He took what he had learned about transactions at Wells Fargo and moved to Definity Health in 2000. “This was a chance to be part of a disruptive business model and make health care more efficient,” he says, noting that financial transactions typically carry a 1.5 percent transaction cost, while health care transactions cost 24 percent. United HealthCare bought Definity in 2004; eighteen months later, Halling left for FiServ Health.

He headed that firm’s health care arm until 2008, when United HealthCare bought that company, too. “Friends called and said, hey, could you tell me where you’re going next? Because we know that United HealthCare will eventually buy them,” Halling says. Now Halling focuses on helping employers “who want to change the way their employees think about health care,” he says.

All of his group’s current clients are companies who self-fund health care, and who “are looking for a behavior change that has folks realizing the intrinsic value of being healthier,” Halling says. A healthier employee group requires healthier individuals, and not every employee welcomes an employer’s interest in workers’ weight, blood pressure or other health metrics.

“We did an incentive study last fall, asking employees what motivates them to behave differently around their health. Some employees said that they’re already healthy and don’t need help. Others were offended that the employer wants to take their biometrics,” Halling says. To overcome that resistance, Halling’s group begins by offering clients and their employees information and education.

Follow-up programs encourage healthy lifestyles, and creative incentives bolster participation. Because of its connection with United HealthCare, UMR can provide clients some proprietary information as part of its educational offerings. Most consumer-oriented health care plans, for instance, ask consumers to choose doctors who offer superior service at a competitive price.

But few doctors—and fewer hospitals—can tell patients what a product or service will actually cost, and it can be nearly impossible for a patient to meaningfully compare one doctor’s success rates with those of another practitioner. “It’s tough trying to create customers in a marketplace that doesn’t have the same kind of data they’re used to in other situations,” Halling says. “It’s like buying groceries and hearing what they cost 45 days after you ate them.”

United HealthCare’s data set, with its enormous, multi-year claims history, can shine the necessary spotlight on medical costs and outcomes. “It gives us the ability to start ranking providers for using evidence-based medicine and for cost-efficiency in outcomes,” Halling says. The group can then begin encouraging employees to use practitioners and facilities that offer the best value for money.

UMR’s client employees also get a dose of education, often in the form of FlashMedia presentations, about the actual cost of health care interventions—and the practices that can help individuals make interventions unnecessary. A company might send workers information on managing common health conditions, such as type two diabetes, depression or back problems, emphasizing the large number of people affected by each complaint.

“A lot of these concerns can make people feel very isolated,” Halling says. “Creating assurance that they’re not alone in a health concern can help them move forward.” That forward movement might take place in the group settings of UMR-designed programs that encourage employees to adopt healthier lifestyles.

These could include Biggest Loser-style contests to see which work group can lose the most total weight, on-site vaccinations, coaching programs that pair a professional with workers who share similar concerns, Weight Watcher meetings on company time or old-fashioned company softball games.

It’s one thing to offer education and programs, of course, and another thing to persuade workers to put those opportunities to use. For most firms, positive incentives do the job. “I’m seeing more employers using carrots than sticks,” Halling says. To choose the right carrots, he adds, “a company needs to understand the currency that really elicits a response for that population.”

Financial rewards are always popular, but firms have also had success by offering health savings account deposits, preferential parking spots, gift cards to stores that employees frequent, lunch with senior management, time off, or the chance to help design future company-wide health initiatives.

Client companies are also working to connect benefits strategies to corporate strategies in employees’ minds, Halling says. One client company builds boats, he says. It challenged workers to find ways that the company could do things more efficiently. The winning group showed that, by spending $12,000 on better lighting, it could save nearly $124,000 in production costs.

From there, Halling says, it’s no great leap to the idea that every dollar a company doesn’t spend on health care is one more dollar that it can spend on better lighting, a new product line or a pay raise for workers. As workers understand that what a company does today affects its future, they can also connect with the fact that health behaviors now have future consequences, both positive and negative.

“I’d like to see us model for health care like we model for finances—like we explain how long it will take to pay off a credit card bill, for instance. What happens if you decide to “pay” a little more than the minimum on your health?” Halling asks. At a minimum, consumers who understand that often become more savvy consumers, Halling said.

One of UMR’s clients reported an example in the story of an employee, a young man who fell while playing Frisbee and cut his arm on a sprinkler head. “The cut required stitches, so the doctor opened up a suture kit, used the necessary materials, and began to throw the rest of the kit in the garbage. ‘Um, Doc, I think I just bought that whole kit,’ the patient said. ‘Could I have it, please?’

He took it home and outfitted his medicine cabinet with the gauze and bandages,” Halling says. At maximum, Halling says, the right kind of consumer-directed medicine could have a profoundly positive impact on the American health care delivery system. “At first, consumer-directed health care was a chance for employers to push back expenses onto employees.

That’s not a long-term solution,” Halling says. “But to me, there is a shining beacon of light in trying to get folks more engaged in managing their health care. If I can get more active in managing my health and understanding that it will affect my financial bottom line, wouldn’t it be great to have 300 million of us out there actively doing this? That would change the trajectory of the $4 trillion we’re spending on health care.”