KNOXVILLE, Tenn.—While many large private-sector employers have turned to wellness and disease prevention to address rising health care costs, public entities have been slow to embrace the concept.

Politics, entitlement mentalities among government workers and budget constraints all work against public entity benefit managers' ability to introduce new ideas.

Gary Eastes, risk and benefits manager for the City of Knoxville, Tenn., is an exception.

Mr. Eastes faced those challenges head-on in overhauling the city's benefit program in 2006, enduring harsh criticism from city workers and even calls for his resignation at local City Council meetings in the process.

But with the full support from Knoxville's mayor and City Council, Mr. Eastes has remained undaunted in his quest to improve the quality of life for city employees. He knows that if he can encourage employees and their family members to make healthier lifestyle choices, they will live better and longer lives, and in return the city will have more productive employees and lower health care costs.

“Gary feels very strongly about what he's doing, and it's not just all couched in, "I'm doing this to save the city money,'” said Knoxville's Deputy Mayor Larry Martin, to whom Mr. Eastes directly reports. “While that's a worthy cause—and certainly all of our taxpayers would have us be about that—Gary's actually so wrapped up in it because he knows it to be the right thing to do for the health and well-being of our employees.”

But bringing wellness to Knoxville has not come easy.

One challenge for Mr. Eastes has been the employee population. In addition to a high prevalence of obesity and tobacco use, the city's workforce is mostly male—about 80%—and most are over age 40, a demographic that historically has the highest prevalence of chronic diseases. In addition, a large percentage of the population is made up of police officers, firefighters and service workers, who also traditionally have higher-than-average costs.

In addition, a majority of the city's employees were enrolled in the State of Tennessee's first-dollar health maintenance organization medical plan and felt entitled to that level of coverage.

Given those factors, it was of little surprise to Mr. Eastes that the city's paid medical claims per member were 28.3% above BlueCross BlueShield of Tennessee Inc.'s norm in 2006 and that the prevalence of chronic disease was 40% higher at the city than normative data for the region. Overall, health care costs had risen 141% from 2001 through 2006.

To tackle the issue, Mr. Eastes began putting more personal responsibility into the city's health care equation and has teamed up with partners that share his ideas, including the Tennessee Blues plan, the HealthCare 21 Business Coalition, Cowan Benefit Services Inc., Summit Medical Group and software provider NavigatorMD Inc.

Since 2006, Mr. Eastes has:

Although the programs still are evolving, they are showing signs of success.

Health care costs are under control at the city, rising 4.2% in 2008 and 4.1% in 2009, well below BlueCross BlueShield of Tennessee's medical care trend of 10.8% and 9.5%, respectively.

In addition, more than 1,000 of the city's 1,500 benefits-eligible employees have made healthy lifestyle choices and qualified for HRA incentive dollars. And in 2010, the number of tobacco-free employees receiving an incentive has increased to 836 from 634 in 2006.

More importantly, Mr. Eastes says, the improvements are changing people's lives.

In the first year the city began offering more complete annual physicals and health screenings, 40 diabetes cases were diagnosed; there were 12 referrals to cardiologists due to blockages and other heart disorders; three employees received heart surgeries within four days of the assessment; and two cases of early prostate cancer were diagnosed.

“There are a number of employees who say the programs we're running have saved their lives,” Mr. Eastes said. “It is very possible that might be true in some of those cases. I am certain that our programs have encouraged employees to take better care of themselves and improve the quality of at least some of their lives, which in turn has made them more productive employees.”

Mr. Eastes' efforts have not only earned him a spot in Business Insurance's 2010 Benefit Manager of the Year Honor Roll, but also have won him accolades from his peers.

What defines Mr. Eastes best is his passion, said Matt Cowan, president of Cowan Benefit Services, the city's Franklin, Tenn.-based benefits broker.

“He lives and breathes and dies for these concepts and puts himself on the line daily to try and implement these things.”

However, “you've got to give credit to the City of Knoxville—the mayor and City Council—because they did step forward and back his decision to take the risk and pull out of the state plan and to allow all these changes to be made. Most cities are afraid to make changes,” Mr. Cowan said.

“We're just so fortunate in the city to have Gary here—someone with that level of patience,” said Marilyn Roddy, a Knoxville City Council member. “The adage in government is that it takes government three times as long as it does the private sector to get anything done, so change comes slowly, but Gary is someone who sets a goal and keeps his eye on the prize.”

“There are certainly larger national companies that have done this and have invested a significant amount of money to show a return,” said Dr. Warren Sayre of Summit Medical Group, who serves as the city's wellness program's medical director. “I think Gary's done that on a very tight budget.”

“That's probably one of the things that's impressed me the most about this program, knowing that he has that scrutiny of every taxpayer in the city limits and the city government...and really squeezing every ounce of what he can get out of that to implement a pretty robust program,” said Dr. Sayre, whose group is based in Knoxville.