title: Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis.
abstract: Many employers offer worksite wellness programs, including financial incentives to achieve goals. Evidence supporting such programs is sparse.
  
  
  
  To assess whether diabetes and cardiovascular risk factor control in employees improved with financial incentives for participation in disease management and for attaining goals.
  
  
  
  Retrospective cohort study using insurance claims linked with electronic medical record data from January 2008-December 2012.
  
  
  
  Employee patients with diabetes covered by the organization's self-funded insurance and propensity-matched non-employee patient comparison group with diabetes and commercial insurance.
  
  
  
  Financial incentives for employer-sponsored disease management program participation and achieving goals.
  
  
  
  Change in glycosylated hemoglobin (HbA1c), low-density lipoprotein (LDL), systolic blood pressure (SBP), and weight.
  
  
  
  A total of 1092 employees with diabetes were matched to non-employee patients. With increasing incentives, employee program participation increased (7 % in 2009 to 50 % in 2012, p < 0.001). Longitudinal mixed modeling demonstrated improved diabetes and cardiovascular risk factor control in employees vs. non-employees [HbA1c yearly change -0.05 employees vs. 0.00 non-employees, difference in change (DIC) p <0.001]. In their first participation year, employees had larger declines in HbA1c and weight vs. non-employees (0.33 vs. 0.14, DIC p = 0.04) and (2.3 kg vs. 0.1 kg, DIC p < 0.001), respectively. Analysis of employee cohorts corresponding with incentive offerings showed that fixed incentives (years 1 and 2) or incentives tied to goals (years 3 and 4) were not significantly associated with HbA1c reductions compared to non-employees. For each employee cohort offered incentives, SBP and LDL also did not significantly differ in employees compared with non-employees (DIC p > 0.05).
  
  
  
  Financial incentives were associated with employee participation in disease management and improved cardiovascular risk factors over 5 years. Improvements occurred primarily in the first year of participation. The relative impact of specific incentives could not be discerned.
authors.affiliation: Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA. misraa@ccf.org.
authors.forename: Anita D
authors.initials: AD
authors.lastname: Misra-Hebert
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Bo
authors.initials: B
authors.lastname: Hu
authors.affiliation: Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Glen
authors.initials: G
authors.lastname: Taksler
authors.affiliation: Diabetes Center, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Zimmerman
authors.affiliation: Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000191:economics / Q000523:psychology* / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006293:Health Promotion / Q000191:economics / Q000379:methods*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009786:Occupational Health Services / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D017132:Workplace / Q000191:economics / Q000523:psychology
keywords: chronic disease; diabetes; disease management; health promotion