Desperate to find something -- anything -- to control rising health-care costs, companies in Pittsburgh and across the country are dusting off a tool that's been around for more than two decades but always raised some doubts: wellness programs.

Tony Tye, Post-Gazette Eric T. Hall, a senior accounts receivable representative at Highmark Inc., works out in the company's gym. More companies are offering fitness programs for their employees in an effort to control rising health-care costs. Highmark employees have made about 57,000 visits so far this year to the company's exercise facility at Penn Avenue Place, Downtown. The facility, which opened two years ago, is a key part of the company's wellness initiative for its workers. Click photo for larger image. Related coverage Employers find it pays to have healthier workers

Ranging from nutrition and smoking cessation classes to the distribution of pedometers so that employees can count their steps per day, the current wellness resurgence features an increase in the number of both wellness programs and firms offering financial incentives to encourage worker participation.

Last month, Highmark Inc. launched a program called Lifestyle Returns that enables companies to reward wellness program participants with everything from discounted insurance premiums and expanded benefits to good old-fashioned cash.

Late last year, UPMC Health Plan initiated a similar effort that provided incentives for University of Pittsburgh Medical Center employees to complete a wellness assessment. The health system is now developing work-site wellness programs to help employees reduce their risks, a test that could help it market wellness products to other employers.

The wellness push fits with the consumer empowerment rhetoric surrounding both the movement toward increased cost-sharing with employees and Health Savings Accounts (HSAs), insurance options that ask consumers to take more responsibility for their health-care costs.

While people have talked for years about the potential for wellness programs to save money over the long run as people live healthier lives, proponents say they finally have the numbers to show the programs can deliver a significant return on investment in the short term, too.

Those are the numbers that employers are eager to see, said Christine Whipple of the Pittsburgh Business Group on Health, a coalition of human resource executives and benefits managers at roughly 60 area companies that is sponsoring a forum next month that will touch on wellness plans.

"The challenge that the employers have is marrying that incentive cost with the impact on their total health-care" spending, she said. "The payout for incentives is immediate, but the recognition of savings from people entering the health care system or not entering the health-care system might be further down the road."

The first step in many wellness programs is for workers to complete a health assessment form that identifies their risk factors.

Companies look at the aggregate information about employee risk factors and then provide resources for people to lower their risks -- whether it's targeting smokers by offering cessation classes or trying to address obesity by making it easier for workers to exercise.

While employers get information about the overall health risks of employees, they don't get information about individuals. Workers, however, do receive information from a third party about how they can lower their individual risks, whether through diet, exercise or stress management.

Costs vary depending on the sort of programs employers want to provide, which can range from simply encouraging people to take the stairs to creating an on-site gym. The richness of the incentives varies, too. But comprehensive programs can cost $100 to $150 per employee per year, said David Steurer, membership director at Wellness Councils of America, which provides educational materials to companies that run wellness programs.

As more companies have shifted health-care costs to workers in recent years, they have created an incentive for workers to enter wellness programs. "A company might announce that there will be an increase in the employee premium next year, but the company will waive the increase if the employee will do certain things in a wellness program," Steurer said.

"We've seen companies make health insurance eligibility dependent on enrollment in a wellness program," he said. "There are companies that do other types of incentives, but I think this is a trend we'll see continue."

A June survey of 365 national companies by Deloitte Center for Health Solutions found that 62 percent of companies had implemented wellness programs and another 33 percent said they were considering doing so. Employers surveyed said wellness programs were part of a broader strategy to shift some health-care costs to employees, the survey found, although most said they didn't expect healthier lifestyles to make an immediate impact on their overall costs.

Companies that offered wellness programs reported that fewer than one quarter of employees were participating, but 47 percent said they were offering incentives to boost participation.

The University of Pittsburgh Medical Center is one such employer.

Late last year, it and its insurance subsidiary, the UPMC Health Plan, announced a joint venture to encourage workers to complete confidential, online personal health questionnaires. Workers who did so received feedback about lifestyle and behavior changes they could make to improve their health, and the health system is now designing wellness programs that will help employees address their risk factors.

Completion of the online forms was voluntary, but employees who completed the paperwork were exempt from a new deductible on hospital and laboratory expenses of $200 for individual coverage and $400 for family coverage. About 93 percent of workers completed the form, said Michael Culyba, the vice president for medical affairs at UPMC Health Plan.

Wellness programs are part of a broader movement that is seen shifting more of the responsibility toward controlling health-care costs onto individuals, Culyba said. Another example would be the growing use of HSAs, which let individuals put pre-tax dollars into investment accounts. The funds are not taxed as long as the money is spent on qualifying medical expenses. The accounts typically are coupled with high-deductible insurance policies.

HSAs and high-deductible insurance plans are being adopted by a growing number of employers with a goal not only of reining in their health care costs but providing consumers with incentives to judiciously use care. Wellness programs provide consumers with tools to do so.

"This has become a very popular topic for employers," Culyba said.

HealthAmerica also has seen an increase in employer interest and is developing an enhanced level of wellness programs in response. As is true at UPMC Health Plan and Highmark, basic wellness programs have been part of the basic package of HealthAmerica benefits for years, and the insurer has seen how financial incentives can boost participation rates, said HealthAmerica President Robert L. Dawson.

At Highmark, 228 employer groups are implementing work-site wellness programs this year, up from 173 groups that had signed on by this time last year. That has resulted in big increases in the number of employees completing health risk assessments, up from 17,048 in 2003 to 59,204 during the first seven months of 2005.

The new Lifestyle Returns program provides incentives for workers to participate in these programs as well as other services such as Blues on Call, which provides health coaching to individuals with health problems. The major cost to the employer depends on the incentives.

"We offer as part of our product a baseline level of work-site wellness," said Dr. Don Fischer, the chief medical officer at Highmark. "It's something that has been available, but many have not taken advantage of it. I think some think it's touchy-feely, but the fact is we've had more data that show there's an impact to this -- that it isn't just kooky."

Not all employers have been fully aware of Highmark's work-site wellness programs, said Jere Cowden, president of Cowden Associates, a Downtown actuarial and employee benefits consulting firm. But nowadays, the insurance company is doing a better job publicizing the option, Cowden said, and the market is responding.

"Health care costs are so high, and there are no silver bullets," he said. "So organizations are looking for solutions that have the possibility of success not only in controlling medical costs, but also improving the quality of life and productivity of their employees."