According to the Centers for Medicaid Services, at $8,086 per person annually, the United States spends more per capita on health care than any other country in the world. However, at least half of the country’s population has one or more chronic diseases, 33% are diabetic or pre-diabetic and 66% are overweight or obese. These statistics came from the U.S. Centers for Disease Control and Prevention. Lack of exercise, poor nutrition and smoking are three leading contributors to such a high percentage of unhealthy people.
Promoting a Healthy Lifestyle. People are naturally wired to keep doing what they’re already doing. If there is no incentive to change, even if it’s beneficial, they won’t. This also applies to offering passive open enrollment. Employees are more likely to keep their current coverage. VBID is a new insurance design based on value. It also encourages wellness proponents. The main idea is to match patients’ out-of-pocket expenses with heath service values. Different levels of value are recognized in this approach. By making high-value treatments more available and discouraging low-value treatments, this approach works to yield improved health outcomes on all health care expenditure levels. Research shows that barrier reductions improve patient compliance for recommended treatments.
In addition to increasing compliance for treatments, this approach has also been shown to increase compliance in patients who need regular medication. A study performed by the Center for Health Value Innovation and the University of Michigan Center for Value-Based Insurance Design showed that patients with chronic illnesses who required medication were more willing to take it. Their cooperation for preventative services was also better. However, there is still one troubling issue, which is people who have the opportunity and encouragement to comply but don’t. This has left researchers wondering what is missing from the VBID approach that is necessary to make such people more compliant. The solution is to implement the use of loss aversion and productive tension to raise individual involvement for improving healthy behavior.
Raising the Productive Tension Level. The main idea of productive tension is to create a program that gives enough initiative to provide patients with a positive reason to change. In order to be optimal, productive tension needs to have four different components:
- Information – Although it increases knowledge, it doesn’t always encourage action. If it did, the country’s population would be rich, fit and happy. After purchasing $46 billion on diet and self-help books in 2010, Americans still need help.
- Infrastructure – This includes having the right tools, technology and resources to help people. Keep in mind that infrastructure alone doesn’t necessarily initiate action.
- Incentives – Nothing works better for motivation than a reward. Financial rewards are especially enticing. These still may not initiate action in all people. In a Global Survey of Health Promotion and Workplace Wellness Strategies, only 48% of employers stated that their incentive programs were minimally effective.
- Imperatives – These are important for accountability and understanding. People need to know what they must accomplish, why they need to do so and what happens if they fail.
Applying the Behavioral Design. One illustrative example of applying the behavior-based design is depicted by Safeway. The supermarket chain’s CEO, Steven Burd, said that 70% of his employees’ health care costs were because of their own behavior. In addition to this, 74% of those cases included four major chronic health conditions. The conditions were cancer, diabetes, cardiovascular disease and obesity. During the following five years, the supermarket chain redesigned its health care infrastructure. Their new focus, after launching the Healthy Measures Initiative, is consumer-based strategies. As a result of the positive changes, Safeway has seen a great increase in voluntary participation among their workers for controlling and preventing these conditions.
Solutions for Creating Tension. There are several different ways to encourage participants to become healthier. The following are a few good examples of beneficial changes:
- Health Requirements – Having employees pass an annual physical and health exam is a great idea for an incentive.
- Company Gym – While providing an outside gym membership may be effective sometimes, having a gym or fitness center in the workplace is even more effective.
- Company Contests – Hosting contests that all employees can participate in is beneficial. Weight loss or health competitions with cash prizes and contribution pools are extremely successful.
The bottom line is that increasing tension to promote a healthy lifestyle change is the best way to make it happen. People are much easier to convince when there are both incentives and rewards.