NEW YORK—Identifying and addressing risk factors that indicate the development of costly health problems is an important step for employers trying to reduce health care costs.

Although return on investment may be difficult to measure, employers that have implemented health promotion programs say they have a noticeable impact on the use of health care products and services and health care cost trends.

JPMorgan Chase & Co., for example, has implemented a number of health management initiatives, including health education, health risk appraisals and screenings for conditions such as high cholesterol and depression, said Dr. Wayne Burton, senior vp and medical executive for the New York-based financial services firm.

The JPMorgan Chase health risk appraisal measures three categories of health risks: lifestyle, which includes smoking, physical activity, alcohol use and seat belt usage; perception, including job, life or health dissatisfaction and high stress; and biological factors that include high blood pressure, high cholesterol and unhealthy weight.

"Our goal is to work to control these risk factors before they become diseases and become more costly to the organization and more costly to the individual," Dr. Burton said at the New York Business Group on Health's Feb. 7 conference, "Trends in Health & Productivity Management: Measuring the ROI of Health Programs."

The company has implemented measures to try to address those risk factors that lead to high-cost claims, he said. For example, JPMorgan Chase has implemented lower health insurance premiums for nonsmokers and smoking cessation programs for smokers who want to quit, he said.

Reducing the number of risk factors an employee has is critical because employees with a high number of risk factors will have higher health care costs, employers say.

For Imperial Chemical Industries P.L.C., a specialty chemical company, employees identified as having more than four risk factors had medical expenses that were about 26% higher than the rest of the population, said Judith Kleemeier, the Bridgewater, N.J.-based director of health and wealth strategies.

Pfizer Inc. encountered the same issue. An analysis of health risk appraisal and claims data by the New York-based pharmaceutical company showed health care costs for employees with four or more risks factors were often substantially higher than those of employees with fewer than four risk factors.

"If you can reduce risk factors, you can definitely impact costs," said Jody Amodeo, director and team leader of Pfizer's Healthy Directions program, which consists of a variety of health and wellness initiatives, including onsite medical and fitness centers and lifestyle management programs.

Driving employee participation in health promotion programs, though, is vital, and incentives for behavior modification are an important factor in the success of these programs, employers say.

Kraft Foods Inc.'s Healthy Living Rewards program introduced in 2004 a $100 credit toward annual medical plan contributions--which average about $1,200 annually for employees--for participating in a health risk appraisal and disease management program, said Kathy McAlpine, associate director for global benefits compliance and communication for the Northfield, Ill.-based company. As of July 31, 2006, the company has given 3,712 credits.

"The employees need to be committed to becoming aware, being informed and taking responsibility," she said. "This is about behavioral change and getting employees to change their behavior is a process."

There are a variety of metrics employers can use to measure the return on investment of their health promotion programs. In analyzing the impact of its disease management program, for example, ICI found that emergency room utilization declined for employees participating in both the diabetes and coronary artery disease management programs, Ms. Kleemeier said.

The wide range of return on investment metrics, though, often leads to cynicism, making it difficult for benefit managers to justify wellness expenditures, Ms. McAlpine said. In response, Kraft Foods joined four other companies in forming the Alliance for Wellness ROI Inc., an organization that is developing a standard methodology for measuring return on investment that will enable employers to enhance these programs and prove they have a positive impact, she said.