After completing a shared first shift on the assembly line at Honda of America Manufacturing in Marysville, Theresa Balsiger and her husband will go home, change into workout gear and return to the plant with their two teenage sons. Even though they're done for the day at work, going back to the automotive assembly campus helps keep them fit as a family through regular exercise at the Watson Wellness Center.

Balsiger and her husband have lost weight and taken up running. Their sons have learned proper strength training techniques and enjoyed basketball league play and swimming. And the family consumes a more nutritious diet. The cost for constant access to personalized fitness and nutrition services is just $25 a year for the entire family.

Balsiger initially lost 25 pounds when she and her husband made a commitment in 2004 to take advantage of Honda's Wellness Center offerings; he lost nearly 50 pounds at the outset. With regular exercise, the couple now can not only keep up with their kids, but also perform better on the job, says the 45-year-old Balsiger, a 21-year Honda veteran.

"We just got hooked," she says. "Your day starts so early; you work all day and it's a physical job. So you could easily go home and sleep for an hour or two. But once you get (to the center), you're OK." Wellness Center staff members are available to answer any question, she says. "If you have a problem and you can't find a solution, then you're not looking real hard."

Although Honda's Wellness Center has been operating at the Marysville campus since 1986, with similar fitness facility or membership subsidy access at plants in its other communities, the company saw alarming inflation in the mid-2000s in costs for its self-insured health plan covering approximately 35,000 participants. Kevin Decot, senior staff administrator and manager of Honda of America Manufacturing's wellness team, says that rising insurance cost was part of the genesis of the company's Destination Wellness program.

"We knew that we had an aging workforce, we had double-digit inflation and lack of consumerism," Decot says. In 2005, the company spent a year determining the top contributing factors to the less-than-stellar health of its workforce. Following individual biometric screenings of employees and spouses, Honda transitioned from a preferred provider plan model to a health reimbursement account (HRA) for insurance coverage, he says.

"It is not a consumer-driven health plan in the traditional nature, where a lot of them have a high deductible," says Decot. Although Honda plan participants do not pay toward premiums, they are incentivized to participate in an "active" program requiring wellness participation through lower deductibles and out-of-pocket expenses. Meanwhile, "passive" plan participants bear higher costs and receive about 50 percent less in company HRA contributions, he says. About 90 percent of participants have joined Destination Wellness since the outset, Decot says; it combines automatic activity reporting completed onsite at the Wellness Center, online reporting through Web-based applications and self-reporting of preventive exam completion.

Corporate wellness benefits such as Honda's may be beyond the reach of many companies seeking to add or enhance wellness programming in their workplaces. But the rewards are tangible, and not just for the participating employees.

Terri Hill, executive vice president of administration for Nationwide and president of the company's Nationwide Better Health wellness consulting subsidiary, says there are typically three factors that contribute to success in building a wellness program within a company: incentivization, senior leadership involvement and authentic communication.

Incentivization does not necessarily have to begin and end with price breaks in coverage for employees, Hill says. "What works best is each step in the process gives you a little something," such as the popular option of a small- to medium-value gift card, she says. Company leaders can contribute by actively participating and being vocal about it, or also sending out regular communications promoting the program, Hill says. Finally, a frank discussion about what the cost of care means for employees - not just an explanation of why the company wants to control costs - will help overcome skepticism and build employee engagement, not just participation, she says.

Although companies frequently will launch a soft rollout of wellness programming without conducting individualized health risk assessments for all employees, Hill says that is always the first step when working with Nationwide Better Health. "We really believe that knowing your numbers on an individual level is really critical, and for an employer to know in aggregate is really helpful for them, too."

"We tend to think, ‘I'm going to eat better, I'm going to exercise more," says Rob Rissmeyer, vice president of human resources for Grange Mutual Casualty Group, a self-insurer. "We've made people take a look at the data." Sometimes, as with the case of an employee who discovered he had high cholesterol following Grange's sponsored screening, "changing behavior might just be going to see your doctor," Rissmeyer says. "He hadn't gone to the doctor in 10 years."

Grange also offered some wellness components for several years on a voluntary basis, Rissmeyer says, including an in-house fitness center, health screenings, a part-time nurse and dietician, and subsidies a smoking cessation program and for health care memberships for field associates. "Now, we're taking those voluntary programs to a more coordinated effort, targeting specific health risks for the associates," he says. "We've got a good handle on what we're spending money on, but the employees don't, so we wanted to create some awareness and change some behaviors on people's individual health."

What employees did know was they saw a recent 19 percent increase in premium contributions, Rissmeyer says. Ninety-five percent participated in the screenings to access lower deductibles, coinsurance and out-of-pocket costs in the following open enrollment, he says. Although he's uncertain where Grange goes from here, Rissmeyer says he's optimistic the company can marshal existing internal resources to build a wellness program. "Right now, the only budget we have is we knew it was going to cost us about $50,000 to do the screenings" for approximately 1,250 employees, he says. "We have a training staff here in Columbus and we have people who work in the benefits area" to build and manage programming, he adds.

An internally run program also has been the approach adopted by Glimcher Realty Trust, which is entering its third year of formal wellness programming. Grace Schmitt, vice president of human resources, had launched wellness initiatives at her previous company and wanted to bring the experience to the national retail property management company. Glimcher has instituted annual thematic programming, starting with "Get Healthy Glimcher" followed by "Know Your Numbers." Emphasis for the next theme will be on nutrition, she says.

Schmitt says the program's objectives are fitness, smoking cessation, weight loss and maintenance, and health and care awareness. But Glimcher is not yet tying participation to better benefits. For instance, the first-place team in the program's "The Biggest Loser"-style weight loss contest chose Trader Joe's gift cards instead of a $500 break on annual co-pays. However, even without the threat of higher personal health care contributions, nearly 50 percent of employees still participated in biometric screenings conducted by UnitedHealthcare, which were incentivized by gift cards handed out by the health care provider, Schmitt says.

Constant promotion has been key to keeping the program front-of-mind for employees. "To keep people interested in the challenge each year, every week or every other week we had little mini-challenges that would keep people's interest," says Sarah Kersanty, Glimcher's director of compensation and benefits. "So you could win a gift card for a smaller monetary value."

Kevin Hinkle, a regional vice president for Anthem Blue Cross and Blue Shield in Ohio, says that five years ago, large employers were pushing Anthem for wellness programming solutions. Now, Anthem is actively working to integrate wellness programming among medium- to small-size employers, including workforces of two to 50 employees, he says. "Cases that we win year over year, they tell us that's why they're coming with Anthem," Hinkle says. "We're probably setting the trend. I wouldn't say that was the case five years ago."

Todd Miller, senior vice president and branch director for Cleveland-based insurance brokerage Oswald Companies, says Anthem has integrated wellness offerings even for the smallest employer by offering insurance pools for brokers to place companies participating in their proprietary initiatives. The Employers Resource Council's ERC Health pool has generated single-digit renewal increases or stayed flat for 80 to 85 percent of employer groups over the past two to three years, Miller says.

"Five years ago, one of the big road blocks was collective bargaining groups," Miller says. "The needle has moved so that now we've had a number of groups that have bargained (wellness participation) into their contracts."

Employers need to think of wellness programming as an investment and communicate it in that fashion to their workers, says Scott Streator, CEO and executive director of the Ohio State University Health Plan Inc., which covers 50,000 Ohio State employees and dependents and is expanding to service additional public and private sector groups in the future. "This is an investment, just like a 401(k). And once you invest in it, it requires active management," says Streator. For example, Ohio State can claim a 30 percent decrease in chronic disease costs for participants in its health management program, he says.

"We have no problem publicly stating we have golf coaches or executive coaches or financial advisers," Streator says. "We want that next step to be, ‘I have a health coach.' Wellness programming doesn't work at its best without individualized, face-to-face coaching, he says. "At the end of the day, we're talking about behavioral change and it is the crux of health care."

Fitness consultant Scott Mendelson, CEO of Blacklick-based InfinityFitness.com, says wellness is not just about health, but productivity and self-image as well. In 2009, Mendelson started to reach out to corporations to give presentations on basic exercise and nutrition.

Mendelson says most companies would be surprised how little their employees know about simple ways to improve their diet and fitness. "Contests, where there are things that are motivating people, are an excellent idea to get people going and consistent with their routine," he says. "But that's not enough. Offering those employees access to information arms them with the tools they need to be successful."

"Insurance companies look at body weight, they look at body mass," Mendelson adds. "The fatter your employees, the higher your premiums are going to be, and corporate America plays a big part of that. So if profits are the motivation, give people some help to make the right choices."

Mendelson says investing in wellness provides opportunities for all employees to better themselves professionally as well as personally. "Obese people do not get hired or promoted," he says. "HR and hiring people look at obese people as people that don't take care of themselves and are at a higher risk." Corporate wellness initiatives can help provide the same fitness advantages, from an entry-level employee to the CEO.

Brent Wilder is a freelance writer.

Reprinted from the May 2010 issue of Columbus C.E.O. Copyright © Columbus C.E.O.