For people who exercise regularly, the idea of getting a break on health insurance for being fit sounds like a pretty good deal. But what about those who are sedentary or obese? Should they be penalized for not doing anything about their weight?

Health insurers, public policy makers and health ethicists alike have been looking for answers to these questions, particularly as healthcare costs continue to spiral out of control. One question, however, appears to have been answered by a recent study: When people had to choose between paying up to 20 percent more for health insurance or exercising more, the majority of enrollees met fitness goals one step at a time via an Internet-tracked walking program. 

Meeting Fitness Goals, One Step at a Time

Blue Care Network, a major health insurance company, created quite a stir a few years ago when it implemented one of the largest-scaled financial incentive programs in the country by requiring adults who were obese and in the Healthy Blue Living program to enroll in a fitness program to qualify for lower out-of-pocket healthcare costs. Enrollees could choose between several programs, including Weight Watchers and WalkingSpree, which uses a digital pedometer to upload walking data on a wellness tracking web site.  

Researchers from the University of Michigan Health System and Stanford University evaluated a group of people insured by Blue Care Network who were enrolled in a pedometer-based program as a requirement to receive insurance discounts. After one year, nearly 97 percent of the enrollees had met or exceeded the average goal of 5,000 steps a day—including the most resistant participants who disagreed with the financial incentives and found the program “coercive.”

“There are ethical debates around the idea of forcing someone to be personally responsible for healthcare costs related to not exercising, but we expect to see more of these approaches to financially motivate healthier behaviors,” says senior author Caroline R. Richardson, M.D., assistant professor in the U-M Department of Family Medicine, investigator with the VA Center for Clinical Management Research and member of the U-M Institute for Healthcare Policy and Innovation.

“Our evaluation of Blue Care’s incentivized program showed a surprisingly high rate of people who enrolled in the Internet-mediated walking program and stuck with it—even among those who were initially hostile to the idea. Wellness interventions like this clearly hold significant promise for encouraging physical activity among adults who are obese.”

For some families, the out-of-pocket cost of failing to meet the new criteria in one of the wellness programs was nearly $2,000 more per year. Those with medical conditions were exempt if they had waivers from their doctors.

Nearly half of the more than 12,000 enrollees who met criteria for a wellness program picked the pedometer-based program, and the study’s authors evaluated their success. The 6,548 participants were required to reach an average of 5,000 daily steps in each three-month period, or 450,000 steps a quarter, to remain eligible for enhanced benefits. Just 3 percent failed to do so.

Among users who responded to a satisfaction survey about the program, one-third of the participants were unhappy with the financial incentives because they felt the incentives were coercive. The remaining two-thirds of respondents, however, liked the program.

Validation—and Opportunity—for Health and Fitness Professionals

It is important to note that policies under the Affordable Care Act are expected to expand the types of wellness programs offered by employers and insurance companies who ultimately save on health costs when employees and enrollees maintain healthier habits.

“Our findings suggest that incentivized wellness programs are acceptable to many individuals and that these programs encourage healthy behaviors,” says lead author Donna Zulman, M.D., Instructor in the Division of General Medical Disciplines at Stanford University and research investigator at the VA Palo Alto Health Care System.

These findings also create important opportunities for qualified health and fitness professionals.

“Workplace wellness programs are increasingly being outsourced to local fitness facilities and health clubs,” says Cedric X. Bryant, Ph.D., ACE Chief Science Officer. Employers and health insurers alike are recognizing that having healthy employees equals higher productivity and less absenteeism and are increasingly turning to the fitness industry and its qualified fitness professionals to reinforce healthy lifestyle habits in their employees.

Acquiring the needed skills and education to serve corporate clients is an important first step for fitness professionals who want to expand both their client roster and their income. Bryant recommends pursuing certification and continuing education in the areas of health coaching, behavior modification and corporate wellness.

While further studies are needed to determine whether participation in these programs translates to meaningful changes in health and costs of healthcare, there is no question that increased participation in health and wellness programs benefits all stakeholders, particularly those who were previously sedentary.