For health insurers, the quest to spread consumerism begins at the office.

Insurers are encouraging their own employees to become better health care consumers by offering consumer-driven health plans and information tools and providing financial incentives for good health care decisions.

But health insurers have different ideas about how to promote consumerism within their own ranks, with some demonstrating their commitment to consumerism by completely replacing traditional health insurance plans with consumer-driven plans, while others prefer to encourage, rather than mandate, their employees' participation in these plans.

Minnetonka, Minn.-based UnitedHealth Group Inc. last year became the first major U.S. insurer to replace its traditional plans with CDHPs, followed this year by CIGNA Corp. Both companies offer their employees two health reimbursement arrangements and a health savings account linked to a high-deductible health plan.

Prior to 2005, UnitedHealth offered an HRA plan as an option, but the insurer replaced its traditional plans with consumer-driven health plan options effective Jan. 1, 2005, in "a fairly dramatic commitment to consumerism," said Meredith Baratz, vp-market solutions, for Definity Health, a unit of UnitedHealth. "We sought to preserve the element of choice for our employees."

Among UnitedHealth's employees, 34,321 enrolled in HRAs. Some 2,226 enrolled in HSAs-an HSA enrollment rate that's slightly less than what the company has seen across its book of business, Ms. Baratz said.

Before replacing its traditional plans, 42% of CIGNA's employees had enrolled in consumer-driven options, with the majority choosing HRAs.

"The HRA has been very popular with the employees," said Marilyn Paluba, benefits consultant for CIGNA in Philadelphia. "Employees find the fund very attractive with the HRA. I think the HSA is a different design than what they're used to."

Committing to consumerism, though, does not require replacing traditional plans with CDHPs, others say.

WellPoint Inc., for example, will add an HSA plan to its benefit program next year alongside two HRA and several health maintenance organization plans. The Indianapolis-based insurer offered an HRA plan for the first time last year, with 17% of its employees enrolling in the plan. The company anticipates enrollment in the range of 34% to 44% in its CDHPs in 2007, said Christine Miller, vp-human resources.

Many employees will choose to stay in WellPoint's "efficient" HMO plans, with which the company is comfortable, she said. "I'm certainly not of the persuasion that we need to have all our associates in our CDHP products," Ms. Miller said. "I do not want to remove choice for our associates."

Insurers generally have a harder time fully replacing their traditional health plans with consumer-driven options than other employers because of insurers' traditionally rich benefit packages, said Tom Hricik, national director, HSA product distribution for ACS/Mellon HSA Solutions based in Pittsburgh. "The employees are such strong believers in HMOs," he said. "They're your most difficult customers, for sure. They expect more. They're more critical."

But insurers, like other large employers, have to manage rising health care costs, Mr. Hricik said. "We do expect over time for insurance companies to adopt (consumer-driven health plans) more," he said. "Given the nature of their traditionally rich benefits, it's going to be a little longer."

As a result of employing a full replacement approach, UnitedHealth has had a positive cost experience with overall health care cost trends that were both lower than expected and below previous years, Ms. Baratz said.

Signs that consumerism is being adopted are evident even for insurers that still offer traditional health plans. For example, employees of The Regence Group, which offers CDHP options alongside traditional products, used to complain about copayments and deductibles, said Denise Johnson, the Portland, Ore.-based director of the employee service center for Regence, a group of Blue Cross Blue Shield Assn. plans in Idaho, Oregon, Washington and Utah. Now employees complain about transparency issues, such as not knowing what providers will charge, she said.

"What we were encouraging our employees to do was see the importance of holding themselves accountable for their health care," Ms. Johnson said. "It's changing the culture. It's changing the way our employees look at their behavior."

A lack of information is a deterrent to people enrolling in CDHPs or becoming better health care consumers, Ms. Johnson said. "The more we can do in that regard, the more success we'll have," she said. "Once they learn more information, they're more inclined to move in the direction of those kinds of programs."

All insurers agree on the need to provide the right tools to help employees make the right health care decisions. While many insurers offer tools to their employees and individual and group members, some limit the use of certain tools strictly to their employees.

Regence has an employee Web site called Building a Healthy Future that provides a wide range of information, including healthy food recipes, advice on how to begin a fitness program and schedules for onsite fitness center classes such as yoga, kickboxing and pilates.

The company also provides a medical plan cost estimator in which employees can enter costs and estimate out-of-pocket expenses under each of the company's health plans-a very popular tool, Ms. Johnson said. About 15% of the company's 6,200 employees are enrolled in CDHPs.

Health care companies also try to encourage good health care decisions by offering financial incentives-or disincentives in some situations.

The Anthem Rewards program, for example, allows WellPoint employees performing physical activities to earn points that they can redeem for prizes. About 40% of the company's employees participate in the program.

Regence has a similar program that gives employees points for activities such as participating in a smoking cessation program or an onsite Weight Watchers program. Regence also provides a 35% discount on healthy foods at its cafeteria to encourage employees to make healthy eating decisions. "It's a way to keep employees engaged," Ms. Johnson said.

Several insurers provide financial incentives to employees to take health risk assessments.

UnitedHealth, for example, gives credits worth about $100 to its employees who complete a health assessment in a program that is integrated with a health coach to help manage existing or potential health problems, Ms. Baratz said.

Insurers, like other employers, also are taking steps to address the issue of smokers in the workforce and the impact they have on health care costs.

CIGNA has instituted a premium differential for smokers and non-smokers while implementing an I Can Quit smoking cessation program, for which 1,100 people have signed up, Ms. Paluba said.

As a company, WellPoint plans to go tobacco-free on Nov. 16, meaning employees no longer will be able to smoke on company property, but they will be provided free nicotine replacement therapy to help them quit.

While the company would not fire anyone who fails to abide by its anti-smoking rules, managers will have individual conversations with employees to stress the importance of quitting for their own health and the company's overall promotion of better employee health. "If individuals don't choose to abide by that, maybe we're not the best place for you to be working," Ms. Miller said.

However, unlike other employers, WellPoint has not implemented tobacco surcharges to encourage employees to quit. "I have caution around becoming too punitive in terms of actions," she said. "We don't want to be in a police role."