Making Good Health Easy

The behavioral psychologists from Abacus Employer Health Solutions advised Amica to create a separate wellness program for its diabetic employees, based on their specific needs and unique barriers to care. Today Amica covers all co-pays on necessary diabetes drugs but only for patients who attend five key annual preventive-health checkups, including an eye exam and a foot exam. Within eight months of the program's launch in 2008, about half of Amica's diabetic employees were enrolled. It was a win-win situation: members had saved nearly $35,000 in out-of-pocket expenses, and Amica's health-care costs on compliant members dropped 50% within a year. Best of all, unlike the nonparticipants, not one of the compliant members had landed in the hospital.

There's nothing revolutionary about using incentives--financial carrots and sticks that reward and punish behavior--to coax workers toward good health. But behavior experts note that not all perks motivate all people. "To get a high-risk, overweight, four-pack-a-day smoker to change behavior, it's going to take a whole lot bigger incentive than for a 22-year-old who's healthy as a horse," says Bill Sims, president of an eponymous behavior-change consulting firm. Amica's diabetic employees weren't tempted by a subsidized gym membership. But they did respond to a plan that focused on behaviors they could manage and that offered appropriate rewards--free meds--to reinforce them.

But good options and good incentives are not always enough. Sometimes people still need a helpful cue about their best choice, says Richard Thaler, a behavioral economist at the University of Chicago and author of Nudge: Improving Decisions About Health, Wealth and Happiness. Faced with a vast array of alternatives, many people--paralyzed--pick nothing, according to Thaler's research. "Sending people a bunch of options--that they can join health clubs or Weight Watchers or something--is probably not going to work," he says. What works is making good health effortless--say, by having a nurse come into the office to administer vaccines and allowing workers to opt out if they're not interested.

At Amica Mutual, Boyd awaits the forthcoming results of employees' health-risk assessments, conducted last fall with high staff participation, thanks to a program that allowed workers to take medical tests on-site. Boyd asks, "What are some of the other chronic conditions our employees have? Do they need to work on cardiovascular? Depression? Asthma-type issues?" Whether it's a persistent illness or a failed New Year's resolution, maybe a well-placed nudge can help get them back on track.

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