By Diane Carman

For employees at Van Gilder Insurance Corp., it may feel like tough love, with fruit replacing the more typical bowls of candy often found in office meeting rooms and the not-so-subtle pressure to quit smoking and get fit.

That’s OK with Steve Purkapile.

The vice president of Van Gilder in Denver has seen the benefits to the bottom line — in his company’s health care costs, his coworkers’ fitness levels and on the bathroom scale.

Wellness programs aren’t just fringe benefits at the company, which sells a broad range of insurance products. They’re part of a corporate policy designed to increase profitability by controlling health care costs at the source. Healthier employees cost less. For Purkapile, it’s that simple.

“The fact is 70 to 80 percent of illnesses are preventable,” he said. “People can argue all they want. Empirical data show … that lifestyle choices are the No. 1 driver of health care costs. At least 50 percent of the cost of health care is related to lifestyle choices, not environmental factors or genetics.”

Van Gilder is just one of many companies around the country that are experimenting with different strategies to reduce health care costs and improve employee health and fitness.

“The way health care is delivered now largely through employers, they have to be involved,” said James O. Hill, executive director of the Anschutz Health and Wellness Center.

“A lot of aspects of workplace wellness programs are showing potential,” Hill said. “They’re doing one thing or another well. We don’t know exactly what works, so we need companies to keep trying.”

Major lifestyle change

Steve Purkapile doesn’t just talk wellness.

“I’m one of those people who, when I hit 45, I weighed over 220 pounds,” he said. “I decided that I had to do things differently. I realized I can’t consume alcohol at this level. I can’t eat this food.”

Steve Purkapile before he got fit

He embarked on a “major lifestyle change,” working out five days a week, changing his diet and building strenuous activity into his life.

“Now I weigh 180 pounds and my numbers all are in the normal range,” he said of such health markers as blood pressure, heart rate and serum cholesterol. He climbs 14ers on weekends and runs marathons.

Dozens of his coworkers have caught the fitness bug, especially since the company began implementing new health care plans and wellness initiatives six years ago.

It didn’t happen all at once, he said. “One of our earliest ventures was to make fruit available around the office.” Then in 2007, “we became much more intentional.”

The company changed its health care offerings and began encouraging employees to move to high-deductible health plans with health savings accounts. Leaders at the company wanted to help employees better understand the connection between the lifestyle choices they make and the cost of health care. With the high out-of-pocket costs of the high-deductible plans, they figured it would get everyone’s attention. They made it clear this was the direction the company was taking, and offered programs designed to help employees minimize their health care costs.

Van Gilder held a health fair with medical tests and health screenings to help workers identify their risk factors, and challenged them to improve their diets, lose weight and stop smoking.

“We did it lightly at first,” Purkapile said. “We got 40 to 50 percent participation.”

In 2008, “we really began to intentionally and specifically create strong contribution differentials,” he said. Those who participated in the wellness programs received significant company contributions to their health savings accounts.

Employee participation rate extraordinary

Last year the company transitioned all employees to the high-deductible health care plans, and now 90 percent of employees participate in the wellness activities, earning points that qualify them for company contributions to HSAs and other incentives.

The company provides an on-site fitness center, locker rooms, exercise classes and a masseuse. There’s a company hiking club and the walking team takes regular mid-day jaunts around lower downtown.

Steve Purkapile

Purkapile said that while Van Gilder’s wellness program isn’t cheap, it more than pays for itself. “Our health care costs per employee per month have remained flat for four years.”

For every dollar the company spends on wellness, he said it saves three in health care costs. Purkapile estimates the annual cost of the wellness program runs between $375 and $400 per employee.

“I give them credit for doing this,” said Hill.

The big problem with most workplace wellness programs is that participation remains low. Often, only the employees who already are committed to fitness take advantage of them. “It’s hard to move the needle,” Hill said.

The Van Gilder program “uses both the carrot and the stick,” he said, providing financial incentives for participation and the likelihood that non-participants will bear higher health costs. Ninety percent participation is extraordinary.

The key question in this and most other wellness programs is whether participants can sustain their weight loss and fitness levels over the long term.

“I hope they’re collecting outcome data,” Hill said.

At this point the Anschutz Health and Wellness Center does not maintain records of the performance of these various employer programs. “I wish there were some way to do that,” Hill said. “It would be great if we could capture both successes and failures and learn from them.”

Everyone pays high cost of care for unfit

The Denver Business Journal recently highlighted several companies – including Van Gilder — for their wellness programs. Among them were Oakwood Homes, IMA Inc., United Healthcare and the University of Colorado Hospital.

Kenneth Thorpe, a professor at Emory University, did a study published this month in the journal Health Affairs and found that over a 10-year period, $7 billion or more in Medicare spending could be saved by getting overweight, pre-diabetic people to participate meaningfully in wellness programs that emphasize good nutrition, weight loss and exercise.

The data are clear, Purkapile said. “The impact of a smoker on a company is 10 ½ more unproductive days a year than nonsmokers, and being an obese person is now worse than being a smoker in terms of the additional medical costs.”

It’s one reason he is not a fan of universal, national health care.

“Who’s going to make the guy who’s 400 pounds, smokes and never walks pay five times what I pay for health care because it costs that much more? There’s no incentive to do the right thing in the system,” he said.

That’s why Purkapile believes it’s up to employers to create incentives for workers to make better lifestyle choices.

“Sure, it’s a free country. Civil liberty is great,” he said, “but we have to have to be accountable.”