Making Good Health Easy

It’s seven weeks into the new year. Do you know where your resolution is? If you’re like millions of Americans, you probably vowed to lose weight, quit smoking and drink less in 2009. You kicked off January with a commitment to long-term well-being–until you came face-to-face with a cheeseburger. You spent a bundle on a shiny new gym pass. Turns out, it wasn’t reason enough for you to actually use the gym.

People can make poor decisions when it comes to health–despite their best intentions. It’s not easy abiding by wholesome choices (giving up French fries) when the consequences of not doing so (heart disease) seem so far in the future. Most people are bad at judging their health risks: smokers generally know cigarettes cause cancer, but they also tend to believe they’re less likely than other smokers to get it. And as any snack-loving dieter can attest, people can be comically inept at predicting their future behavior. You swear you will eat just one potato chip but don’t stop until the bag is empty.

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So, what does it take to motivate people to stick to the path set by their conscious brain? How can good choices be made to seem more appealing than bad ones? The problem stumps doctors, public-health officials and weight-loss experts, but one solution may spring from an unlikely source. Meet your new personal trainer: your boss.

American businesses have a particular interest in personal health, since worker illness costs them billions each year in insurance claims, sick days and high staff turnover. A 2008 survey of major U.S. employers found that 64% consider their employees’ poor health decisions a serious barrier to affordable insurance coverage. Now some companies are tackling the motivation problem head on, using tactics drawn from behavioral psychology to nudge their employees to get healthy.

“It’s a bit paradoxical that employers need to provide incentives for people to improve their own health,” says Michael Follick, a behavioral psychologist at Brown University and president of the consultancy Abacus Employer Health Solutions.

Paradoxical, maybe, but effective. Consider Amica Mutual Insurance, based in Rhode Island. Amica seemed to be doing everything right: it boasts an on-site fitness center at its headquarters. It pays toward Weight Watchers and smoking-cessation help, gives gift cards to reward proper prenatal care and offers free flu shots each year. Still, in the mid-2000s, about 7% of the company’s insured population, including roughly 3,100 employees and their dependents, had diabetes. “We manage risk. That’s our core business,” says Scott Boyd, Amica’s director of compensation and benefits. But diabetes-related claims from Amica employees had doubled in four years. “We thought, O.K.,” Boyd says now, “we have to manage these high-risk groups a little better.”

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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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