Reward programs, known as contingency management, are perceived positively by participants and can increase rates of successful smoking cessation, according to researchers at RTI International. Researchers examined how participant characteristics, perceptions and behavior are influenced by contingency management interventions, which offer rewards such as money or vouchers to participants for successfully quitting smoking.

The researchers found that participants perceive incentives for successfully quitting smoking as motivating, but that smokers' preferences for rewards are varied. They suggest that identifying rewards that are most meaningful to the smoker attempting to quit would help increase the cessation rate. The review also showed that reward programs may lead to greater withdrawal symptoms initially for participants, such as craving for cigarettes. They noted that these symptoms tend to decrease at a greater rate over time compared with non- incentive group participants. The authors suggest that this may occur because contingency management participants are motivated by the reward and thus have greater focus on the symptoms presenting potential challenges to success.

According to the U.S. CDC, while almost half of smokers attempt to quit each year, only about 5 percent are successful. This further indicates the need for tailored, consumer- focused smoking cessation programs, such as those that can be provided using a contingency management approach.

"According to the review, contingency management interventions have the flexibility to adapt to individual preferences and needs, which leads to greater participation and likelihood of successful cessation," said the researchers. "Thus, contingency management provides an important framework for addressing the need for consumer-focused smoking cessation interventions."

"Our members have an incentive program tied to wellness, in which we try to get them to adopt healthy lifestyles. As they do that, they are provided with monetary incentives. We are also looking at programs to incentivize physicians for doing certain things as well. We plan to align those two initiatives so that the physician can be active in supporting the member in acquiring those lifestyle patterns or habits that we hope they will adopt. For example, physicians should prescribe exercise. Data now shows that’s very effective for a physician to actually write a prescription for exercise rather than just mentioning it. The prescription should include how much exercise the person needs to do and which activities they might be able to do — and have that discussion about the benefits to the patient. If we’re incenting the member to increase their exercise, at the same time, we would develop incentives for the PCPs to have those conversations with the individual."
                                        — Dexter Shurney, Vanderbilt University and Medical Center

The overall percentage of people who think getting a financial incentive would be extremely or very useful for choosing a more effective treatment decreased from 61 percent in 2009 to 55 percent in 2010, according to a new report released by the Employee Benefit Research Institute (EBRI). Similarly, the percentage of people who had an interest in using high-quality provider networks that offer lower cost-sharing incentives dropped from 45 percent in 2009 to 42 percent in 2010.

Despite the overall drop, young people, minorities and low-wage workers are still more likely to find financial incentives extremely or very useful, EBRI found. There was no significant difference between women and men and no difference found in education level. Among other findings in the report:

Medication adherence programs can improve patient care and lower healthcare costs by more effectively managing chronic medication utilization. We wanted to see at which points in care organizations were most heavily focused on improving medication adherence.

Question: How can an organization create an incentives program that encourages participation?

Response: It traditionally relates to either a monthly or an annual number that individuals will see. It’s usually a premium-based reduction. For the employer, their decision about premiums in any given year is whether or not they really to use the premium in a reduction or the premium to incent participation in their program. Some are overt and some are less overt about the law of large numbers. The fundamentals of health insurance are based on a law of large numbers and that insurance only works if everyone is in the game at a certain level. We know in any given year that those who are healthier and are paying a bit more than they would’ve needed are the ones that are going to offset the costs of the people who are sicker that year and actually didn’t pay as much as they need. That’s how it works. In these premium-adjusted designs, they know that not everyone is going to take advantage of a premium reduction and that in effect the overall premium differential between participants and non-participants can help pay for the costs of the program.

(Dr. Paul Terry, president and CEO of StayWell Health Management.)

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