More than just medicine: the impact of behavior on health outcomes
February 8, 2021

It’s estimated that health care only accounts for 10-20% of a member’s health outcomes, leaving the rest up to genetics, social and environmental factors, and individual behavior. 

In fact, studies show that individual behavior accounts for 40 to 50 percent of an individual’s health outcomes, making it critical for payers and providers to understand how to influence member behavior. 

When it comes to member outcomes, medical care is only part of the story

The education gap

Classical economics suggests that when you educate people about what will be best for them, they will choose what’s best for them. 

But that’s not always true. 

For example, according to the American Heart Association, 80% of cardiovascular disease is preventable through basic things like diet, exercise, and keeping blood pressure and cholesterol under control. Yet despite its preventability, cardiovascular disease remains the leading cause of death in the U.S. Why? 

The American Medical Association shares eight reasons patients and members often fail to take their medications—or follow other care plan tasks—and only one has to do with lack of knowing it’s important. The rest include:

  • Fear
  • Cost
  • Too many medications
  • Lack of symptoms 
  • Mistrust
  • Worry
  • Depression

In other words, people need more than just education to make the right choices. They need motivation.

The role of motivating members

Even with the best intentions, we all sometimes fall short. 

Let’s say you made a New Year’s resolution to disconnect from technology and read before bed. And yet, night after night, you find yourself binge watching a show while checking emails or social media until you fall asleep instead. 

This happens in healthcare, too.

For example, for mothers diagnosed with gestational diabetes, successfully managing the condition often requires a multi-faceted care plan often involving a strict diet, careful glucose monitoring before and after meals, regular insulin injections, and/or oral medications and treatments. While we take for granted that most mothers want the very best for their children, adherence to these care plans is low—with only 7% of mothers achieving adherence at least 73% of the time. 

When behavior accounts for 40% of a member’s health outcomes, health plans that are able to change behavior through effective motivation will ultimately see healthier members. The following Wellth programs have helped prove the impact that motivation through incentives can have on increasing member adherence above the average 50% threshold:

In addition, Net Promoter Scores, measuring member loyalty to the program, averaged 88+ for these programs, showing that members were not only healthier, but happier.

Changing behaviors through Wellth

Wellth builds motivation for healthy habits through carefully structured incentive programs—encouraging members to eat right, exercise, take glucose readings, follow medication plans, obtain important preventative care, and more for a financial reward. 

Leveraging the science of behavioral economics, Wellth uncovers and addresses the unique obstacles that our members face that keep them from adhering to care plans. Wellth then institutes programs to overcome these obstacles through better motivation—rewarding members with daily

financial incentives for submitting scheduled check-ins that align with their care plans.

Ultimately, the rewards of healthy living go beyond the incentives, and include better health, confidence, and quality of life. The funds our members receive can be used toward groceries, prescriptions, utilities, and other essentials—helping address outside social determinants of health and creating a win for both our members and the payers and providers that support them.