in the hope that they may grab hold of and
embrace healthy lifestyle choices.and embrace healthy lifestyle choices.

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Fidelity Investment and the National Business Group on Health report that 90 percent
of employees offer wellness incentives, or financial rewards, or prizes to employees
who work toward getting healthy. Thats up from 57 percent of businesses in 2009.1
The immediate objective is noble enough: to improve the health of employees. Not
a bad intention, considering the findings of a Canadian survey, which reported that
83 percent of primary health plan benefit members claimed they were more likely to
remain on the job if they believed their employer was seriously concerned about them
maintaining good health.2
Companies are putting their wallets where their mouths are as well. The Fidelity
Investment and National Business Group on Health also found that employers planned
to spend an average of $521 per employee on wellness-based incentives within
corporate programs. Those dollar amounts mark an increase of 13 percent from the
average of $400 reported for 2011, and double the per-employee average of $260
claimed in 2009. Whats more, Towers Watson reports that 84 percent of employers
plan to up spending for workplace health and wellness programs over the next two
years.4
1

New Healthcare Survey Finds Spending on Wellness Incentives has Doubled in the Last Four Years; Fidelity and National Business Group on Health; Feb. 27, 2013; http://www.businessgrouphealth.org/pressroom/pressRelease.
cfm?ID=207; Accessed Dec. 19, 2013
2

Sanofi Healthcare Survey; Sanofi-Aventis Inc.; December 2007; http://www.sanofi.ca/l/ca/index.jsp; Accessed Dec. 19, 2013.

New Healthcare Survey Finds Spending on Wellness Incentives has Doubled in the Last Four Years; Fidelity and National Business Group on Health;
Feb. 27, 2013; http://www.businessgrouphealth.org/pressroom/pressRelease.cfm?ID=207; Accessed Dec. 19, 2013.

Healthcare Reform Heightens Employers Strategic Plans for Healthcare Benefits; Towers Watson; Aug. 21, 2013; http://www.towerswatson.com/en/Press/2013/08/Health-Care-Reform-Heightens-Employers-Strategic-Plans-for-HealthCare-Benefits; Accessed Dec. 19, 2013.

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Investment in Health
Employers are banking that the investment they make
in healthy attitudes will pay dividends in their ability
to manage the escalating cost of healthcare benefit
offerings for both the employee and company.
While the benefits for employees can be both shortand long-term, a company that implements a wellness
program should expect to see a reduction in healthcare
costs over an extended period of time. The Rand
Corp. reported in 2012 that participation in a wellness
program over five years reduced annual healthcare
costs by an estimated $157 per employee, about the
same dollar amount the company typically spends on
their wellness program.5
Numerous other studies have indicated healthcare
costs can be reduced or even contained by
implementing wellness programs. The National
Business Group on Health contends that companies
that increase their support for wellness programs
can save more than $1,600 per employee per year in
healthcare costs.6
Employers looking for added motivation beyond lower
company healthcare costs will soon be able to turn
to Uncle Sam. Beginning in 2014, the Affordable Care
Act creates incentives up to 30 percent tied to an
employees total premium cost -- for employers who
encourage wellness programs and establish more
opportunities to support a healthier workplace.7

Workplace Wellness Programs Study: Final Report; RAND Corporation; 2012; http://www.rand.org/content/dam/rand/pubs/research_reports/RR200/RR254/RAND_RR254.sum.pdf; Accessed Dec. 12, 2013.

New Healthcare Survey Finds Spending on Wellness Incentives Has Doubled in the Last Four Years; Fidelity and National Business Group on Health; Feb. 27, 2013; http://www.businessgrouphealth.org/pressroom/pressRelease.
cfm?ID=207; Accessed Dec. 19, 2013.
7

Volk, J., Corlette, S.; Premium Incentives to Drive Wellness in the Workplace: A Review of the Issues and Recommendation for Policymakers; Health Policy Institute; Georgetown University; February 2012; http://www.rwjf.org/content/
dam/web-assets/2012/02/premium-incentives-to-drive-wellness-in-the-workplace; Accessed Dec. 19, 2013.

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When done correctly using company specific research and planning wellness
programs can not only lower healthcare costs, but offer employers:

Reduced absenteeism;
Higher employee productivity;
Reduced workers compensation and disability-related costs;
Reduced injuries;
Improved employee morale and loyalty.

Reducing Health Risks

The American Journal of Health Promotion
reported that healthcare costs rose at a
slower 15 percent rate among employees
who consistently participated in wellness
programs when offered than colleagues who
did not.8
Healthcare costs have become a key
component in the calculation of a companys
operating income. The lower the companys
operating expenses are, the more profitable
Source: Boles, M., Pelletier, B., & Lynch, W. (2004). The relationship between
the business generally is. Although studies
health risks and work productivity. Journal of Occupational and Environmental
Medicine, 46, 737745
have linked healthcare costs to wellness
programs, quantifying overall company
success is much more difficult to pinpoint. One study, in the Journal of Occupational
and Environmental Medicine, did find a relationship between the number of
employee health risks and productivity loss. Not surprisingly, employees with more
health risks had seven times more lost productivity at work than those without
conditions. They also accounted for excess annual medical costs of about $887 per
employee.

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Morath, E., Radnofsky, L; Medical-Price Inflation Is at Slowest Pace in 50 Years; Wall Street Journal; Sept. 17, 2013; http://online.wsj.com/news/articles/SB10001424127887323342404579081312680485476; Accessed Dec. 19, 2013.

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Wellness programs can when designed effectively play a part in reducing or

eliminating employee health risks including common factors like high blood pressure,
high blood glucose, depression, obesity, tobacco use, physical inactivity, poor diet
and excessive alcohol use. A Sanofi Canada Healthcare survey found 92 percent of
plan members would likely participate in on-site health risk screenings for conditions,
such as diabetes. While smoking cessation programs might not be high on the list
of every employee, the data that the company collects from the metric might prove
beneficial in reassessing other wellness initiatives.
Changing lifestyle behaviors is ultimately an individual decision. However, employers
have a golden opportunity to ensure that their employees see the value of adopting
healthy attitudes and fit lives. Employers who chose to seize upon a workplace
culture that sets the tone for healthy employees should design a wellness program by
first:

Establishing goals;
Determining the companys involvement in program;
Establishing budget and expected return on investment;
Effectively communicating program and policies;
Choosing employee incentives.

Klachefsky, M.; Connecting Health Risk, Absence and Lost Productivity; Journal of Occupational Health and Environmental Medicine; 46; 737-745; The Standard; March 27, 2012; http://www.shrm.org/multimedia/webcasts/
Documents/12klachefsky.pdf; Accessed Dec. 19, 2013.
10

The Sanofi Canada Healthcare Survey; Sanofi-Aventis Canada Inc., Rogers Publishing Ltd.; 2012; http://www.sanofi.ca/l/ca/en/layout.jsp?scat=C3588838-0978-4F25-9A92-6F37FA912C05; Accessed Dec. 19, 2013.

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d
GiftCard
Partners

INC.
INC.

Engine behind the Wheel

Incentives are the engine that can drive and maximize employee participation in
any wellness program some faster than others. Rewards can increase employee
participation in the areas of:
Prevention by fostering health risk assessments, health fairs and flu shots;
Lifestyle changes, such as smoking cessation, weight loss and nutrition or stressmanagement classes;
Managing specific conditions, such as help desks that offer advice on treating
diseases and ailments including diabetes;
Education including business websites or links that raise awareness in regard to
wellness program initiatives; details and information; and health advice.
Employers use both so-called carrots and sticks to keep employees healthy and
manage the costs of benefit offerings. The 2013/2014 Towers Watson Staying@Work
survey found that both employers and employees view initiatives at the workplace
differently.11 Even though employers can act as marionettes and pull strings that
influence health insurance plans, employees are far from puppets. Most employers,
in fact, believe their employees hold the keys to the companys healthcare cost
containment goals.
Towers Watson researchers found that 70 percent of employers say getting
employees to take more responsibility for their health is job one. These same
employers say in the next few years they will use financial incentives and penalties to
enforce employee accountability and dictate outcomes.

11

2013/2014 Global Staying@Work Survey: The Path to Health and Productivity Effectiveness; Towers Watson; April 2013; http://www.towerswatson.com/en-GB/Insights/IC-Types/Surveys/2013/Staying-at-Work-survey-the-Path-toHealth-and-Productivity-Effectiveness; Accessed Dec. 19, 2013.

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Almost four in 10 U.S. companies or 36 percent will use penalties, such as higher
health insurance premiums and hefty deductibles for employees who decide against
their employers judgment and opt out of wellness activities. Most notably, Towers
Watson predicted when the smoke clears next year, 54 percent of employers will have
implemented outcome-based incentives that either reward or penalize employees
based on tobacco use. The following year, that number will jump to 71 percent.12

Food for Thought

Theres more food for employees to give thought to. Rewards or penalties for other
ideal biometric outcomes identified through body mass index, blood pressure or
cholesterol level will dramatically increase from 26 percent in 2014 to 68 percent in
2015-2016.13 Outcome-based incentives can be effective in pushing employees to
improve their health. A Mayo Clinic study reported participants lost nine pounds on
average when they received $20 per month for achieving weight-loss goals; or paid
$20 instead when they didnt.14
Almost half of all employers who offer small rewards for individual wellness
achievements do so by means of cash or gift cards, according to Fidelity Investments
and the National Business Group on Health. These incentives can offer instant
gratification for a job well done compared with insurance premium deductions that
might minimally boosts take-home pay on a periodic basis. Big payouts make bigger
impacts and tend to motivate employees to take action sooner rather than later.
However, current psychology warns against focusing too heavily on immediate
incentives to promote sustained outcomes. Properly balanced health and wellness
programs work to engrain a culture of wellness, which is imperative to participants
long term success. Plus, these rewards are taxable and while they may precipitate
activity, they may not warrant changes in lifestyle behaviors for very long. Hence,
individuals should be encouraged to adopt a culture of wellness, as long term health
outweighs the tax implications of the rewards received. Incentives are proven to help
employees get off on the right foot and lose weight right away, but in the long run,
the same workers may not keep the pounds off, without adopting lifestyle changes.
12

2013/2014 Global Staying@Work Survey: The Path to Health and Productivity Effectiveness; Towers Watson; April 2013; http://www.towerswatson.com/en-GB/Insights/IC-Types/Surveys/2013/Staying-at-Work-survey-the-Path-toHealth-and-Productivity-Effectiveness; Accessed Dec. 19, 2013.
13

2013/2014 Global Staying@Work Survey: The Path to Health and Productivity Effectiveness; Towers Watson; April 2013; http://www.towerswatson.com/en-GB/Insights/IC-Types/Surveys/2013/Staying-at-Work-survey-the-Path-toHealth-and-Productivity-Effectiveness; Accessed Dec. 19, 2013.
14

Money Talks when It Comes to Losing Weight, Mayo Clinic Study Finds; Mayo Clinic; San Francisco; March 7, 2013; http://www.mayoclinic.org/news2013-rst/7357.html; Accessed Dec. 19, 2013.

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On the other hand, 61 percent of the companies in the Fidelity Investment and
National Business Group on Health study offer lower premiums for employees who
finish specific wellness tasks. The good news for employees is that these pre-tax
incentives make maximum use of the full award promised by employers. The
unfortunate outcome for employers is that when these assignments are fulfilled
generally prior to open enrollment the employee behavior modification activity
sometimes stops short.

Attention! Keep Options Open

Incentives inherently attract attention. The best incentives change up the design
plan often enough to keep employees on their toes. That said, too many options
can overwhelm employees and companies can waste money on programs that dont
address employee needs.
Engagement should be the moniker behind any incentive. A company could believe
to have designed the best wellness program, but if only a small percentage of
employees participate, then the chosen reward is not an incentive at after all.
Finding a one-size fits all incentive can be challenging for any company. Incentives
must meet the ardor of employees from all walks of life and include options to satisfy
demographics, interests, needs and lifestyles.
The prerequisite for satisfying multiple tastes makes gift cards or cash an ideal
incentive for even the most difficult to please. Gift cards from popular retailers and
restaurants to Visa and MasterCard branded offerings -- tender variety to recipients.
Gift cards can be shared by family and friends, are easy to customize and administer,
and fit a multitude of corporate needs. Best of all, employees want gift cards.

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Its In the Cards

The Incentive Research Foundation and the Incentive Gift Card Council reported
that 8 of 10 employees prefer gift cards over all incentives because they can be used
when and where they want to be. Plus, cards can also be awarded for multiple levels
of rewards in any denomination up to $500. When it comes to rewards valued at
$50, 83 percent of recipients prefer some type of gift card. Just 17 percent polled
preferred cash.15
Dialogue is inescapable if gift cards are to be optimally effective. Think of the
embarrassment engulfing an employer who awards a gift card for a steakhouse to an
employee who happens to be a vegetarian. But, gift cards can be powerful incentives
for employees who are more likely to be motivated by a guilt-free spending spree
rather than by a cash reward that might be more suited for household necessities.

Cash Not Always King

Cash does not necessarily have to be king behind the success of a wellness program
if employers are willing to go an extra mile to encourage participation. Employees
at Excelas, a Cleveland-based medical consulting firm with 44 employees, offers
staff one extra hour of paid time off for every 33,000 steps they walk during the first
three months of the year, for up to three extra days of paid leave. The company also
makes charitable donations based on each employee milestone walked. No wonder,
employees are motivated to walk laps around the company parking lot at lunch or
take an extra stroll at night after work.16

15

Research Shows Recipients Prefer the Control and Personalization Gift Cards Provide vs. Cash; Incentive Research Foundation and Gift Card Council; April 30, 2012; http://theirf.org/research-shows-recipients-prefer-the-control-andper
sonalization-gift-cards-provide-vs.-cash.6087533.html; Accessed Dec. 20, 2013.

16

Hellmich, M.; Small Businesses Get Creative to Cut Health Cost; USA Today; Dec. 13, 2013; http://www.usatoday.com/story/money/business/2013/12/13/wellness-programs-small-businesses/3862759/; Accessed Dec. 19, 2013.

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Another company, AstraZeneca Pharmaceuticals, invited employees at their

Wilmington, Del., site to take healthy cooking classes hosted by local celebrity chefs.
Employees not only became versed in meals that would keep them and their families
fit, but also earned points that could be later redeemed for gift cards. Another idea
is to provide space at work for a farmers market to set up shop during the summer
months to make fresh produce convenient and affordable for employees to purchase.
Thinking outside the box can work, but only when the thoughts appeal to employees.
Naturally then, engaging employees to participate in the reward selection process
can be a healthy step toward ensuring that incentives are meaningful to all. So what
incentives might work best? Probably those that employees say they like best. Some
ideas include:
Name-brand merchandise;
Corporate-identified merchandise, such as tote bags and apparel, when used in
exchange for registration;
Increased company contribution to Health Savings Accounts;
Additional benefits to health plans;
Gym memberships;
Perks unique to company including prime parking spaces, preferred vacation
times;
One-on-one time with company CEO or other executives;
Reduced co-pay or deductibles.

Keep It Simple

About half of all U.S. employers with 50 or more employees offer workplace wellness
programs, according to a study by the Rand Corp. Larger companies, generally, tend to
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have more complex wellness programs. Simple activities can be a good means for
introducing employees to engage in healthy behavior and a mechanism to figure
out what their needs are as well. The National Business Coalition on Health reports
90 percent of eligible employees at Caterpillar Inc. complete a company health-risk
assessment and enjoy the $75 a month reduction in insurance premiums in return.
As more employers of all sizes struggle with healthcare costs, small companies are
choosing to pool their resources to cut expenditures associated with both their
insurance plans and wellness programs. But, to join these pools, employers have to
agree to take on measures that will work to make employees healthy and reduce
claim costs. To reap the benefits of lower healthcare costs, employee buy-in and
participation in wellness programs becomes imperative.
Many employees are already onboard. Those that are about 62 percent say they
see the benefits of a health-conscious lifestyle in reduced medical risks, improved
health, and more energy and motivation at the workplace, according to the Principal
Financial Well-Being Index for American Workers.16 Some of the benefits cited in the
account include:
51 percent of participants say they work harder and perform better;
59 percent say they have more energy and are more productive;
45 percent say that health-related programs encourage them to stay in their
current position;
43 percent say they miss fewer days of work as a result of wellness programs.
So, why then do 34 percent of employees disregard wellness programs and refuse to
participate? Many say they lack incentives. To earn rewards, employees are sometime
required to take action, like joining a weight-management program. Those who dont
participate sometimes face penalties. The prospect of penalties may be enough to
motivate employees to pursue wellness activities.

17

The Principal Financial Well-Being Index: 2012 Wellness Summary; Principal Financial Services, Inc.; http://www.principal.com/wellbeing/2012/wbwellness-4q2012-data.pdf; Accessed Dec. 19, 2013.

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Legal Dilemmas
Employers concerned about playing paternalistic roles and infringing on personal
health habits of their employees might be hesitant to adopt penalties. More
employers dont use a combination of penalties like garnishing pay or premium
surcharges -- and rewards for participation in wellness programs, according to a
survey by Aon Hewitt.18 Experts say the process of sidestepping penalties has three
times the motivating power of a reward. Take Johnson & Johnson, which recoups the
companys $500 wellness incentive from paychecks when employees dont heed the
advice from health assessments.19
No one likes to feel like they are getting punished. Some say penalties can dampen
employee morale. Perhaps, a softer approach is to allow only employees who
complete certain assignments like smoking cessation to enroll in the companys
most appealing health plans. StayWell Health Management claims up to 99 percent
participation among clients adopting this strategy.20
Unhealthy workers who set the tone for increased insurance premiums can put a
financial strain on frustrated employees who consistently meet company health
targets. However, monetary incentives aimed at slashing rising healthcare costs for
everyone can create a backlash.
Faculty at the University of Pennsylvania revolted this year over the schools plan to
have nonunion employees visit a doctor, complete biometric screening measures and
fill out a lengthy online health risk survey. Non-compliance resulted in a $100-a-month
payroll deduction. Following protests from professors who claimed the policy violated
their privacy, the university shelved the plan.21
Privacy, anti-discrimination and insurance laws differ from state to state and at
the federal level. Rewarding an employee especially monetarily -- for lowering
cholesterol may seem like a harsh penalty for those who dont. In some jurisdictions,
employers must offer workers who dont hit targets an alternative method to earn an
incentive, such as a doctors note. A good idea is for employers to first consult legal
advice before pursuing eligibility incentives.
18

2012 Total Rewards Survey: Transforming Potential into Value; Aon Hewitt; http://www.aon.com/human-capital-consulting/thought-leadership/talent_mgmt/2012_aonhewitt_total_rewards_survey.pdf; Accessed Dec. 19, 2013.

19

Evert, M.; Proof of Wellness ROI Is Growing; Northwest Credit Union Association; July 15, 2010; http://www.waleague.org/member-resources/anthem/proofofwellnessroigrowing; Accessed Dec. 19, 2013.

20

Singer, N.; On Campus, a Faculty Uprising over Personal Data; New York Times; Sept. 14, 2013; http://www.nytimes.com/2013/09/15/business/on-campus-a-faculty-uprising-over-personal-data.html?_r=0; Accessed Dec. 19, 2013.

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Inside Job
Cost-conscious employers determined to offer employees healthcare benefits,
maintain wage scales and keep their doors open for business should remain
committed to wellness programs. Just how much information about personal health
habits that employees are willing to share with their bosses will go a long way toward
making or breaking these initiatives. If healthcare costs continue to escalate despite
what might be the governments best intentions and employers consider shifting
expenses to employees, perhaps, the greatest incentive for the most vulnerable
employees to get fit and stay in shape may come from themselves. Satisfying the
bottom line for both employee and employer then becomes an inside job.

17

The Principal Financial Well-Being Index: 2012 Wellness Summary; Principal Financial Services, Inc.; http://www.principal.com/wellbeing/2012/wbwellness-4q2012-data.pdf; Accessed Dec. 19, 2013.

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About the Corporate Health and Wellness Association

The Corporate Health and Wellness Association (CHWA), also known as the Health and Wellness
Association or the Corporate Wellness Association is the first national non-profit association
focused on health, wellness, disease prevention and management for employers, employees and
their families.
We are in a serious healthcare crisis. The rate of Americans that are unhealthy is climbing
significantly each year. Many Americans do not live lifestyles that promote health and wellness,
and many are not focusing on managing their diseases and preventing diseases or preventing
diseases from becoming worse. This rising problem of Americans becoming more unhealthy is a
major contributing factor to the rising and unaffordable healthcare costs.
Many Americans live an unhealthy lifestyle, not by choice but because of a lack of education as to
what they need to do to maintain a healthy lifestyle. A lack of education about being healthy and
well, as well as a lack of motivation to get employees to engage in healthy behavior is one of the
largest problems the United States faces.

About GiftCard Partners

GiftCard Partners is one of the nations largest developers of corporate Gift Card programs;
dedicated to growing their clients B2B gift card business through innovative approaches in the
incentive, loyalty, promotion, fundraising (Scrip), and affinity markets. GiftCard Partners works
with a broad range of leading brand companies as an out-sourced program management solution.
Their clients gift cards are placed in workplace safety programs, health and wellness programs,
employee recognition, motivation and sales incentive programs, and customer rewards and
loyalty programs. Some of their clients include CVS/pharmacy, The Childrens Place, AutoZone,
Nutrisystem, Charming Shoppes (Lane Bryant, Catherines), The Cheesecake Factory, Boston
Market, and more.

CHWA Resources:
CorporateWellnessConference.com
CorporateWellnessMagazine.com
WellnessAssociation.com

Contact GCP:
Info@GiftcardPartners.com
USA 800-413-9101

Contact CHWA:
Info@WellnessAssaciation.com
USA 561-204-3676
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