The survey of 117 U.S. companies conducted in December 2007, at the end of the annual enrollment process, found that more than half (53 percent) have incorporated health risk assessments into their enrollment systems or will incorporate these programs by 2009. More than one-third (36 percent) use enrollment systems to encourage employees to sign up for disease management programs or will do so by 2009.

"Open enrollment marks the one time each year in which most employees' attention is focused on their benefits programs," said Jeri Stepman, Watson Wyatt's national leader for health and welfare administration. "Including behavior-change information and decision-support tools directly in the enrollment process can make a big difference in the number of people who sign up for wellness programs and take them seriously. Sending out information on healthy behaviors and asking employees to take the initiative is not nearly as effective."

Employers Consider Integrating a Variety of Programs Into Enrollment Systems

  Program or activity      Incorporated in       Considering for
                          enrollment process         future
                          now or planned for
                                 2009

  Health risk assessment         53%                  32%
  Disease management             36%                  32%
  Addressing tobacco use         29%                  30%
  Participation in
   onsite health screenings      26%                  32%
  Surcharge if spouses
   have access to other
   coverage                      20%                  21%
  Exercise frequency
   or fitness center use         16%                  32%
  Weight or body mass
   index management              14%                  36%

Despite these efforts, most employers have yet to make much progress in integrating their enrollment systems with other benefits-related resources, such as linking directly to an external health plan provider or health  savings account/flexible spending acocunt administrator.  Although 67 percent have integrated their entrollment system with their HR portal  or intranet, only 27 percent have integrated it with their health care provider's system, which often contains robust information on disease  management and healthy lifestyles.  One out of three (30%) has not integrated their enrollment system with any other system.

A key aspect of engaging employees in their benefits -- health care cost modeling -- is the subject of some concern among employers. A significant portion of all respondents -- more than 20 percent -- are dissatisfied with their organization's decision-support and plan-modeling tools. More than half of all respondents are either neutral or dissatisfied with the information provided to employees on managing health and health-related incentives.