Deselecting prospects for HM interventions can occur before they are invited to participate, by simply deciding that particular people who are eligible for a given intervention do not promise sufficient potential risk/reward ROI for the cost of the intervention considered.  This is really no more than careful selection of whom to invite in the first place.  The more serious de-selection challenge arises with people who have enrolled, but do not participate, cooperate or change their behaviors/lifestyles enough to deliver the predicted value.

Many such participants will de-select themselves, by simply not responding to invitations to participate, or dropping out once they are enrolled in a particular HM intervention.  Many will drop out if they do not participate, or make no changes that would deliver any benefit to them anyway.  But when there are incentives for participation, some may continue to do the minimum needed to qualify for incentives, but not make the changes needed to either gain personal health benefits, or deliver any value to HM sponsors or providers.

When participants choose not to enroll, or when they de-select themselves, sponsors and providers may decide to seek to “recapture” them through new persuasive communications, incentives or both, assuming their predicted value is great enough to warrant added effort and expense.  If participants do not show any signs of achieving close to their predicted value, such as not participating with coaches, not opening e-mail, making website visits, and particularly if not making the kinds of lifestyle/behavior changes needed to deliver value to sponsors, then the sponsor or provider may choose to “fire” them.

This should obviously be done carefully and politely, with reasons for doing so made clear, along with the fact that their dropping out will save them time and save the sponsor effort that is now being wasted.  Such a notice may be enough to spur some to re-energize their participation, but many will probably be happy to drop out if they are not gaining any incentives.  It is for this reason that incentives should be linked to clear demonstration of behavior changes, rather than merely going through the motions to qualify.

For members of insured populations, insurers will clearly worry about losing the members who are “fired” from an HM intervention.  They may prefer that members who do not respond well to one HM intervention be offered another they might respond to better.  With employee participants, the potential of a loss of an employee over being dropped from an HM intervention may not be pretty low, but employers may object to the idea, or prefer offering non-responders other options as well.

Since the average participant in an HM intervention will have five or more health risk behaviors, risk conditions or chronic diseases, the option of offering another option might make sense anyway.  It may be that the behavior changes for one risk are significantly more difficult for a given participant to make than the changes required in another.  Non-responsive participants may be offered the option of selecting from among as many HM options they are eligible for, in which case, their act of making a choice, rather than being “recruited” to the one the sponsor/provider prefers may also help engage them better in the new intervention.

De-selecting or switching non-responsive participants is at least a logical option to consider when trying to optimize the overall ROI from a given HM intervention and overall investment.  Of course, when incentives are based on behavior changes, or even better health improvements, the lack of any gain by non-responsive participants in one HM intervention may make them more likely to drop out, or even request another option.  When incentives are based on improved productivity and performance by employees, the prospect of added pay for performance can be the most powerful incentive for enrollment, cooperation, and behavior change.

There are also intrinsic benefits to participants that may affect both their willingness to enroll in HM interventions, and their persistence therein.  By calling participants’ attention to behavior changes they have succeeded in making, health improvements that have resulted, etc. HM providers and sponsors may increase participant retention as well as cooperation, and thereby decrease reliance on extrinsic and expensive incentives.  Intrinsic benefits also do not tend to diminish in impact over time the way extrinsic ones do.  Personal health and life quality benefits often arise so gradually that participants may not notice them, or be aware of how significant they are unless asked about them, reminded of progress and their significance.

The combination of selection of HM targets based on predicted risk/reward potential, graduating HM interventions based on such potential, and careful de-selection or intervention modification among those who are not responding can significantly improve providers’ and sponsors’ success rates and ROI.  This requires additional investment in predictive modeling, and planned adjustments during participation.  It also requires tracking specific behaviors, health status, and cost/productivity/performance changes that may risk violating HIPAA regulations, as well as added costs, but careful use of selection and de-selection or offering options should more than cover such costs.