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When staffers approached management of the Central Arkansas Library System about sponsoring a fitness challenge this summer, they ended up with something akin to a reality show: Twelve weeks, 30 library employees and $1,800 in the kitty for weight loss.

Actually, it was a companywide program named for the sadistic/uplifting NBC program "The Biggest Loser," which pits obese people against scales. The library's version required a $60 buy-in from each participant, with cash prizes for the five people who lost the biggest percentage of their body weights. Library management chipped in four hours' comp time for anyone who lost at least 5 pounds, fully 18 people by the time the contest ended in October.

"There were people who didn't accomplish what they wanted during the time frame," said library spokeswoman Susan Hill Gelé, "but it did get them started on better habits."

Better habits, ultimately, were the point. Like all employers, the library system grapples with rising health care costs, something many companies are addressing at their source by encouraging workers to stay healthy. Hence the gym in the main branch basement, the annual health fair that includes $10 blood tests for employees and family members, the programs to help employees quit smoking, the flu shots. "We are self-insured," Gelé said, "and one of the motivating factors is for us, of course, to have the most effective use of the money that goes into that program."

The money in any health program has become considerable. The Henry J. Kaiser Family Foundation's 2009 survey of employee health benefits found the average annual premium for an individual is nearly $5,000. For a family, premiums are more than $13,000, about 34 percent more than in 2004 and 131 percent higher than in 1999. That means the annual price of covering a family 10 years ago was only about $1,000 higher than covering a single worker today.

Costly in Two Ways

Employers, too, pay on both ends. A sick employee, or an employee home with sick family, costs money to insure and can't do his or her work.

"Employers are becoming more interested in creating that wellness culture within their organization," said Max Heuer, a spokeswoman for Arkansas Blue Cross & Blue Shield, Arkansas' largest health insurer. "Clearly the healthier your employees are, the lower your costs are going to be. Your employees are going to be happier and more productive. And employers too are like everyone else, trying to provide the highest level of benefits to their employees while keeping costs in check."

Following a 13.5 percent single-year increase in its premiums, Paragould Light Water & Cable began a series of wellness initiatives in 2003 that have blossomed into brown-bag lunch lectures and mandatory health fairs that offer cancer screenings, blood exams, smoking-cessation programs, the works. Bill Fisher, CEO and general manager of the not-for-profit Paragould utility company, said premiums for his 128 employees cost about $1 million a year, but have held steady, with only a 1.9 percent average annual increase, since the company began those health programs.

The savings are actual and actuarial: The utility's insurer, Arkansas Blue Cross & Blue Shield, has told him that the premiums stay low because his employees' participation in health programs simply makes them less of a risk to cover.

"Certainly there's an economic benefit to this, but more than that, we're trying to emphasize to our people and their families that they can live a better life if they're healthy," Fisher said. "We want to look after and take care of each other."

Nationally, the most prominent proponent of an incentive-based approach to health coverage is perhaps Safeway CEO Steven Burd, whose Coalition to Advance Healthcare Reform counts among its members 60 companies employing 1.7 million people.

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