Incentives are commonly used in connection with health improvement and wellness programs. One of the most widespread of these programs is smoking cessation. A study reported in the New England Journal of Medicine looks at what kinds of incentives and incentive structures seemed to work best at obtaining participation and lasting results. (NEJM Article) The study was done on about 2500 CVS Caremark employees and involved four intervention groups and usual care. Two of the intervention groups were aimed at individuals and two at cohorts of six smokers each. One of the individual interventions and one group one paid rewards of about $800 for stopping tobacco use and one of required the smoker to make a $150 deposit which could be gotten back along with $650 in additional rewards. The study design was used to study whether not just the size but the structure of a reward could make a difference in a program’s effectiveness. People may be more motivated if they have some of their own funds at risk, at least initially. And it is possible that peer pressure from being in a team program might also enhance the likelihood of quitting smoking, so the incentives for the group arms of the study were partly based on overall group performance.
The primary measures were the number of people who participated based on the reward structure and the percent who stopped smoking for six months after the intervention. Of the 2070 people in one of the intervention arms, about half accepted participation, but the rate of acceptance was much higher in the reward programs as opposed to the deposit-based ones. Participation was equal in the group-based and individual reward programs. All four of the intervention groups had better quit rates than usual care. Six months and one year after the program started, however, the reward cohorts had markedly better abstinence rates than the deposit ones, with no significant differences between the individual and group reward arms. Although it appeared that the reward groups had better results, this was largely due to the greater participation rate. In fact, people who would have participated in either structure, generally did better under a deposit structure. This kind of research is extremely important if we are to understand the most effective ways to engage patients and help them maintain behavior change. Although this was a study at one employer aimed at one health improvement area, it suggests that people who have skin in the game may be more motivated, but that any incentive can be effective in helping people improve their health.