The Influence of a Wearable-Based Reward Program on Health Care Costs: Retrospective, Propensity Score–Matched Cohort Study (Preprint)

Abstract

BACKGROUND Mobile health (mHealth) technology holds great promise as an easily accessible and effective solution to improve population health at scale. Despite the abundance of mHealth offerings, a minority are grounded in evidence-based practice, while fewer have line of sight into population-level healthcare spend, limiting the clinical utility of such tools. OBJECTIVE To explore the influence of a health plan-sponsored, wearable-based, reward-driven, digital health intervention (DHI) on healthcare spend over one year. METHODS This study deployed a propensity score matched two-group, pre-post observational design. Adults (≥18 years of age) enrolled in a large, national commercial health plan and self-enlisted in the DHI for ≥7 month were allocated to the intervention group (N=56,816). Members who were eligible for the DHI, but did not enlist were propensity-matched to the comparison group (N=56,816). Average (and relative change from baseline) medical and pharmacy spend per user per month (PUPM) was computed for each member of the intervention and comparison group during the pre- (ie, 12 month) and post- enlistment (ie, 7-12 month) periods. RESULTS Compared to a propensity-matched cohort, DHI users demonstrated ~$10 PUPM lower average medical spend (P=.015) with a concomitant increase in preventive care activities and decrease in non- emergent emergency department admissions. CONCLUSIONS This employer-sponsored, digital health engagement program has high likelihood for return on investment within one year owing to clinically meaningful changes in health-seeking behaviors and downstream medical cost savings. Future research should aim to elucidate health behavior-related mechanisms in support of these findings and continue to explore novel strategies to ensure equitable access of DHIs to underserved populations that stand to benefit the most.