America's Best Health Plans

Marsha Vorhis, 55, had no problem with her employer's proposal to set health goals.

Weight Watchers, spinning, and classes in healthful nutrition and cooking led to a 90-pound loss for Betty Gravelle, 54—and a gain of $60 a week in her paycheck.

The company hoped when the program was initiated in 2002 that employees would be likelier to stick to their drug regimens if offered the carrot of reduced cost—which should lower overall healthcare expense for employees and employer alike. Sure enough, spending on employees with asthma and diabetes has declined by 15 percent and 8 percent respectively, says Jack Mahoney, Pitney Bowes's director of strategic healthcare initiatives.

This year the company added osteoporosis and seizure medication, blood thinners and drugs to prevent breast cancer recurrence. Employees with diabetes and heart disease get free cholesterol-lowering drugs. "We don't want to be a police state," says Mahoney. "When you start weighing people and doing blood tests it sends a message that you don't trust your employees."

Behavioral psychology suggests that Pitney Bowes-style programs could indeed change employees' behavior—to a point. "In general, we know from behavior modification that you reward behaviors that you want people to continue and ignore what you don't want them to continue," says Michael O'Donnell, editor-in-chief of the American Journal of Health Promotion and director of health and wellness at the Cleveland Clinic. "Punishment rarely works." The catch, says O'Donnell, is that external motivators rarely change behavior permanently. For that to happen, O'Donnell says, people must decide to change for their own benefit.

That's what Betty Gravelle did. An energy-monitoring coordinator for Hannaford Bros., a supermarket chain in the Northeast, she had struggled with her weight for years, but when she took the company's health risk assessment this year, "my numbers were way at the wrong end of the chart"—including a cholesterol reading of 291. "That was the final shock," she says.

Gravelle took drastic action, and it has paid off. Through a combination of an online Weight Watchers program, "spin and tone" classes at the on-site gym, and company-sponsored healthful cooking and nutrition classes, she has dropped 90 pounds. Her BMI, formerly almost 43, is now just over 28.

Future muscle. Financial incentives from the company didn't play a big role in her decision, Gravelle says, but they've been a nice sweetener. She gets a "healthy behavior credit" of $20 a week against her health insurance premium for completing a health risk assessment, not smoking, and working on weight-loss goals that she set with the company nurse, even if she doesn't achieve them. Her husband is covered under her health policy, and while he is not a Hannaford employee, he must participate for his wife to receive the $20 credit.

As Gravelle works toward trimming that last 20 pounds, she is further motivated by thoughts that companies might someday put more muscle into their wellness programs. "Being overweight causes just as many problems as smoking," she says, "and I keep thinking the day is going to come when they'll start penalizing me for my BMI."

O'Donnell thinks the real impact of wellness incentives could come more from their influence on workplace culture than from individual employee decisions. He observes that until the 1990s, when smoking was banned in hospitals, people insisted that allowing patients to smoke during this difficult time was crucial to their recovery. Now the idea of smoking in a healthcare facility is unfathomable. If that kind of disapproval is extended to other forms of unhealthful behavior, some day there may be little need for wellness programs at all.