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BLOOMINGTON - Tom Mercier cut the number of his employees who smoke by nearly 50 percent and the incentive was $26 a month.

Mercier, president and chief executive officer of BOPI (Bloomington Offset Process Inc.), told employees who smoke that they would pay an additional 10 percent in health insurance premiums - or $26 a month - effective June 1. In response, 11 of 25 employees quit smoking.

Mercier told that anecdote Tuesday during a McLean County Chamber of Commerce forum at Illinois Wesleyan University on tactics for small businesses to contain health care costs. About 50 employers, health care providers and health insurers attended.

Costs have increased for a variety of reasons so there's no one solution to control cost increases, said Dr. Richard Bartsh, chief executive officer of UnitedHealthcare for Iowa and Central Illinois. Jeff Ingrum, chief executive officer of Health Alliance Medical Plans, said premium increases are moderating but likely will remain higher than inflation.

Bartsh said consumer-driven health plans - such as health savings accounts - require employees to pay more upfront. They encourage employees to protect their health and to ask more questions about prescriptions, treatments or tests and specialist recommendations.

Bartsh said patients need to ask questions such as: "Is generic available? Will that test change what you will do for me? Is Dr. Smith the best doctor for this surgery? What are his outcomes? What is the cost?"

He encourages patients to consult friends, colleagues, nurses and doctors whom they trust.

Denise Grazer of Fox and Hounds Hair Studio & Day Spa said moving to a consumer-driven health plan in 2005 meant a 6 percent premium increase rather than an expected 26 percent jump. All employees participated.

"We (businesses, insurers and health care providers) need to work closer together," Grazer said.

Bartsh said UnitedHealthcare offers online medical records and health coaches who call to remind members of things like mammograms and kids' immunizations.

BlueCross BlueShield of Illinois is offering a diabetes checks-and-balances program to encourage members to manage the disease, said Joe Sternberg and Bill Patten of BlueCross.

BlueCross also is measuring 93 hospitals on five criteria and - based on those results - is paying different rates to different hospitals, Patten said. In January, BlueCross hopes to have some performance information available on certain member physicians, he said.

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