For some time, employers have offered employees wellness programs that provide incentives for maintaining healthy lifestyles. While these programs can offer positive returns on investment, those returns are dependent upon plan participation and, in particular, whether at-risk employees participate and improve their health. Additionally, wellness programs typically have been disconnected from employers' insurance plans. Although employees were rewarded with incentives such as discounted health club memberships or merchandise, there was no direct impact on plan benefits.

However, that connection has begun to develop. "In the past few months there has been an uptake on the health-plan side to design benefit packages that tie employee participation in health and wellness programs with changes in premiums and co-payments rather than [insurers'] just charging premiums for when people get sick," observes Cynthia Burghard, research director in Gartner's healthcare insurance industry advisory services.

"It makes sense for health insurers to do this because they are in the health business, and it fundamentally makes more sense for employers to have just one company dealing with health [coverage] and wellness [benefits]," she adds. It also has the potential to spur greater employee participation in wellness programs if employees who do not participate in the program are charged greater premiums or are responsible for higher deductibles, co-payments, or other out-of-pocket healthcare costs.