Spokane-area employers that offer wellness programs in some cases are seeing an uptick in employee participation, in part because incentives for participation have become more compelling.

Kathy Worden, co-owner of Spokane-based Workwell Consultants LLC, says the incentives employers offer have shifted to monetary ones and largely away from gift cards and other goods.

"Companies are saying, 'We're going to hold you accountable. We have to get a handle on our health care, and we need employees to have skin in the game,'" she says.

Wellness initiatives generally involve health-risk assessment and healthy activities, such as walking challenges, health-awareness seminars, and other events that promote an active lifestyle.

A health-risk assessment often starts with employees of participating companies undergoing a biometric screening, which tests cholesterol, blood-sugar levels, and other risk factors that can be identified through blood tests. Deb Brady, director of employee benefit operations at Spokane-based employee-benefits organization Associated Industries, says that company uses a kit, called BioIQ, which is mailed to an employee's home and is self-administered. Brady says the participants mail their blood samples to the testing company, which mails the results back to the person.

Once the person receives those results, he or she fills out an online survey containing questions about the results of the blood work, height, weight, waist circumference, and health-related behaviors. The program then makes recommendations to improve the worker's health.

Brady says an employer never receives worker's personal data, but it does receive aggregate data that paints a picture of the overall health of its employees.

"It makes people more aware of their wellness," Brady says. "There have been some life-altering changes in people's health (as a result)."

Brady adds that she is among those who have dramatically changed behaviors after seeing the results of the assessment. After some of her results came back as unfavorable, she lost 53 pounds and worked to get her cholesterol back to normal levels—a level she says she's working to maintain.

Associated Industries provides its member businesses with a health-care plan through a partnership with Portland-based ODS Health Plan Inc. With that plan, the wellness incentive is given to employers in the form of a 4 percent reduction in annual premium costs. Whether that savings is passed to employees is up to each employer.

"We still see a lot of small employers paying 100 percent of coverage" for their employees, Brady says, so those companies receive the full benefit of the rate reduction,

For an employer to receive that cut, at least 50 percent of its employees must participate in the health screening.

Brady says 60 percent of the companies involved in Associated Industries' health-insurance plan enroll to participate in the wellness initiatives, but only 40 percent of the companies have enough people participate in the screening to receive the discount.

Mary Prince, manager of corporate benefits at Avista Corp., says that company provides incentives in the form of additional contributions to an employee's health-reimbursement account, which employees can use to pay deductibles or health care not covered by insurance.

At Avista, employees who participate in all of the company's various wellness initiatives can receive up to $400 annually in a health-reimbursement account. For participating in the health-risk assessment alone, an employee receives $75 put in such an account.

Some small perks of participation are also available, Prince says, such as receiving a free pedometer for participating in a companywide walking challenge.

While wellness programs are becoming more common in the workplace, Prince says Avista has had wellness initiatives in some form for decades. Consequently, she says, the company has a high rate of participation. Among its nonunion employees, which mostly is its office workers, between 70 percent and 80 percent of people participate. The number is closer to 50 percent with Avista's union employees. Prince attributes that to the fact that most of them work in the field or odd hours and aren't always able to block out time to participate.

Avista's health-insurance plan is self-funded, and Prince says, "One good thing about being self-insured is we see the benefits of improvements."

Workwell's Worden says many of the employers that she works with are tying wellness initiatives to their premium payments. For example, she says, an employer might pay 80 percent of workers' insurance costs, with the employee having to cover the remaining 20 percent. At renewal, that employer might say that it will continue to cover 20 percent for those who participate in the wellness program, but those who elect not to participate will have to pay 40 percent of the overall premium cost.

"Twenty percent can easily be $200 a month," Worden says.

Typically, the incentives are based on participation, rather than on the results of the health-risk assessment, Worden says.

In some cases, however, once an employer has an established wellness program, they can base their premium incentives on employee's actual health status and reward those who are healthy or show improvement in health, she says.

Worden says some of the companies that contract with Workwell are getting more than four-fifths of their workers to participate. Those employees who don't participate typically decline, she says, because they don't trust the system. She says they think the information won't remain confidential, and that their employer might use that data against them in some way.

For a smaller group of those who don't participate, the incentive simply isn't compelling enough.

"Engagement is so important," Worden says. "If you can get in front of those employees who are fearful, you can nudge some people over the edge."