Karen Roberts, Senior Vice President at Aon Consulting, is always amazed when employers tell her that they can't afford to invest in employee wellness, at least not "this year." What such employers aren't acknowledging, she told her audience at the 2006 WorldatWork Total Rewards Conference & Exhibition in Anaheim, California, is that the costs of health care are only going to increase.

"If you can't afford to invest in wellness this year, you're never going to afford it," Roberts asserted. She said employers need to invest in programs that can help reduce future costs today. What they really can't afford to do is wait.

Roberts pointed to some statistics that underscore where the opportunities lie to reduce health care costs. First, she explains, half of all disease is preventable. That is, an individual's lifestyle plays a huge role in disease prevention. Unhealthy lifestyles are responsible for billions of dollars in health care costs every year. For example, smoking alone costs $157 billion annually and obesity costs $117 billion. And continuing to shift costs and cut benefits aren't going to fix the real problem-that 27 percent of the population accounts for 85 percent of all health care costs in the United States. Instead, she encourages employers to implement some type of program-or programs-designed to educate consumers and influence the choices they make.

"We have their attention more hours a week than any other segment of their lives," Roberts says, stressing to her audience that employers have the opportunity to drive change. To that end, her presentation included a total of 30 ideas for cutting health care costs.

A number of these were tied to the idea of making employees aware of the "true" costs of health care and more than one involved doing away with co-pays. Roberts says that by having employees use co-pays, we have shielded them from the actual money being spent. One idea is to go from co-pays to co-insurance and reintroduce deductibles just for pharmacy costs; another is to take this approach towards the entire plan. In general, Roberts was in favor of ideas/programs that point out to employees that the money being spent isn't just the insurer's money, but their own.

Consumer Driven-Health Plans - A Win-Win

Roberts provided powerful statistics regarding consumer-driven health (CDH) plans, where employees take more responsibility for their medical treatment decisions and costs. According to a recent study, which analyzed "early evidence" regarding CDH participants, such individuals are:

• 50 percent more likely to ask medical providers about cost
• 300 percent more likely to choose less extensive and expensive medical treatment
• 25 percent more likely to engage in healthy behaviors, including exercise
• 20 percent more likely to participate in wellness initiatives
• 30 percent more likely to get an annual checkup
• 200 percent more likely to shop for a lower prescription cost

Roberts also strongly backed the idea of encouraging employees to take health risk appraisals: "No amount of claim data can tell you who is pre-diabetic, a smoker, or sedentary. Only self-reporting can do that." Health risk appraisals identify pre-chronic cases for cost avoidance. Remember, Roberts notes, that the best time to intervene is before a person's health condition is a problem. It's this large group of "pre-chronic" employees that, if they're willing and ready for change, you can focus on to significantly reduce future costs. Health risk appraisals "tell you who's ready for change," Roberts says. This could include those with high-risk family histories, those who are borderline diabetics or who have borderline high blood pressure, and those with a high body mass index (BMI).

Whatever your program, Roberts says that consumer education "must be part of your strategy." And she offered a few other takeaways for wellness programs:

• People often revert to old behaviors when programs are withdrawn -- short term interventions don't work
• Intensive programs reverse heart disease and hypertension, prevent diabetes, and delay prostrate cancer
• Well-designed programs save more money than they cost through medical cost containment and increased productivity