Podcast: Wellness Incentives with Abbey Griffin

In this episode of the Well-Being Experts podcast, we’re discussing wellness incentives as a way to drive behavior change. We sat down with Abbey Griffin, Director of Product Development at Onlife Health, to talk about how to define the difference between participation and engagement as well as the difference between outcome-based incentives and participation-based incentives.

“Behavior change is delicate, it's tricky, and I think that it takes a lot of thought and effort to really move the needle.”




Want to dive deeper into this Well-Being Experts podcast? Here's the full transcript from our discussion with Abbey Griffin, Director of Product Development at Onlife Health.


Abbey Griffin: Behavior change is delicate, it's tricky, and I think that it takes a lot of thought and effort to really move the needle.

Host: This is the Well-Being Experts podcast and you just heard from Abbey Griffin, Director of Product Development at Onlife Health. We had the chance to sit down to discuss all things wellness incentives, including topics like how to define the difference between participation and engagement.

Abbey: With incentives a lot of times it's participation based, it could be outcomes based. All different things that go into it. Making sure people know what's available to them, and what they could be earning and why it's valuable. It's sometimes hard to convey that message.

Host: For more content like this, go to onlifehealth.com/resources. Enjoy the conversation.

Abbey: Hi, my name is Abbey Griffin, I'm Director of Product Development at Onlife Health. I've been at Onlife for about 11 years now. I've been in the industry for 15, maybe getting close to 20. I started as a registered dietitian, and kind of moved up into the health coaching world and became a manager and really loved that proactiveness of corporate wellness and being able to touch a lot of lives. The creativity aspect of product really was intriguing so kind of worked my way into product development, so I could work on creating some new solutions that would help improve people's health.

Host: Excellent. Well today we're going to talk a little bit about wellness incentives. And I would love to talk a little bit about your thoughts on outcome-based incentives and participation-based incentives. But before that, just how do you define the difference between those two?

Abbey: Sure, great question. Participatory based incentives are historically what we've known in our space, and what we've done. So we award people on doing certain activities like completing a health assessment or using a tracker to track their weight, or participating in a corporate challenge. And so those are activities that are kind of easy to do across the population, and attainable. Outcomes based it something a little newer in our space. Where it can tie to achievement of a health outcome. So where you are BMI, or body mass index of 27. And if you can get to 25 over the course of the year you might earn an incentive. So it's either moving into a healthy range for something like BMI, or blood pressure, or you could just make a small improvement. So you could lose five pounds, and then you've met that goal, because you've improved that metric. So that's more in that outcomes based realm of incentives.

Host: How do you define the difference between participation and engagement?

Abbey: I would say, participation is actively, [laughter] to be a little redundant, participation or taking a part in an activity, and you could be excited about it. You might not be excited about it, but you could be doing it for an incentive. You might not be doing it for an incentive, but that then can lead to some form of engagement because you're engaged in that activity at different levels. We start by participating and then the more you participate, the more you learn, potentially the more engaged you may become in that activity.

Host: So on the surface it seems it might be the same thing, but when you zoom in a lot more it is a big difference.

Abbey: Yeah, I'd say that's fair. I say sometimes in this industry, I see that that term's used interchangeably and it's just how this industry – the wellness base – has evolved, where there is no standard definition of engagement so a lot of times participation metrics equal engagement. But I think it continues to evolve on a daily basis.

Host: When you start having that conversation about incentives with health plans, from your experience, how does that conversation normally go?

Abbey: So incentives is – gosh, it's been embedded in wellness programs for years, almost since the initiation of wellness programs whether it was a mug – you got a branded mug - or a t-shirt after some sort of on-site challenge. The conversation has been around a while. I think it's evolved over the years, as well to be a little more fun – like the mug and the t-shirt – to a little more serious. There's a lot of money [laughter] involved. You know, that conversation is a delicate one. It revolves around that client’s budget, a lot of times. Because if you've been keeping up with the news there's a lot of money being shelled out for incentives. And so I think over the last couple of years it's gone from $300 a person per year to $600. So when you start having that conversation with the client, it gets serious fast. Because there's a lot of money involved. And if they're contributing that much money, they want to see that participation or engagement [laughter]. And the results that come there after.

Host: You use that phrase "shelling out a lot of money," I can see what you're saying. Because it can add up really quickly. So how do you respond to someone who may have the perception that incentives, they're just paying someone to participate?

Abbey: That is a really good question. I think that it is, again, incentives have an embedded in our world for a while now. And it's gone deeper and deeper over the years. And so I guess you would say, it goes hand in hand. If you think an employee or an employer of your wellness program you know that you have to so these activities and there's probably some sort of incentive. If we want to look at extrinsic versus intransigent motivation, and is that money or that incentive really going to drive that long lasting behavior, I think that it's a paradigm shift to kind of change that mentality and really focus on ways you can focus on that intrinsic motivation for the individual. And I think there's a balance there with incentives, with these dollars, with this money that people are putting towards that, but also looking at it a little bit differently and at ways you can, in conjunction with that, work on your culture, work on helping people build the tools to really hone in on that intrinsic motivation to help create that long-lasting behavior change.

Host: So in this conversation around extrinsic versus intrinsic, what do you think about this? If someone really, really wants to change, why do they need to be incentivized?

Abbey: Well, sometimes it's a start. Again, everyone's different and so some people are just going to be intrinsically motivated to get up every day and exercise and eat that apple for a snack versus the Snickers bar and take four minutes to do some deep breathing, and they don't need an incentive. But it's also nice to reward people for being healthy. And so rewards, if they're done carefully and correctly and you really know your population, can complement people that are both intrinsically and maybe not so intrinsically motivated.

Host: Okay, so it's that first step. It's just to help someone moving along on that journey. So, when you think about that journey, how do you see someone going from an extrinsic reward to eventually becoming maybe more intrinsically motivated?

Abbey: So, I think that with a well-designed incentive program that really takes into account the company's culture, the client's culture, takes into account the goals of the organization, but gets the employee's feedback on what they want, what their desires are with regards to well-being. That coupling all those into that program strategy, marrying up your incentive strategy to kind of use that as impetus, but then to drive those other program components, like on-site challenges or things that the employees and the employer might be interested, can work in parallel to kind of get people from just that get your foot in the door, that five dollars as an extrinsic motivator, to becoming intrinsically motivated.

Host: Right. And it doesn't happen overnight, it takes time.

Abbey: It's hard work [chuckles]. For sure, yes. Behavior change is delicate, it's tricky and I think that takes a lot of thought and effort to really move the needle.

Host: I like that you said just a few moments ago, "everyone's different," and that I think is a great transition to talk about. Every health plan is different and people have different needs, and so I love the transition into this as a conversation. So, does earning incentives translate into better health for individuals? How do you approach that?

Abbey: That's a tricky question.

Host: Right, it's a tricky question [chuckles].

Abbey: I think it's very correlative at this point. I think that with the right program goals, and the right engagement tactics, and the right communication plan coupled with incentives, that the combination of all those things can lead to participation, which then can lead to engagement, which then can lead to outcomes. I think our data over the years shows that if done correctly, that all can happen. So, I wouldn't necessarily tie the incentives directly to that health outcome, but it's a combination of things, including incentives, that can help produce outcomes.

Host: When you talk a little about that data, are there any things that kind of come to mind, in the moment, of just how it – that chain reaction of – there's a correlation to that, there's a correlation to this, anything that comes to mind?

Abbey: I think that the incentive drives that initial participation, especially for the people that aren't intrinsically motivated. And so that, again, is kind of the spearheads the then, "Okay, I'm doing some things. I may earn a little more. I may start liking some of these things, because actually, you did listen to me and you did create a program as I as an employee wanted. And so then I become engaged more, and maybe I developed a social network at work because other people are engaged." Then that leads to, "I lost five pounds," or "I'm walking every day," and so which drives those health outcomes and those cost savings.


Well-Being Experts is supported Onlife Health. Onlife Health is a comprehensive wellness provider serving health plans and large employers nationwide. With over 10 million members and 20 years of industry experience, Onlife takes a high touch, high tech approach to wellness that creates real results for your population. Find out more at onlifehealth.com.


Host: Are incentive plans hard or easy to communicate to members? Are they hard for companies to decide on? How does that relationship look?

Abbey: It can be easy, but it often times is difficult. I think that communication is core to program success, whether you're talking about incentives or any other piece of the program, and I think that's pretty well known in our industry. Sometimes the opportunity when working with large customers that may have multiple divisions underneath or multiple companies, say it's a health plan, working on an engagement incentive strategy that works well for everyone underneath and then being able to communicate that to those groups, and then those members within those groups, it's kind of like the telephone game where if it's not really well thought out, and you have different modalities for communication, different messaging based on who you're talking to, some things can get lost in translation. If the incentive design isn't clearly communicated, it can lead to frustration.

Host: That's frustration primarily from the boots on the ground, but because of that though, that goes all the way back to the top because if they're not happy, right.

Abbey: Right. It's a cyclical thing. It's really important to get that communication correct, and with incentives a lot of times it's participation based. It could be outcomes based. There's multiple activities that can play a part. There's different dollar amounts or you could have HSA contributions. There's just all different things that go into it, so it can be complicated. Making sure that people know what's available to them and what they could be earning, and why it's valuable, it's sometimes hard to convey that message.

Host: When you talk about communication being key, do you find that – how much conversation and communication should take place, maybe, in the planning of the incentive plan between those who will be receiving the incentives?

Abbey: A lot [laughter].

Host: Does that surprise people ever?

Abbey: What?

Host: That, "Hey, we know what you want and so here's your options." Does that get skipped over frequently?

Abbey: The boots on the ground people?

Host: Right.

Abbey: Well, that's why it's really important to understand that before you get into the design. You survey your populations. You have wellness champions. You have focus groups. You really get every level of that organization's input, and so it should be a nice surprise versus a, "What is this?" I don't think any of us want this." So that should then complement the goals as well as what the employees want, what the whole organization wants.

Host: Now, this is probably easier said than done. I think you kind of – what you're saying makes into this. Why is determining the right incentive structure for an organization so complicated in your opinion?

Abbey: Multiple reasons, I think that it's not maybe complicated, it's just maybe it takes a little due diligence, and it takes a lot of work to understand. Like I was saying, the organizational culture, what your employees want out of this wellness program, tying up those goals to an incentive structure that works well for your budget, that aligns with your goals, that's easy to communicate. So, there is that soft spot of you don't want 20 different activities for someone to do because it really gets hard to communicate what those are, how to do it, how to, you know – so you want to make sure you have a refined comprehensive incentive program that aligns with everyone's goals, aligns with your budget, is easy to communicate. So that's where it kind of just gets, again I wouldn't say complicated, but just a process.

Host: When you think back to seeing some of these incentive structures be organized, are there any examples or case studies that come to mind that once have worked really well compared to the ones that have failed miserably? And maybe why there's that difference between the two?

Abbey: I've thought about that before, and I can't think of an instance where it was just dreadful and it failed miserably, or it was just so fantastic that we want to try to model this around for other clients. Because again, everyone's so unique – individual and organization. And so, what works well is if the incentive structure has a nice balance of activities that are participation based, that anyone can do. It's a nice balance of frequency.

So some things you do daily that revolve around wellness. Some things you do a couple times a year. Maybe you go see your PCP, or you go to biometric screening. Some things like using an activity tracker to track 5,000 steps, we want to get people to do that daily. So if there's a few activities that span a lot of different interest, a lot of different modalities and frequencies, those seem to work the best. And then, of course, the monetary reward or that true incentive is contingent on the budget of the client.

Host: Now I'm curious to hear about your thoughts on outcome-based incentives versus or compared to participation-based incentives.

Abbey: Outcomes based incentives has been around for a couple of years now. It was a hot topic, gosh, in 2013, '14, just starting to become part of some incentive programs. And we have had experience with outcomes based, and we think that the combination of outcomes based activities with participatory activities has worked for some of our groups.

I think that we need more data across the industry, not just us, to see if it's truly moving the needle, and outcomes based is truly making the changes that we desire. But I think that it comes across negatively if it's not communicated well, so as we talked about, it's really important to communicate the incentive structure. But then when you have to, on top of that, it's somewhat perceived as a negative message that you have to achieve this weight loss goal to earn this incentive, even if there's all these other activities they can do, it's really hard for some segments of our population not to just focus on that.

And so, I think with outcomes based, you've seen a little bit of a negative reaction from employees and we're starting to see a little bit of a decline in our industry of those employers that want to incorporate outcomes based. I think it could work. I think we need more data to support the benefit of that solution.

Host: Something you talked about earlier, it's about those one step at a time and what I'm hearing from you is if that is the only thing you're looking at and thinking about – if you lose this much weight, you get this. That can seem a little intimidating and a little scary.

Abbey: Right. And there's a lot of different ways you can slice and dice outcomes based. Of course you have to have your appeals option, your alternate means, so people have, if they can't achieve that goal, they have other ways to do it or they can appeal it, so that's all part of it, and you just have a slight improvement and we can give you your incentive. But it's perceived a little bit negatively still, no matter how you slice and dice it.

Host: So, I've noticed in the news that annual employee incentive amounts are increasing year by year. I know we talked a little bit about this earlier on too. So I'm curious to hear, are there any best practices on how much an employer should budget on incentives? How do you approach that?

Abbey: So, we've been in the industry a while, and so we have a lot of great experience to go off of and build on recommendations, and as I stated, the amount employers are spending continues to increase. Right now, I think the average is around $600 a person per year for incentive payouts. And what we've found in our data, with the right incentive plan, and of course, aligning with the budget, around $500, $550 dollars per year, per participant is kind of that sweet spot where we see the engagement they were anticipating, that participation and engagement, but anything over that, we really wouldn't see much more return on that investment, so that's – but based on our research and experience have seen that.

Host: That's the threshold?

Abbey: Mm-hmm.

Host: And if you start spending more than that, just out of curiosity, what does that money, what would that go to? Even though it's not really changing much of what you want people to have incentives to change?

Abbey: People get more money [chuckles].

Host: More money, more mugs, more t-shirts?

Abbey: Right [chuckles], more mugs and t-shirts. That's what I mean, there might be a slight increase, but it doesn't really move the needle all that much more, so we've found that you should use that money on other program components versus incentives.

Host: Excellent, I like it. It all comes back to the communication, understanding from boots on the ground what they really care about, and making sure you can implement a program that can help them. That's what they're interested in. How would you suggest an employer really understand what the participants are interested in when it comes to incentives?

Abbey: So, going back to what we've talked about, really understanding your employees in every level of your organization. Really understanding what they believe in, what their interests are, what they see as part of a wellness program can really guide you in picking the right incentive, which can take many shapes and forms. For example, there's the traditional old school mug or the t-shirt, but then there's some rewards that are charitable. So, if you do a team challenge and everyone works together to get 100,000 steps for that week, maybe then the award is a little bit different, and you donate a certain amount of money or all your money to a charity.

Then there's typical HSA deposits, so if you earn your incentive for a quarter, you may get 100 bucks in your HSA, your health savings account, or you just get cash or a gift card. And there's merchandise catalogs, there's a lot of different ways to offer incentives but I think the most important thing is making sure it is the incentive that is most meaningful to your employees.

Host: I really appreciate you sharing your thoughts and your expertise. I really enjoyed it. I can't wait to do this again soon.

Abbey: Great. Thanks.

Host: Thank you to today's guest and a big thank you to you for listening along with us.


Well-Being Experts is brought to you by Onlife Health, a comprehensive wellness solutions company that has spent years working with health plans and large employers nationwide. Today's podcast and additional perspectives from the Well-Being Experts can be found at onlifehealth.com/resources. We welcome your comments, questions, feedback, all of the above at engage@onlifehealth.com.