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Why No Single Health Incentive Works | Launching a Nudge Unit | Promise of Patient-Reported Outcomes

Health plans, Medicare has for the past ten or more years attempted to incentivize patients to do what is best for them.  Wellness programs, membership to sports gyms, Cooking classes, education on illnesses, prevention, dietary advice, free coupons for compliance with medications, and a potpourri of rewards.  

Some even use penalties for non-compliance.  Some plans monitor the use of remote monitors, such as CPAP machines and if they find it is not in use will remove the device and/or refuse to reimburse for it.

Patient engagement initiatives come in a variety of forms. While insurers, employers, and providers all use financial incentives and penalties for engagement, improvement in health outcomes has been elusive



Patient Engagement Survey Why No Single Health Incentive Works
Charlene Wong, MD, MSHP Duke University
Namita Seth Mohta, MD NEJM Catalyst

We surveyed members of the NEJM Catalyst Insights Council — who comprise health care
executives, clinical leaders, and clinicians — about patient engagement incentives that do and
don’t work. The survey explores the most effective approaches to engaging patients to realize
health goals, sources of financial awards to realize health goals, sources of a financial penalty when
goals are not realized, the effectiveness of financial rewards from various sources, activities for which
financial rewards are the most effective, the effectiveness of financial rewards and penalties to engage
patients, and whether health care provider organizations should incentivize patients. Completed
surveys from 607 respondents are included in the analysis.

Initiatives to improve patient engagement come in a variety of forms. While insurers, employers, and health care providers are all involved in using financial incentives and penalties for engagement efforts, improvement in health outcomes has been elusive. Achieving that ultimate goal will usually require a combination of financial and social approaches.



Responses to a survey of NEJM Catalyst Insights Council members in January 2019 suggest that financial incentives alone are not enough to move the needle to realize patients’ health goals. The most effective approach to engaging patients to realize health goals is family/friends support (chosen by 35% of respondents), followed by education (30%), clinician support (30%), and financial rewards for healthy behaviors (27%).

There are many competing methods to obtain patient engagement. In the past most patients would ask a friend or family member for a physician referral. Now online methods have gained a strong foothold to find a physician.  Yet, patients still verify with their friends their choice made online. They will schedule a visit, and if disatisfied with their choice they will find another provider.

The patient remains supreme in making most choices when allowed.


NEJM Catalyst Connect: Why No Single Health Incentive Works | Launching a Nudge Unit | Promise of Patient-Reported Outcomes

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