Newswise — (Orlando – April 30) As more and more employers use outcomes-based incentive programs to encourage their employees to participate in workplace wellness programs, they need to adopt best practices to ensure such programs are both fair and effective for all. That was the overarching message from workplace wellness experts who participated in a panel discussion on the second day of the annual meeting of the American College of Occupational and Environmental Medicine (ACOEM) being held here this week. Titled “Workplace Wellness and the Use of Outcomes Based Incentives,” the panel offered advice for employers to ensure their incentives programs maximize the health improvement results such programs are designed to achieve, while also providing proper protection for employees against discrimination or unfairness and impacts on health care coverage.

Among the panel’s suggestions were formal recommendations released late last year by ACOEM in partnership with several other leading health care organizations. Outcomes-based incentives are expected to become more common in the workplace as a result of provisions in the Patient Protection and Affordable Care Act — which encourage their use. Proposed federal regulations guiding use of such incentives are currently in formulation.

Incentive programs typically may offer discounts on health plans and other financial rewards for employees who achieve certain health outcomes – ranging from blood pressure measures to body mass index (BMI). Improperly structured programs run the risk of treating employees unequally or impacting their access to affordable care.

Alan J. Balch, PhD, vice president of the Preventive Health Partnership of the American Cancer Society, American Diabetes Association and American Heart Association, said one of the most important messages in the use of such incentives is that they should be considered “just one small part of an overall wellness program, a tool to encourage participation.” Employers shouldn’t rely only on incentives, but should strive to accomplish “cultural change” in encouraging healthier behaviors through a broad range of programs.

Dr. Balch said research shows that employees respond much better to programs that they believe are achievable -- so employers should be careful to make sure the goals employees must attain to receive discounts or other awards are not overly ambitious. Employers should also consider making their programs customizable to meet individual circumstances. An employee whose goal is to lose a pre-determined percentage of weight may be more likely to participate than one who must reach a specific weight, for example.

Dr. Balch urged employers to keep in mind that behavior modification is “hard stuff, even for people who work on it every day.” They must be committed over the long haul to comprehensive wellness programming.

Laurie Whitsel, PhD, director of policy research for the American Heart Association (AHA), discussed research by AHA of employees across the United States showing that most agree that they should be accountable for their own health and are comfortable with their employer helping them achieve good health. Employers should take note, she said, that those surveyed strongly preferred programs that reward good heath-behaviors rather than penalize poor health-behaviors.

According to Dr. Whitsel, health-screening programs are popular with employees and research shows that as many as two-thirds of employees who participate in a screening take action later to adjust their health behavior.

Dr. Whitsel said the increase in the use of workplace wellness incentive-programs is “leading us to a national debate on how employers may hold us accountable for our health.”

“We need more evidence and more information on what the minimum standards should be for programs that do work,” she said.

Ron Loeppke, MD, vice-chairman of U.S. Preventive Medicine (USPM) and president-elect of ACOEM, offered several key attributes that make up well-designed workplace wellness incentives-programs.

According to Dr. Loeppke, research by ACOEM has shown that successful programs must emphasize overall cultural change -– leading to the adoption of a “true culture of health” in the workplace -- and that employers must build strong communications channels with employees about these programs so they are well understood and embraced. Incentives are a key to helping motivate employees to participate.

Additionally, employers should use evidence-based prevention programs -– built on solid research and proven results – in structuring their wellness initiatives. They should focus on what Dr. Loeppke called “the whole population and whole person integrated strategies” approach: That is, seek to manage overall health rather than concentrating efforts on individual health conditions in isolation.

Similarly, employers should integrate their programming within their organizational structure, aligning health promotion (wellness) activities with health promotion (safety) activities. He noted that these activities are often found in separate “organizational silos,” but when they are integrated as part of a “continuum of activities that enhances the overall health and well- being of the workforce” they can be more effective.

Finally, Dr. Loeppke said, employers should strive for built-in, ongoing measurement and evaluation of the results of their programming so they can make adjustments as needed to increase effectiveness.

Pamela Hymel, MD, chief medical officer, Walt Disney Parks and Resorts, moderated the session. For more information, visit

About ACOEM — The American College of Occupational and Environmental Medicine (ACOEM) represents nearly 4,500 physicians specializing in occupational and environmental medicine. Founded in 1916, ACOEM is the nation’s largest medical society dedicated to promoting the health of workers through preventive medicine, clinical care, disability management, research, and education. For more information, visit

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