Wellness plus higher deductibles

Small cities also have combined wellness programs with high-deductible health plans to contain health care costs. In 1999, Montgomery, Ohio, with a population of a little more than 10,000, created a health care benefits committee composed of employee groups and managers to take responsibility for making decisions about health insurance coverage, using guidelines and cost ceilings set by the city. The wellness program grew out of the committee's work as a way to involve employees and reduce costs.

With 75 percent of the city's employees participating, the program has focused its educational efforts on physical fitness, nutrition and healthy lifestyle changes, says City Manager Cheryl Hilvert. The city has seen sick leave use per year decline by 24 percent, health care premium increases limited to 33 percent compared to other communities in the Cincinnati area, and significant improvement in health measures, such as lower cholesterol readings, reduced blood pressure and a drop in tobacco use. The city also contributes to health savings accounts to offset the high deductible plan, which encourages employees to shop for the best health care program.

"We believe in giving employees ownership in things," Hilvert says. "An educated consumer saves the city money and leads to better usage."

Ames, Iowa, has a 20-year-old wellness program, that gives employees different tools and resources to share responsibility for their health, says Stephanie Downs, the city's health promotion coordinator. A key component of the program is a variety of incentives for participating in city wellness offerings, she says. "We believe in a comprehensive approach to the health of our employees," she says.

The incentives range from cash payments for following certain requirements — such as attending health care classes, undergoing an annual physical and showing improvement in their physical condition — to gift certificates and water bottles for participating in group walks and completing online quizzes. As a result of the initiatives, the city has seen health care cost increases of about 4 percent, "well below trend," Downs says. "We see our employees getting healthier," she says. "We regularly get 80 percent to 90 percent participation in the program. We would like to get over 90 percent. We're not quite there yet."

Kellar thinks that the recently passed national health care reform legislation will only encourage more programs like the ones in Asheville, Montgomery and Ames. "The new health care law is designed to encourage cities to do things smarter," she says. "These programs help employees take care of themselves so they don't fall into critical care. Governments have learned a lot from these programs."

Robert Barkin is a Bethesda, Md.-based freelance writer.