Incentive-based wellness programs can lead to low health care costs

A new longitudinal study conducted among participants in the world's largest incentive-based health enhancement program shows that wellness programs incorporating positive incentives can lead to behavior change that, over time, are associated with lower health care costs. The Discovery Vitality research of more than 300,000 participants over a five-year period is published in the May/June issue of the peer-reviewed American Journal of Health Promotion.

"This research provides compelling evidence that effectively designed incentive programs can motivate people to change their behaviors, leading to better health outcomes and lower healthcare costs over the long term," said Arthur C. Carlos, CEO of The Vitality Group, a subsidiary of Discovery Holdings Limited. "This increase in activity is particularly exciting as we know from secondary research that physical activity typically decreases with age."

Discovery Holding's incentive-based wellness program, Vitality, is offered to nearly 2 million consumers worldwide. The Vitality Group, based in Chicago, provides Vitality as a standalone program in the U.S. and Canada. Vitality is offered in South Africa and the U.K. through Discovery's health insurance subsidiaries, Discovery Health and PruHealth.

The retrospective study examined the changes in participation in verified fitness activities and the impact on hospital claims over five years among members of Discovery Health medical plan. The findings included:

• The percentage of Vitality members using the gym, one or more times a week increased by almost 23 percent.
• Over time the percentage of members who joined the gym but were "inactive" decreased by eight percent, and there was an increase in the percentage of members classified as "medium- and high-engaged" in fitness related activities.
• Members who consistently maintained or increased engagement with fitness-related activities had the best outcomes related to hospital admission and costs. Hospital costs were six percent lower in those members who were inactive and became active and 16 percent lower in those members who were active throughout the study compared to those members who remained inactive.
• There was also a dose-response relationship, meaning the increased frequency of gym visits was associated with a lower probability of hospital admissions; two additional gym visits per week reduced the probability of hospital admission by 13 percent.

The study looked at more than 300,000 adult members of the Discovery Health plan of which 192,467 members were registered with the Vitality wellness program and 111,587 were not on the program. Researchers assessed engagement with fitness activities over a three year period and medical claims data over the fourth and fifth years. Vitality members were incentivized to participate in fitness activities which were measured based on the frequency of electronically-documented gym visits and other verified activities.

Vitality is a comprehensive health and wellness solution that educates, assists and motivates individuals to engage in a broad set of verified activities with proven outcomes. The program employs sophisticated behavior change models supported by an actuarially-sound incentive program to achieve meaningful and measureable health improvement.

"While there is considerable evidence that incentive programs are effective in getting people to address simple health behaviors such as vaccinations and screening tests, there is less available research for the effectiveness of these programs to address more complex behaviors such as unhealthy eating and physical inactivity," said lead researcher Deepak N. Patel, MD, Mmed, University of Cape Town and senior clinical specialist, Discovery Health. "This study provides evidence that well-structured incentive and reward programs may also be effective in addressing these entrenched complex behaviors."

Ken Thorpe, Ph.D., Robert W. Woodruff professor and chair of the Department of Health Policy and Management at Emory University and executive director of the Partnership to Fight Chronic Disease noted, "These findings are important for employers as they look for ways to reduce their healthcare costs and improve the health of their employees. This is also important news for the government as it seeks ways to decrease costs and improve health outcomes in our healthcare system."

The longitudinal study is follow-on to a previous study released in 2010 in the American Journal of Health Promotion that examined the medical claims data over one year of almost 950,000 members of Discovery Health. The research found that high engagement in an incentive-based wellness program was associated with lower healthcare costs. For those highly-engaged members who were admitted to a hospital, the length of stay and frequency of admission was significantly lower than those less engaged.