Participation in a workplace smoking cessation program incentivized by lowering the cost of health care coverage: Findings from the LLUH BREATHE cohort

Abstract

INTRODUCTION Systematic analyses of workplace smoking cessation programs indicate that efficacy can be enhanced by using incentives. There is variation in the type of incentives used and their effect on participation and efficacy. The aim of our study was to examine whether lowering employee health plan costs (employee contributions, co-pays) encourage employee smokers to participate in workplace smoking cessation. METHODS We conducted a 2014-2015 prospective cohort study of 415 employee smokers of Loma Linda University Health (LLUH). The employees were offered participation in a workplace smoking cessation program (LLUH BREATHE Initiative) with the incentive of enrollment in an employer-provided health plan that had a 50% lower employee monthly contribution and co-payment relative to the employer-provided health plan for non-participants. Participation rates and variables associated with participation were analyzed. RESULTS In the LLUH BREATHE cohort, we found a very high rate of participation (72.7%; 95% CI: 69-77%) in workplace smoking cessation that was encouraged by a lower out-of-pocket health plan cost for the participating employee and/or spouse. Participation did, however, vary by gender and spouse, whereby female employee households with a qualifying smoker were more than two times more likely (employee: OR=2.89, 95% CI: 1.59-5.24; or spouse: OR=2.71, 95% CI: 1.47-5.00) to participate in smoking cessation than male employee households. The point prevalence, at four months, of abstinence from smoking among the participants was 48% (95% CI: 42-54%). CONCLUSIONS Our findings indicate that a workplace smoking cessation program that uses a novel reward-based incentive of lower out-of-pocket health plan costs results in a participation rate that is much higher than US norms.

Pilot Feasibility Study of Incorporating Whole Person Care Health Coaching Into an Employee Wellness Program

“…Loma Linda University Health (LLUH) offers an “opt in” health plan option—the Wholeness Health Plan (WHP)—to its benefit-eligible employees which incentivizes social determinants of health. Through this plan, employees have an opportunity to receive an “opt in wellness discount” on out-of-pocket health plan costs (i.e., monthly premiums, co-pays) ( 17 ) by completing specific wellness activities (i.e., interventions such as weight management for high risk patients, smoking cessation for current/relapsed smokers). To date, this innovative workplace health plan model was developed at LLUH and has been used to date to accomplish a high rate of participation (73%) and success (48% 4 months point prevalence abstinence) in WHP sponsored employee smoking cessation ( 17 ).…”

Cohort profile for the Loma Linda University Health BREATHE programme: a model to study continuously incentivised employee smoking cessation

“…One potential reason why the overall participation rate of employee smokers in LLUH BREATHE is higher than national norms is that the cash/reward model is of particularly high cash value 1. Specifically, the LLUH BREATHE model1 of decreasing out of pocket health plan costs by 50%–53% provides a financial incentive (US$600 to US$1200 in lower health plan costs per year) that far exceeds other incentivised cash/reward employee smoking cessation models (up to US$800 is annual cash/rewards) that have been reported in the peer-reviewed scientific literature 7–9. For the LLUH BREATHE cohort, further study is needed to measure the relationship between the cash value of the incentive on long-term abstinence.…”

“…Our group has reported that, during the first year of follow-up, there was a 73% participation rate among in the continuously incentivised model of employee smoking cessation in LLUH BREATHE. 1 The first year cessation rate of LLUH BREATHE participants was also notably high (48% achieved a 4-month point prevalence abstinence) 1. Pilot qualitative data provide preliminary clues that the WHP cohort members and their providers are receptive to the incentivised intervention model 14…”

“…Loma Linda University Health (LLUH) is an academic medical centre with over 16 000 employees working in eight health science schools, six hospitals and a physician practice corporation. In 2014, LLUH introduced an option within the employee health plan—The Wholeness Health Plan (WHP)—that provided employees with an ‘opt-in wellness discount’ that consisted of 50%–53% lower out of pocket health plan costs (ie, monthly employee premiums, copayments for prescriptions) 1. The rationale for the WHP ‘opt-in wellness discount’ was to address the burdens caused by social determinants of employee health by investing health plan resources in an incentivised prevention model.…”

“…To qualify for the WHP ‘opt-in wellness discount’, employee smokers (identified through self-report, health claims data, organisationwide health risk assessments (HRAs) and biometric screening) were required to participate in LLUH BREATHE—the WHP’s smoking cessation programme 1…”