If you don't have a wellness program yet at work, one likely will come your way soon. And if you do, count on your employer aggressively making sure you participate.

Employers generally are still cutting benefits and shifting more health care costs onto you. But they are throwing more money into wellness programs, hoping you'll adopt a healthier lifestyle and that insurance costs will go down over time.

"We have tried everything else. There is nothing left," says Sara Taylor with benefits consultant Hewitt Associates.

Wellness initiatives have been around a while, but employers have intensified efforts in the past three to five years. They lure workers with financial carrots - sometimes a stick - to take part in, say, health risk questionnaires, weight-loss programs or medical screenings.

And wellness programs are now part of the health care reform debate. Legislation in the Senate would allow employers to offer even larger financial incentives to workers who meet wellness objectives. Some health advocates fear this could be used to penalize unhealthy workers who can't meet the targets and would undermine reform goals.

With growing focus on wellness programs, the question is: Do they pay off?

"It is very hard to measure these kinds of things. That's one of the reasons we had a hard time selling this to our management to begin with," says Bruce Weinel, director of total compensation at Northrop Grumman in Linthicum, which launched a wellness program in the late 1990s. "We convinced them that there was a long-term cost savings with health care if you eventually change the culture of the people and get them to live more healthy lifestyles."

Today, workers are more productive and Northrop's insurance costs have risen more slowly than the national average, he says.

Benefits experts say it takes three to five years to see results. Comprehensive wellness programs typically reduce an employer's medical costs by 2 percent to 4 percent in three years, says Susan Connolly, with benefits consultant Mercer. W.R. Grace & Co. in Columbia is convinced its wellness program works. The company will see its health care costs go up 4.8 percent next year, compared with a national average of 12 percent, says Allison MacKenzie, manager of employee benefits for North America.

Its program includes subsidized weight-loss programs and fitness classes, a gym at its headquarters, free flu shots and yearly medical screenings, plus an on-site clinic.

A health risk assessment filled out by employees identified diabetes as one of the manufacturer's top health concerns, MacKenzie says. So Grace launched a program in which workers regularly meet one-on-one with a pharmacist who coaches them on managing their diabetes. Grace picks up the full tab of medications and supplies for participating workers.

Nizam Usta, a project director, signed up last year. Diagnosed with diabetes five years ago, the 57-year-old travels a lot on his job and acknowledges that he has struggled to manage his disease. The pharmacist explained Usta's medication and how he could use it more effectively, as well as lifestyle changes necessary for controlling diabetes.

Usta says regular coaching motivates him. He tests his blood-sugar levels more frequently and doesn't need to visit his doctor as often. Plus, he figures he saves about $1,800 a year on medication because Grace pays for it.

"I'm more fit now," says Usta, adding he exercises more now that he's learned how much activity he can handle without adversely affecting his blood sugar levels.

Sparks-based spice maker McCormick & Co. also has a long-running, comprehensive wellness plan that includes yearly health screenings.

"A lot of employees may recognize they have a health issue, but they don't know the seriousness of that health issue until they have the screening," says James Downing, manager of corporate benefits strategy. McCormick gets aggregate information from the screenings that it then uses to design health initiatives.

"They keep it very confidential," says Danette High, a creative design manager who undergoes screening each year.

This year's results warned her that she suffered from anemia and needed to see a doctor. High had blamed her exhaustion on working harder. The report also advised that she needed to lose weight. She now takes vitamins for her anemia and dropped 26 pounds.

These are the sorts of results that employers want to see - workers taking care of their health before conditions worsen and medical bills climb.

The key, of course, is to get workers on board, and that's where incentives such as gift cards or lower premiums come in.

Without an incentive, up to 20 percent of workers will participate, says Andie Rowe, regional wellness director in Rockville for insurance giant UnitedHealthcare. But big participation, like 70 percent, requires big incentives. "The magic number is $100," she says.

Yet some employers frustrated by low participation have switched from a carrot to a stick, such as charging higher premiums to workers who don't fill out a health risk assessment.

Some health advocates worry that reform legislation in the Senate will give employers greater leeway to penalize unhealthy workers in wellness programs.

It used to be that employers with group plans couldn't charge one worker more for insurance than another based on wellness outcomes, such as lowering cholesterol levels, says Karen Pollitz, a research professor at Georgetown University Health Policy Institute. The Bush administration opened the door by permitting employers to offer incentives worth up to 20 percent of the total cost of the worker's premium if workers met wellness targets.

Senate reform legislation would raise those incentives to 30 percent, and potentially 50 percent. Those incentives - or penalties - can be worth thousands of dollars given that the typical family coverage costs around $13,000, Pollitz says.

What can happen, she says, is an employer could jack up the deductible for all workers from $500 to say $2,500. Employees would see a reduction in their deductible if they participated in the wellness program and each time they met one of the program's objectives. Eventually, healthy employees would return to the old $500 deductible while unhealthy workers unable to meet the targets are stuck at $2,500, she says. And unhealthy workers could end up leaving an employer's plan, defeating the purpose of reform to expand coverage and protect the sick from paying more for it.

"The slippery slope is quite steep here. And you start thinking there are no limits in this legislation on what insurers and employers can penalize you for," she says.

House legislation doesn't include this provision. And Maryland employers interviewed say they will stick with positive incentives.

Whatever the outcome of health care reform, it appears wellness programs are here to stay. Mercer's Connolly says workers should focus on the good. As employers shift more insurance costs onto employees, staying healthy will mean lower costs for workers, too, she says.

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