Effect of Health Plan Financial Incentive Offering on Employees with Prediabetes - 22/11/17

Doi : 10.1016/j.amjmed.2017.09.024

Anita D. Misra-Hebert, MD, MPH ^a,^b,^* , Bo Hu, PhD ^b, Phuc H. Le, PhD ^a, Michael B. Rothberg, MD, MPH ^a
^a Center for Value-Based Care Research, Cleveland Clinic, Ohio
^b Department of Quantitative Health Sciences, Cleveland Clinic, Ohio

^*Requests for reprints should be addressed to Anita D. Misra-Hebert MD, MPH, Cleveland Clinic, Medicine Institute, Center for Value-Based Care Research, 9500 Euclid Avenue, G10, Cleveland, OH 44195.Cleveland ClinicMedicine InstituteCenter for Value-Based Care Research9500 Euclid Avenue, G10ClevelandOH44195

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Wednesday 22 November 2017

Abstract

Background

Prediabetes may be improved or reversed with lifestyle interventions. A worksite wellness program offering financial incentives for participation may be effective in improving the health of employees with prediabetes. We studied the effect of employee health plan financial incentives on health outcomes for employees with prediabetes.

Methods

We conducted a retrospective cohort study using electronic medical record data from January 2008 to December 2012. Our study participants were employees with prediabetes and propensity-matched non-employees with prediabetes and commercial health insurance, all receiving care within one health system. Exposures included fixed annual financial incentives for program participation and later a premium discount divided between program participation and achievement of goals. We used longitudinal linear mixed models to assess yearly changes in glycosylated hemoglobin (HbA1c), weight, and low-density lipoprotein cholesterol in employees versus non-employees. We also compared outcomes of employees by ever- versus never- program participant status.

Results

Our study population included 1005 employees and 1005 matched non-employees. The yearly reduction in HbA1c for employees versus matched non-employees did not differ in 2008-2010 but was greater in 2010-2012, when incentives were tied to program participation as well as achievement of goals (−0.10% vs −0.08 %, respectively; P for difference in change [DIC] = .01 from 2010 to 2012). Analyses from both periods showed that employees lost more weight per year than matched non-employees (−1.85 vs −0.21 lb [1 lb=0.45 kg] from 2008 to 2010; P for DIC < .001 and −2.35 vs −0.65 lb from 2010 to 2012; P for DIC < .001). Employees who participated in disease management lost more weight than those who did not (−2.14 vs 0.79 lb yearly before 2010 and −2.82 vs −0.91 after January 1, 2010, P for DIC < .01 and < .001, respectively).

Conclusion

A worksite wellness program offering health plan financial incentives for participation and outcomes was associated with improvements in weight and HbA1c.

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Keywords : Employee health, Incentive plans, Prediabetes

Esquema

	Funding: ADM-H is funded by Agency for Healthcare Research and Quality grant K08HS024128.
	Conflict of Interest: ADM-H has received grant funding from the Merck Investigator Studies Program and Novo Nordisk, Inc., both unrelated to this study.
	Authorship: All authors had access to the data and a role in writing the manuscript.