The Patient Protection and Affordable Care Act (PPACA) poses both a moral and business dilemma for worksite wellness programs, but a leading authority suggests that it can be overcome with careful thought and the right strategy in place.

Don Powell president and CEO of the American Institute for Preventive Medicine, will address the issue in a workshop entitled, “Motivation Innovations: The Latest in Carrots & Sticks,” at the EBN-produced 25th annual Benefits Forum & Expo Sept. 9-11 in Phoenix, Ariz.

“The whole area of incentives, particularly financial ones, has become somewhat controversial in the wellness field,” he cautions. There’s evidence to suggest that cash awards, gift cards and free merchandise increase wellness program participation, but he says “it’s unclear whether such success can be sustained long term without intrinsic motivation taking hold.”

Put another way, he believes that while it’s important to raise participation, it’s quite another to drive meaningful and lasting behavior change promoted by a corporate culture of health with senior management buy-in.

Powell notes that the average wellness incentive value was $460 per participant last year, whereas the average wellness program price-tag was just $167 per participant. It begs the question: Does it really make sense to be paying more for an incentive to participate than the actual program cost?

He also warns that once a wellness incentive is offered, many employees will expect a greater payoff for each year of participation, while others will view it as the company trying to control their personal choices.

“So unless you set up a situation where good health is its own reward, I think there’s a lot of shortcoming with the extrinsic motivation concept,” Powell opines.

The trouble is that being leery of wellness incentives runs counter to PPACA, which encourages employers to increase discounts on the value of health care coverage to 30% from 20% starting in 2014 and as high as 50% thereafter.

Regardless of how the use of incentives plays out over the next few years, Powell says employers must make healthy choices easier. Those efforts could involve anything from eliminating lines for the salad bar in corporate cafeterias to intentionally slowing down elevators so that more employees decide to take the stairs.

One significant obstacle to more meaningful wellness programs is the concept of “present bias,” which Powell says recognizes that people value an immediate payback more than delayed gratification. Another is loss aversion, which he explains suggests people are more motivated to prevent loss rather than explore the possibility of gains.

Still, he believes the path to helping increase intrinsic motivation should be paved with different types of wellness challenges and social networking models that make programs engaging. “If somebody is having fun and there’s a camaraderie, which we all enjoy at the workplace, then having to give money becomes less necessary,” according to Powell.

He says it’s also more important to use anecdotes than statistics as a source of motivation. For example, that may involve publishing various case studies in employee newsletters or an e-mail blast. People relate better to know “the guy in the cubicle three doors down lost 30 pounds” as opposed to learning that 7% of the company’s employee population lost weight, Powell explains.

For more information on the BF&E program and registration, visit

Bruce Shutan, a former EBN managing editor, is a freelance writer based in Los Angeles.

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