title: The impact of an incentive on the use of an online self-directed wellness and self-management program.
abstract: BACKGROUND
  Those who pay for health care are increasingly looking for strategies to influence individuals to take a more active role in managing their health. Incenting health plan members and/or employees to participate in wellness programs is a widely used approach.
  
  
  OBJECTIVE
  In this study, we examine financial incentives to health plan members to participate in an online self-management/wellness program-US $20 for completing the patient activation measure (PAM) and an additional US $40 for completing 8 learning modules. We examined whether the characteristics of plan members differed by the degree to which they responded to the incentives. Further, we examined whether participation in the wellness program was associated with improvements in PAM scores and changes in health care utilization.
  
  
  METHODS
  This retrospective study compared demographic characteristics and change in PAM scores and health utilization for 144,625 health plan members in 2011. Four groups were compared: (1) those who were offered the incentives but chose not to participate (n=128,634), (2) those who received the initial incentive (PAM only) but did not complete 8 topics (n=7099), (3) those who received both incentives (completing 8 topics but no more) (n=2693), and (4) those who received both incentives and continued using the online program beyond what was required by the incentives (n=6249).
  
  
  RESULTS
  The vast majority of health plan members did not participate in the program (88.91%, 128,634/144,675). Of those who participated, only 7099 of 16,041 (44.25%) completed the PAM for the first incentive, 2693 (16.79%) completed 8 topics for the second incentive, and 6249 (38.96%) received both incentives and continued using the program beyond the incentive requirements. Nonparticipants were more likely to be men and to have lower health risk scores on average than the other three groups of participants (P<.001). In multivariate regression models, those who used the online program (8 topics or beyond) increased their PAM score by approximately 1 point more than those who only took the PAM and did not use the wellness program (P<.03). In addition, emergency department visits were lower for all groups who responded to any level of the incentive as compared to those who did not (P<.01). No differences were found in other types of utilization.
  
  
  CONCLUSIONS
  The incentive was not sufficient to spark most health plan members to use the wellness program. However, the fact that many program participants went beyond the incentive in their use of the online wellness program suggests that the users of the online program found value in using it, and it was their own internal motivation that stimulated this additional use. Providing an incentive for program participation may be an effective pathway for working with less activated patients, particularly if the program is tailored to the needs of the less activated.
authors.affiliation: University of Oregon-1209, Health Policy Research Group, Eugene, OR, United States. jhibbard@uoregon.edu.
authors.forename: Judith H
authors.identifier: http://orcid.org/0000-0002-8376-8343
authors.initials: JH
authors.lastname: Hibbard
authors.forename: Jessica
authors.identifier: http://orcid.org/0000-0003-1664-3804
authors.initials: J
authors.lastname: Greene
mesh_terms: D000328:Adult; D003695:Delivery of Health Care; D005260:Female; D006293:Health Promotion / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010358:Patient Participation; D012189:Retrospective Studies; D012648:Self Care / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data*
keywords: Internet; empowerment; health promotion; incentives; patient activation