Article Title

Do Financial Incentives Encourage Health Plan Members to Complete Health Risk Assessments?

Publication Date



financial incentives, health risk assessment


Background/Aims: Employers increasingly offer financial incentives to employees for participation in wellness activities. Whether these incentives are effective is unclear. In a nonprofit health plan, we examined the impact of monetary incentives on completion of a health risk assessment (HRA).

Methods: Harvard Pilgrim Health Care, a nonprofit HMO in New England, began encouraging members to complete a HRA starting in 2010. Any health plan member was eligible to complete a HRA, which included questions about health behaviors, quality of life and medical conditions. Starting in 2011, some large employers who contract with Harvard Pilgrim Health Care for employee health insurance began incentivizing completion of the HRA. Using records on health plan members, the HRA and employer incentives, we gathered data on all adult health plan members from October 2010 to July 2013 (N=991,743). For this analysis, we compared completion of a HRA among the 66,639 members who received incentives versus the 925,104 members who did not, adjusted for demographics. We used survival analysis to examine the association of receiving a HRA incentive with HRA completion.

Results: Among members, mean age was 42.6 years, 52% were female, and 89% were white. During the 2.75-year follow-up period, 18,884 members completed a HRA, including 11,254 among the 66,639 with incentives (16.9%) and 7,630 among the 925,104 without (0.8%). In multivariable models controlling for demographics, being offered an incentive was strongly associated with time until completion of a HRA in 2011, 2012 and 2013 (hazard ratios: 6.0 [95% confidence interval: 5.6–6.4] for 2011, 29.2 [28.0–30.5] for 2012 and 46.4 [41.1–48.8] for 2013). Other important predictors of HRA completion included female gender, Hispanic or “other” race (vs. white race), and older age. Black members were less likely to complete the HRA than white members. Larger incentives were more successful in promoting HRA completion than smaller incentives.

Discussion: Providing financial incentives was strongly associated with completion of a health risk assessment in a nonprofit health plan.




March 31st, 2015


April 28th, 2015