By Dan Hoemke

While much has been written about the use of incentives to advance wellness programs, there is no reason to limit the use of this very constructive tactic to health promotion behaviors. The real potential for the application of incentives, rewards and recognition programs is in the broader context of overall employee health, as well as benefit programs and retirement planning initiatives driven by consumer directed healthcare strategies.

Consider the fundamental issue facing suppliers to the healthcare system: all health plan and employer populations are comprised of a broad assortment of people with different health profiles, different needs and different program and service options. Eighty-seven percent of the population is essentially healthy or experiences only episodic acute health issues. The other 13 percent of the population is always engaged in their healthcare because of health problems—12 percent of which are chronic and one percent of which are catastrophic. Additionally, potential return on investment for development and implementation of health improvement programs needs to be considered in the context of consumption of healthcare services and associated costs. The potential for improvement and the timeframe of program participation necessary for optimal results are critical considerations. For example, the 87 percent of the population that is relatively healthy (and spends 40 percent of our country's healthcare dollars) will obviously benefit from wellness and health promotion programs, but the economic benefit will mostly be seen over the long term, if chronic and catastrophic illnesses can be prevented. Conversely, the 13 percent of the remaining population with chronic and catastrophic conditions that spends 60 percent of the country's healthcare dollars can be impacted in a comparably short period of time through the use of aggressive and targeted health and disease management intervention programs. But only if they engage and comply with recommended treatment and case management efforts. That "if" is the crux of the challenge.

When you consider that average annual family medical premiums have risen to more than $13,000, 60 percent of the American population is overweight or obese, and an average couple retiring today without company paid medical insurance needs $200,000 to pay for out of pocket medical expenses, it's obvious that the problem, and opportunity for improvement, is considerable. Employers and insurance brokers need a sustainable remedy. The real opportunity is getting Americans actively engaged in a new healthcare system, such as the consumer directed options being promoted by major insurers such as UnitedHealthcare, Aetna, Humana and BCBS, and major employers such as American Express, John Deere and numerous others. So, where do we need to engage and develop motivational incentives for employees and their families? Considering most Consumer Directed Healthcare strategies are implemented over a 2-3 year period, there is great opportunity to impact all population cohorts, beyond wellness incentives. The major categories for design and implementation of programs include:

• Pre-Enrollment Awareness Communication and Educational Programs
• Enrollment Knowledge and Understanding of Benefits Program Options and Use of Modeling Tools to Evaluate Costs/Benefit Differentials
• Post Enrollment Engagement in Traditional PPO or CDHP Program...Most of Which Benefit from Employee Registration on Insurer Websites and Use of Administration, Education and Program Tools
• Post Enrollment Engagement in Healthcare Reimbursement Arrangements (HRA's) or Health Savings Accounts (HSA's) and Associated Savings, Spending and Investment Options
• Health Risk Assessment
• Health Improvement Program Enrollment, Participation, Compliance and Health Status Improvement
• Program renewal