Paid to Be Healthy

Update January 29, 2016

For years, some employers have offered workplace wellness programs — voluntary programs that give employees financial incentives for engaging in healthy behaviors, such as exercising regularly or quitting smoking. For employers that provide health insurance for their employees, the reasoning behind these programs is simple: Healthy behaviors lead to lower health-care expenses, which saves both employees and the company money.

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More recently, several states have tried taking a similar approach in their Medicaid programs. (Medicaid is the joint federal–state health insurance program for low-income people, and is administered separately by each state.) According to an article published earlier this week at MedPage Today, more than a dozen states have added incentives to their Medicaid programs in recent years. A big reason they’ve done so is the Affordable Care Act (“Obamacare”), which provided grants for 10 states to test incentive programs and encouraged all states to expand, and experiment with, their Medicaid programs. Connecticut, for example, pays Medicaid enrollees up to $350 a year in gift cards to quit smoking, with different amounts given out for attending smoking cessation counseling, using a telephone counseling service, and taking a breathalyzer test that shows no recent smoking. The state is comparing health-care costs between people who participate in this incentive program, and those who smoke but are not participating.

In some states, like Iowa, the incentives offered are relatively small, such as saving a $10 premium payment for filling out a detailed health-risk survey. In other states, like New Mexico, the incentives are larger and apply to many different behaviors. Medicaid enrollees in the state can earn reward points for having their eyes examined, having their teeth cleaned, getting screened for diabetes, or recording how many steps they take using a pedometer. Points can then be redeemed for gift cards, which can be used to buy health-related items like soap, toothpaste, and over-the-counter drugs and vitamins.

Some private insurance plans offer incentives similar to those offered in some Medicaid programs, but most do not. One reason for this may be that people tend to move between private plans, so the long-term savings from healthy behavior won’t necessarily be reaped by the company that incentivized it in the first place. Private insurance companies are also limited by law in certain areas — they can’t, for example, give you financial rewards or charge you a lower premium for losing weight or improving your blood pressure. A bill introduced several years ago that would have required private insurance companies to offer such incentives failed to gain support in Congress, which we noted here at Diabetes Flashpoints at the time.

What’s your take on insurance-based incentives for healthy behavior — are you glad that some states are encouraging Medicaid enrollees to improve their health? Do you think you’d be more likely to exercise, lose weight, quit smoking, etc., if your insurance plan gave you a financial reward for doing so? Is it unfair to pay people to quit smoking or lose weight, but not pay people who never started smoking or became overweight in the first place? Should incentives be offered only when they pay for themselves through lower health-care costs, or is achieving better health a good use of taxpayer dollars and/or health-insurance premiums? Leave a comment below!

  • Will the patients Quality of life be effected?

    • Your quality of life will probably get better. However your diet needs to be low carb. Just getting blood sugar down with drugs and insulin doesn’t protect you from complications. A low carb diet does., Just cut these things from your diet and your diet is probably low enough. Cut out All forms of sugar, all forms of flour, potatoes and rice. Eat fruit, vegetables, meat, eggs, cheese, etc. No processed foods. Yogurt that is not sweetened.
      You can sweeten it with Splenda.

    • No not at all.

  • I have had diabetes for 25 years. I have no complications. I figured out how to eat for diabetes by trial and error. It took me many years. The medical and insurance people need to learn the proper diet for a diabetic and teach it to those diagnosed with diabetes. What is being taught is incorrect. Getting blood sugar down to an A1c of five or less with drugs does not prevent complications. Low carb diet does prevent complications. Recent research shows that
    diabetics excrete thiamine (B1 nerve vitamin) 75 times faster than non diabetics. This is very likely the cause of nerve damage in diabetics.

    • ED

      Hi….is it better to take B1 suppliments ? Low carb diet is best but didnt know about this B1 nerve vitamin issue. Appreciate you help. thanks
      Ed A.

      • Hi Ed,
        Google diabetes and Thiamine to see that what I am telling you is correct. This research is very recent.
        I suspect most doctors do not know it yet.
        The American Diabetes Association has addressed it but their article is very technical. Look further and you will find ones with language you and I use.
        Thiamine is water soluble which makes it hard to hold onto. However one is made as a supplement that is fat soluble. That is the one you want so your body can hold on to longer. The name of it is Benfotiamine.
        I buy mine at a local store that carries supplements. You can also get it online. Two capsules contain 300 mg. I take two three times a day. That is what the article says. Check it out. The bottom of my feet
        started to get tingly. When I raised the dose from 2 to 6 per day the tingling started to go away.
        The thiamine is non toxic.

      • Ed,
        The name of the form of Thiamine is a fat soluble one called Benfotiamine. The water soluble ones will not be helpful as your body excretes them to quickly.
        I take 2 capsuls 3 times a day according to the articles I read. It is nontioxic.

  • maedell

    An incentive would not change my behavior. I do try to take care of myself but I don’t think my activities are my employer’s business as long as I can do my job. My activities while I am not at work are especially none of the employer’s business.