Acceptance of criteria for health and driver scoring in the general public in Germany

Numerous health insurers offer bonus programmes that score customers' health behaviour, and car insurers offer telematics tariffs that score driving behaviour. In many countries, however, only a minority of customers participate in these programmes. In a population-representative survey of private households in Germany (N = 2,215), we study the acceptance of the criteria (features) on which the scoring programmes are based: the features for driver scoring (speed, texting while driving, time of driving, area of driving, accelerating and braking behaviour, respectively) and for health scoring (walking distance per day, sleeping hours per night, alcohol consumption, weight, participation in recommended cancer screenings, smoking status). In a second step, we model participants' acceptance of both programmes with regard to the underlying feature acceptance. We find that insurers in Germany rarely use the features which the participants consider to be the most relevant and justifiable, that is, smoking status for health scoring and smartphone use for driver scoring. Heuristic models (fast-and-frugal trees) show that programme acceptance depends on the acceptance of a few features. These models can help to understand customers' preferences and to design scoring programmes that are based on scientific evidence regarding behaviours and factors associated with good health and safe driving and are thus more likely to be accepted

Health promotion with physiolytics: What is driving people to subscribe in a data-driven health plan?

Data-driven health promotion programs and health plans try to harness the new possibilities of ubiquitous and pervasive physiolytics devices. In this paper we seek to explore what drives people to subscribe to such a data-driven health plan. Our study reveals that the decision to subscribe to a data-driven health plan is strongly influenced by the beliefs of seeing physiolytics as enabler for positive health behavior change and of perceiving health insurances as trustworthy organizations that are capable of securely and righteously manage the data collected by physiolytics

Incentivizing the Use of Quantified Self Devices: The Cases of Digital Occupational Health Programs and Data-Driven Health Insurance Plans

Initially designed for a use in private settings, smartwatches, activity trackers and other quantified self devices are receiving a growing attention from the organizational environment. Firms and health insurance companies, in particular, are developing digital occupational health programs and data-driven health insurance plans centered around these systems, in the hope of exploiting their potential to improve individual health management, but also to gather large quantities of data. As individual participation in such organizational programs is voluntary, organizations often rely on motivational incentives to prompt engagement. Yet, little is known about the mechanisms employed in organizational settings to incentivize the use of quantified self devices. We therefore seek, in this exploratory paper, to offer a first structured overview of this topic and identify the main motivational incentives in two emblematical cases: digital occupational health programs and data-driven health insurance plans. By doing so, we aim to specify the nature of this new dynamic around the use of quantified self devices and define some of the key lines for further investigation

Implementing data-driven systems for work and health: The role of incentives in the use of physiolytics

Following the recent success of health wearable devices (smartwatches, activity trackers) for personal and leisure activities, organizations have started to build digital occupational health programs and data-driven health insurance around these systems. In this way, firms or health insurance companies seek to both support a new form of health promotion for their workforce/clients and to take advantage of large amounts of collected data for organizational purposes. Still, the success in the implementation of wearable health devices (also known as physiolytics) in organizational settings is entirely dependent on the individual motivation to adopt and use physiolytics over time (since organizations cannot establish a mandated use). Therefore, organizations often use incentives to encourage individuals to participate in such data-driven programs. Yet, little is known about these mechanisms that serve to align the interests of an organization with the interests of a group of individuals. This is an important challenge because these incentives may blunder the frontiers between what is voluntary and what is not. Against this background, this thesis aims, from a critical realist perspective, to build general knowledge regarding incentives in physiolytics-centered organizational programs. By doing so, individuals may be able to recognize challenges linked to participation in such programs; organizations may create sensible incentives; policymakers may identify new social issues that appear with this form of digitalization in organizations; and, finally, researchers may investigate new practical and social challenges regarding digitalization in organizations. In concrete terms, the first explorative phase of the thesis shows that feedback, gamification features and financial incentives are the most implemented incentives in physiolytics-centered organizational programs. There is also an overrepresentation of financial incentives for data-health plans, indicating that health insurance companies are building their strategy on external motivators. A second, more explanatory phase serves to further explore these types of incentives and specify recommendations by taking a higher perspective than normative views, so that it is possible to create more alternative managerial strategies or develop other policy perspectives. This part principally shows that the most influential incentives on user behavior are the ones that are transparent, that stimulate individual empowerment, and that propose defined benefits. In terms of contributions, this thesis allows individuals to evaluate how their autonomy and integrity is impacted by incentives in such data-driven programs. This thesis also outlines the necessity for organizations to invest time and resources to know their audience. Organizations additionally need to develop several strategies, by mixing incentives or gradually introducing them. Policymakers must ensure that regulations permit the clear consent of participants; guarantee a proportionality of incentives, and involve entities that can guide individuals through data-sharing. Finally, this thesis enables researchers to further investigate how organizations can develop appropriate and desirable environments regarding data-driven technology, so that individuals may enhance their decision-making processes and organizations may succeed in their implementation

Health Plan Quality Improvement Strategy Reporting Under the Affordable Care Act: Implementation Considerations

Outlines considerations for implementing the requirement for employer group health plans and those in the exchange to report quality improvement activities, proposes a framework for measures and reporting rules, and summarizes current assessment methods

Attitudes towards personalized insurance tariff models : a survey among students

This paper is based on a survey conducted in 2018 and 2019 among students of a Swiss university of applied sciences, examining the general attitude of young people in Switzerland towards personal data collection by insurance companies as well as towards behavior-based, personalized insurance tariffs in motor vehicle and health insurance. In particular, it identifies perceived benefits and drawbacks of personalized tariffs. It focuses on how much trust young insurance customers have in the personal data collection practices of insurers and other actors in motor and health ecosystems. By analyzing students’ feelings about behavior-based insurance, conclusions can be drawn about the potential of digitalization and personalized insurance tariffs

The Datafied Customer Relationship in Behavioural Life Insurance

Tarkastelen tässä artikkeliväitöskirjassa asiakkaiden käyttäytymisdataa sekä erilaisia digitaalisia hyvinvointipalveluita hyödyntäviä interaktiivisia henkivakuutuksia. Näiden uusien vakuutustuotteiden tavoitteena on tarkentaa riskien ennustettavuutta ja vakuutuksen hinnoittelua, luoda uusia riskienhallinnan muotoja sekä tehdä vakuutuksesta personoidumpi ja kiinnostavampi kulutushyödyke. Interaktiivisia vakuutuksia on käytetty esimerkkinä datafikaation disruptoivista vaikutuksista: niitä on sekä juhlittu että kritisoitu niiden potentiaalista mullistaa vakuutusalan vallitsevat käytännöt. Tässä polarisoituneessa keskustelussa on kuitenkin kiinnitetty vain vähän huomiota siihen, miten dataohjautuvan personoinnin lupaukset toteutuvat oikeissa vakuutuskäytännöissä. Väitöskirjassani tarkastelen sekä interaktiivisten henkivakuutustuotteiden kehittämistä että vakuutusasiakkaiden näkemyksiä ja kokemuksia uusista palveluista. Tutkimus sijoittuu kolmen eri käytäntöorientoituneen ja tieteen- ja teknologiantutkimuksesta ammentavan lähestymistavan rajapinnoille: se nojaa vakuutussosiologian ja markkinoiden sosiologian näkökulmiin sekä tutkimuksiin, jotka tarkastelevat ihmisten jokapäiväisiä kokemuksia algoritmisista teknologioista. Tutkimuksessa tarkastelen 1. minkälaiset ideat ja tavoitteet ohjaavat uusien vakuutustuotteiden kehittämistä ja miten vakuuttajat hyödyntävät digitaalisia teknologioita ja käyttäytymisdataa kokeellisissa käytännöissään, 2. miten asiakkaat sovittavat interaktiiviset vakuutukset arkielämäänsä ja miten he kokevat tuotteisiin liittyvät hyvinvointipalvelut ja interventiot, 4. millaisia suhteita uudet vakuutuskäytännöt luovat sekä 4. miten interaktiiviset henkivakuutukset, niiden markkinat ja dataohjautuva asiakassuhde tuottavat toisiaan uudenlaisissa vakuutuskäytännöissä. Väitöskirja perustuu empiiriseen kenttätyöhön, jonka toteutin kahdessa suomalaisessa henkivakuutusyhtiössä vuosina 2017–2019. Tutkimuksen aineisto koostuu 16 vakuutusammattilaisten asiantuntijahaastattelusta, vakuuttajien käytäntöjen osallistuvasta havainnoinnista sekä 11 vakuutusasiakkaiden kanssa toteutetusta fokusryhmäkeskustelusta. Tämän lisäksi hyödynnän dokumenttiaineistoa sekä omia reflektointejani vakuutuksiin kuuluvien palveluiden käyttämisestä. Toteutin tutkimuksen analyysin rinnastamalla näitä erilaisia empiirisiä materiaaleja ja analysoimalla niitä temaattisesti. Tutkimus osoittaa, että tässä tuotekehitysvaiheessa suomalaiset vakuuttajat pyrkivät käyttämään interaktiivisia vakuutuksia ensisijaisesti riskienhallinnan ja asiakassuhteiden lähentämisen välineinä. Vakuutusyhtiöiden tavoitteiden ja asiakkaiden halujen yhteensovittaminen on kuitenkin haastavaa. Vakuutuksissa käytettävät dataohjautuvat teknologiat eivät aina pysty huomioimaan asiakkaiden muuttuvia tarpeita ja erilaisia elämäntilanteita. Interventiot, jotka asiakkaat kokevat yhdessä hetkessä hyödyllisiksi voivat tuntua toisessa hetkessä tungettelevilta ja ärsyttäviltä. Näin uudet vakuutuspalvelut tekevät algoritmisen hallinnoimisen häiritsevät puolet näkyviksi ja voivat herättää epäluottamusta. Tutkimus osoittaa puutteita niin teknoutopistisissa kuin -dystopisissa näkökulmissa, jotka nojaavat ajatukseen suoraviivaisesta digitaalisesta disruptiosta. Interaktiiviset vakuutukset eivät automaattisesti voimaannuta asiakasta hallinnoimaan hyvinvointiaan paremmin eivätkä ne myöskään ole yksisuuntaisen kontrollin välineitä. Sen sijaan tutkimus osoittaa, että uuden teknologian syntyminen vaatii paljon käytännön työtä, jossa erilaisia ajatus- ja toimintamalleja sovitetaan yhteen. Tämän lisäksi teknologian ja markkinan menestys nojaa niiden kykyyn luoda suhteita kuluttajiin. Interaktiivisen henkivakuutuksen tapauksessa nämä uudet (data)suhteet näyttäisivät katkeavan helposti, koska ne eivät onnistu huomioimaan asiakkaiden tunteita ja arvoja tyydyttävillä tavoilla.This article-based dissertation examines ‘behavioural life insurance’, a novel insurance technology that implements self-tracked data and digital health services to improve risk prediction, pricing and management. As a widely circulated example of the possible effects of datafication, behavioural insurance policies have been both celebrated and criticized for their potential to disrupt the insurance industry. However, in this polarized debate, little attention has been paid to how the promises of personalization materialize in situated practices of developing the products and in policyholders’ experiences. This research scrutinizes these aspects of novel insurance technologies by examining two Finnish behavioural life insurance products. Following the practice-oriented literature streams of sociology of insurance, sociology of markets and research focusing on people’s everyday engagements with algorithmic technologies, this study analyses Finnish insurers’ experimentation with behavioural life insurance products and the aims and ideas behind the development work. Furthermore, it examines the ways in which policyholders weave new insurance products into their everyday lives and experience the health interventions that they perform. By combining these perspectives, this dissertation analyses how behavioural life insurance (market) is co-constituted with the new (data) relations between insurers and policyholders. The study is based on fieldwork that was conducted in 2017−2019 in two Finnish insurance companies. The data consist of 16 interviews with insurance professionals, 11 focus group discussions with real and potential policyholders and participant observations in the insurance professionals’ meetings. Furthermore, these data were supplemented with publicly available document data and reflections on testing the services. The analysis was conducted by juxtaposing and thematically analysing these varied empirical materials. The study shows that instead of risk and premium personalization, Finnish insurers focus more on the promises of datafication to enable effective risk management and more intimate customer relationships. Seamless alignment between company and policyholder goals is, however, difficult to achieve. The data-driven technologies do not readily encompass customers’ lives; interventions experienced as helpful in one situation might feel intrusive and annoying in another. Thus, these technologies can fail to enhance customers’ autonomy and enact trustworthy data relations, rendering the disturbing sides of algorithmic control visible. The study shows that instead of a straightforward story of digital disruption, the emergence and success of a new insurance technology depends on human labour and the connections that are created in the process. However, these new data relations are prone to breakages and do not stabilize if behavioural policies fail to consider customers’ feelings and values in a satisfying way

Pay for performance in health care

This book provides a balanced assessment of pay for performance (P4P), addressing both its promise and its shortcomings. P4P programs have become widespread in health care in just the past decade and have generated a great deal of enthusiasm in health policy circles and among legislators, despite limited evidence of their effectiveness. On a positive note, this movement has developed and tested many new types of health care payment systems and has stimulated much new thinking about how to improve quality of care and reduce the costs of health care. The current interest in P4P echoes earlier enthusiasms in health policy—such as those for capitation and managed care in the 1990s—that failed to live up to their early promise. The fate of P4P is not yet certain, but we can learn a number of lessons from experiences with P4P to date, and ways to improve the designs of P4P programs are becoming apparent. We anticipate that a “second generation” of P4P programs can now be developed that can have greater impact and be better integrated with other interventions to improve the quality of care and reduce costs.Publishe

Evaluating work place wellness in greater Louisville\u27s technology organizations : a case study.

Employers in the Southern Indiana and Greater Louisville region are looking for strategies to help them become a healthier workplace. Many employers see the expense of paying for an unhealthy workforce and they are looking to limit these expenses. The purpose of the study is to determine the state of workplace wellness activities in organizations in Southern Indiana and Greater Louisville. Due to the poor health statuses of Indiana and Kentucky, 39th and 45th, respectively, this study is significant for a number of stakeholders in our area. The purpose of this case study was to understand the state of health and wellness of organizations in Southern Indiana and Greater Louisville, according to the Centers for Disease Control Health Scorecard (CDC, 2014). Participants were first given the Centers for Disease Control Health Scorecard (CDC HSC) to develop a consistent quantitative baseline. The CDC HSC is a 125 question, 264-point survey that covers a diverse set of work place wellness initiatives. During the survey, participants were encouraged to elaborate on any aspect of the CDC HSC, such as organizational structure, tobacco control, physical activity, or any of the other categories included. Participants were then asked a series of open-ended interview questions to explore the ways they are, or are not, addressing the health and wellness in their workplace. The population from the study includes organizations from Southern Indiana and Greater Louisville. The results of the interviews were transcribed and compared to themes in the literature for patterns, themes, and outliers. Twenty-five organizations were included in the study, including a sole proprietorship that shares the thoughts of a mid-20s entrepreneur in the technology industry. The individuals in the study phase have a variety of roles in their organizations, so it is assumed they represent the majority of the workforce in their knowledge of the wellness programs. The pilot study focused on managers and human resources personnel and the researcher felt they were biased in their knowledge of the programs. The organizations vary in size, by industry, for-profit versus non-profit, and in the positions of the respondents. The worksite wellness information is organized in the same order as the categories of the Centers for Disease Control Health Scorecard (CDC HSC). The interview material is presented by sharing the data from high, middle, and low-scoring organizations, respectively. This study found that the importance of leveraging the knowledge of experts can increase the HSC score. Additionally, a variety of wellness programs lead to more employee engagement to help employees find a method of engaging that suits them. Organizations that remove obstacles and open doors can allow healthy actions to naturally take place, through Choice Architecture without coercing or incentivizing employees to participate. Safety was a major theme in the study, even when other aspects of wellness were not present. Smoking and chronic disease management were major challenges for organizations, even when they had robust wellness programs and scored highly on the CDC HSC