HealthyWage Interviews Natalie Johnson, Manager of Health & Lifestyle Programs for Manatee Your Choice Health Plan
Natalie is a Wellness Professional with over 27 years experience working in a variety of capacities including Fitness, Wellness Program Development, Clinical Integration, Medical Fitness, Wellness Coaching and Executive Performance Coaching. She has been the Manager of Health & Lifestyle Programs for the Manatee Your Choice Health Plan since 2006.
HW: Can you briefly describe the specifics of the financial incentives you use in the YWeight program?
Y Weight is a Weight Management Program that rewards individuals who maintain a healthy weight or who lose 2-5% of their weight within a year. Participants are rewarded with Healthbucks that can be put into the employees paycheck to cover the cost of medical, dental and/or vision premiums or placed in a Flexible Spending Account for medical related reimbursements. There are three levels of awards; Gold, Silver & Bronze. The “Gold” Reward increases annually by $100 for every year that a person is successful. Our members receive the “Gold Reward” for maintaining their healthy weight or losing 5% of their weight (if overweight). The Gold Reward is the only reward that increases progressively for every year of success.
Below are all the awards currently available-
$400+ = Gold Reward (Maintain Healthy Weight or lose 5%)
$285 = 2-4.9% Weight Loss (Silver)
$200 = Maintain a weight loss of 10%
Why did you decide to use a carrot instead of a stick as part of the program?
We use both the stick and the carrot in our approach to health management and wellness with Y Weight being a program that focuses on the carrot.
As the Health Plan we use a “stick” for our wellness programs that are integrated into the level of healthcare reimbursement. We offer 4 health plan levels available with the “Ultimate” Plan being the most generous (No deductible; 100% Coverage).
In order for our members to receive the Ultimate Plan they must complete a various evidence-based preventative care programs including Health Risk Assessment, Lab Tests, Age-Based Screenings and Diabetes Education. Tobacco Users CANNOT qualify for the Ultimate Plan. This is the foundation of our wellness program and what we consider our “stick”.
All other optional wellness programs, including Y Weight offer a “carrot” in the form of Healthbucks or Gift Certificates that can be used to cover the cost of programs.
What plan adjustments did you make (e.g., deductibles, cost sharing, co-payments) when you integrated the YWeight program into the overall health plan?
None. As mentioned above we already have health management programs integrated into the health plan. All 4 of our plans (Basic, Better, Best & Ultimate) have the same premium. The difference is the level of reimbursement with the Ultimate Plan being the only one offering 100% coverage.
Y Weight is an additional incentive to help our members manage their weight effectively; it didn’t affect the plan itself.
How did you decide that $400 was the appropriate cash incentive to reward those who lost 5% of their weight?
$400 is close to what the national average is with regards to monetary incentives offered at companies of all sizes. We wanted the amount to be significant enough to motivate but also assist with long-term success by increasing the amount annually. The $400 increases annually for all members who receive the “Gold Reward”. Our hope is that our members will initially be motivated by the $400 and the annual increase in this incentive and at the same time become intrinsically motivated for long-term success.
As mentioned above we also offer rewards of $285 and $200 for those that make smaller improvements. Additionally, as a forward-thinking employer, the County recognizes that the investment of the $400 incentive is minimal compared to the costs to the health plan down the road for complications related to obesity.
How do you verify participants starting and ending weights?
Our members can only weigh in at a Y Weight event on a Y Weight Scale by a Y Weight Staff person. Although we understand weight fluctuates we wanted to get the most accurate weight possible. We invested in very accurate medical-grade scales and our members can only weigh in and out on these scales. Our members are given the opportunity to weigh in (as a new enrollee in the program) or weigh out every July. We offer many Y Weight Events during the month of July at our worksites and in community venues at a variety of times/days.
How do actually pay the money to employees who lose the weight?
Our members earn “Healthbucks” (as stated above) for participating in a variety of wellness programs all year long. Y Weight is just one of the programs where our members can earn Healthbucks. Members receive their healthbucks for the previous year every January in their paychecks or deposited in their Flexible Spending Plan (depending which they chose during Open Enrollment). These HealthBucks are prorated throughout 24 paychecks.
What differences exist between employees who earned cash in the first year and those that failed to meet their goal?
This is a tough question. This is a long-term progressively incentivized program and we’ve only just completed our first year. I think the members who were most successful made a commitment early on to make changes in their lives. Those who were unsuccessful just weren’t ready for the lifestyle commitments.
This isn’t’ the case 100% and we understand many of our members probably lost weight quickly right before they weighed in. The quick “starvation” weight loss will occur most often the first year because a new goal is established with every weigh in. If our members gain weight they receive no reward. In order to continue receiving the Gold Reward they must continue losing or maintain their healthy weight.
We recognize that change is a process and our objective is to continually evaluate what programs and services we can provide to our members so we are meeting them where they are in their own change process.
Why do you think some employees did not participate?
We had great participation the first year with thousands of our members participating and a weight loss of over 5.4 tons. However, we know that there are many members who still weren’t motivated to participate.
It’s our guess that there are several reasons –
1. Members don’t want to lose weight and/or they are not ready
2. Some members need an internal motivation as opposed to an external motivation of money before they will get started.
3. Communication – Employees failed to inform their spouses therefore they didn’t participate
We are currently exploring the reasons why some members chose not to participate and hope to have a better understanding this time next year.
What are you doing to get participants who did not participate, or failed to reach their goal, in year 1 to participate in year 2?
The first approach we have is to let these individuals know that it’s “ok”. We understand that reaching a weight loss goal is a struggle and it takes time. We don’t expect everyone to be successful the first year just like we don’t expect everyone who was successful to continue being successful every year. We are here to help and support our members in becoming healthier. We’d like to think that although some members didn’t reach their weight loss goal they did become healthier in other ways (Blood Pressure, Body Fat, Motivation, Cholesterol, etc). We let them know this when they weigh in/out at the scale individually and offer support in the form of coaching, counseling and programming.
We are also reaching out to them earlier in the year with programs that will support them reaching their Y Weight Goals.
We have a plan to outreach to these members specifically through email and phone calls to see what we could do to help them. We’re also attempting to remind our members to start now instead of waiting until the last minute to try to reach their goal(s). We have new and improved programming that we hope will appeal to the members who didn’t make it and/or didn’t participate last year.
What changes did you make to the program for year 2 after the results in year 1?
We haven’t confirmed any of our modifications yet however some of the changes we are discussing include offering a reward for members who “maintain and don’t gain” and offering a reward for improvements in body fat even though weight may maintain.