Robert S. Galvin

Application of the RE-AIM Framework to Evaluate the Impact of a Worksite-Based Financial Incentive Intervention for Smoking Cessation

Objective: To apply the RE-AIM framework to examine factors that may have influenced the impact of a financial incentive smoking cessation intervention delivered at General Electric (GE) worksites. Methods: Intervention reach and efficacy were examined alone and in combination across worksites. Telephone interviews were conducted with worksite staff to explore organizational-level factors that may have influenced program adoption, implementation, and maintenance. Focus groups were conducted with employees to explore barriers and facilitators to program participation. Results: Intervention impact varied considerably across GE business industries when reach and efficacy both were examined instead of efficacy alone. Barriers that may have hindered program success include time constraints, competing priorities, work stress, and the lack of public visibility. Conclusion: Employers considering financial incentive interventions for smoking cessation should examine how organizational context and real-world constraints may influence differential impact across sites.

Consumerism And Controversy: A Conversation With Regina Herzlinger

Regina Herzlinger catalyzed a national dialogue with the publication of her book Market-Driven Health Care in 1997. Her core argument is that health care should resemble other retail markets, where unleashing consumer choice results in competition and innovations that improve value. In an often pitched debate, critics contend that health care is far too complicated for this model to work. Here Bob Galvin engages Herzlinger on these and other topics. Articulate, passionate, and sometimes controversial, Herzlinger is the Nancy R. McPherson Professor of Business Administration at Harvard Business School, where she was the first woman in the schools history to be tenured.

How Employers Are Responding to the ACA

Although its still early in the game, employers are making key decisions about health care coverage that affect patients, providers, and insurers. So far, under the “play-or-pay” model created by the Affordable Care Act, almost all employers have continued to play.

Still in the Game — Harnessing Employer Inventiveness in U.S. Health Care Reform

The pressures employers face have worsened as health care costs have grown faster than wages. Dr. Robert Galvin writes that although the business community has been a reluctant actor in this arena, it remains skeptical that its interests will be served by solutions arising from the provider community or from increased government control.

The Effect of Cost Sharing on an Employee Weight Loss Program: A Randomized Trial

Purpose: To test the effects of employer subsidies on employee enrollment, attendance, and weight loss in a nationally available weight management program. Design: A randomized trial tested the impact of employer subsidy: 100%; 80%, 50%, and a hybrid 50% subsidy that could become a 100% subsidy by attaining attendance targets. Trial registration: NCT01756066. Setting and Participants: Twenty three thousand twenty-three employees of 2 US companies. Measures: The primary outcome was the percentage of employees who enrolled in the weight management program. We also tested whether the subsidies were associated with differential attendance and weight loss over 12 months, as might be predicted by the expectation that they attract employees with differing degrees of motivation. Analysis and Results: Enrollment differed significantly by subsidy level (P < .0001). The 100% subsidy produced the highest enrollment (7.7%), significantly higher than each of the lower subsidies (vs 80% subsidy: 6.2%, P = .002; vs 50% subsidy: 3.9%, P < .0001; vs hybrid: 3.7%, P < .0001). Enrollment in the 80% subsidy group was significantly higher than both lower subsidy groups (vs 50% subsidy: 3.9%, P < .0001; vs hybrid: 3.7%, P < .0001). Among enrollees, there were no differences among the 4 groups in attendance or weight loss. Conclusion: This pragmatic trial, conducted in a real-world workplace setting, suggests that higher rates of employer subsidization help individuals to enroll in weight loss programs, without a decrement in program effectiveness. Future research could explore the cost-effectiveness of such subsidies or alternative designs.