That incentive is the marketing proposition behind a pilot program at Blue Cross Blue Shield of North Carolina with an unapologetic goal: to get 58% of the insurer's 3.2 million overweight and obese members to lose weight. It's a stopgap measure to tackle $83.1 million in costs the insurer links to those extra pounds.
It's also the latest front in a global obesity battle that's influencing how companies from snack peddlers to fast feeders go to market, and has pulled Washington legislators, courts, media owners and activists into the debate.
With the employers that are their customers desperate to hold down skyrocketing health-care premiums, the nation's major insurance carriers are tackling the obesity epidemic. They have introduced prevention programs as diverse as farmer's markets at hospitals, personal phone calls from weight coaches and online exercise logs with cash rewards-and they're promoting them in advertising to members and corporations.
But such plans also risks a consumer backlash against what can be viewed as a paternalistic approach.
"I've been in focus groups and heard people say, `It's my health and I don't want you to have any say in what I do,"' said Tony Ryzinski, VP-advertising and brand marketing at Blue Cross Blue Shield of North Carolina. In April, it will become the first insurer to classify obesity as a "primary condition," offering coverage for physician visits aimed solely at solving a patient's weight problem.
Mr. Ryzinski plans to integrate the personal story of a member into the program, taking a reality-TV approach to tracking weight loss over a series of spots, created by Stone Agency, Raleigh, N.C., as part of the company's $10 million to $15 million annual corporate-branding effort. Stepping out with such a positioning could help solidify the insurer's status as the largest in the state, ahead of national competitors such as Cigna, UnitedHealth Care and Aetna, which have been slower to respond.
"Much is being cooked in the kitchen," said Ed Faruolo, VP-brand strategy and integration at Cigna, which has 10 million members. The insurer in January ran a series of print ads, created by Omnicom Group's DDB Worldwide, New York, about childhood obesity in The Wall Street Journal and SmartMoney showing a chubby kid on a couch, remote in hand, downing potato chips.
Cigna is adapting a program encompassing childhood obesity to the workplace, making recommendations to benefit managers such as providing healthy snacks in vending machines and opening stairwells so employees can skip the elevator.
"The insurance industry has always plodded a bit slower in terms of its marketing," said Mr. Faruolo. "We want to be careful we don't overpromise anything. ... This is an industry that likes to study things."
Kaiser Permanente, the Oakland, Calif.-based health-maintenance organization, spent two years studying the way its 8.3 million members in nine states might react to programs or marketing aimed at battling obesity.
`health vs. health care'
"People have a fundamentally different definition of health vs. health care. One is the antithesis of the other," said Debbie Cantu, director-brand marketing and advertising at Kaiser. "Health care connotes all that is negative about the insurance and hospital systems for people. It is something that they feel powerless over. In `health,' members felt like they could have control over those levers and we wanted to tap into that."
Instead of taking a lose-weight-or-else approach, the company's latest campaign, from Interpublic Group of Cos.' Campbell-Ewald, Warren, Mich., points to the little decisions members can make to influence their health. Copy lines in ads include, "We stand for broccoli, for pilates and dental floss, we believe in the treadmill and its siblings StairMaster and elliptical." Kaiser plans to support "Thrive" with $45 million in spending this year.
For now, prevention and weight-loss programs offered by major carriers, including Cigna, Kaiser Permanente and Aetna, remain voluntary. Their incentive-based approaches are still in test mode as insurers gather data and employers weigh the benefits of paying more up front to bring down the estimated $13 billion obesity costs them annually.
"Most employers are hesitant to do things like levy penalties on employees for being overweight or having high blood pressure or cholesterol," said Bruce Kelley, a benefits consultant at the Minneapolis office of Watson Wyatt Worldwide. "Employers have shied away from going after employees on what I would call sensitive issues, like weight, but that's changing."
limited penalties legal
The precedent is there, though, added Mr. Kelley, who helps Fortune 500 companies such as Coca-Cola Co. and General Mills choose and negotiate health benefits. He pointed out smoker penalties for life insurance as an example.
And despite the privacy cloak of the Health Insurance Portability and Accountability Act, limited penalties for health conditions-including high BMI (body mass index)-are legal. Such penalties cannot exceed 20% of an employee's premium.
In October, Aetna announced plans for a pilot test of "Healthy Body, Healthy Weight," a voluntary program for which employers pay extra to add to existing health plans.
The program divides members into three tiers, allocating resources and benefits according to BMI. Those on the lowest tier receive newsletters with menu tips, discounts to Jenny Craig and Weight Watchers, pedometers, gym discounts and supportive calls from nurses and dietitians for a total of 12 "touches" a year. For the morbidly obese, outreach can exceed 30 or more touches a year.
Of 35,000 employees eligible to participate in the test, 400 signed up. Aetna did not reveal costs, but said data gathered would need to show a link between weight loss and reduced medical costs before the program is pitched nationally to its 14 million members.
Compliance is a potential hurdle for programs like Aetna's. Ninety percent of large companies already offer employees some form of health or prevention program, yet fewer than 30% used the services, according to a survey by the National Business Group on Health.
Will Americans shed 15 pounds to save $400? "It's going to come down to having a population of those who comply and those who don't," Blue Cross Blue Shield's Mr. Ryzinski said. "Money is going to drive that."