A growing number of states and localities are turning to incentives to move the employees they insure into healthier lifestyles. Indiana is going one step further. It is trying to target employees who are at risk for illnesses and offering them special services to improve their odds of staying healthy.

"We are trying to be proactive in identifying who will be high utilizers of health care in the future," says Debra Minott, director of personnel for Indiana. "We're looking out the windshield rather than through a rear-view mirror."

Instead of relying on the usual predictors of health care use (past diagnoses, age and gender), the state--via a third-party contractor-- is asking all those it insures to fill out a questionnaire that focuses on the way they live their lives. The idea is to pick up on those whose health will be at risk in the near future, be it from stress, poor eating habits or other lifestyle choices.

The contractor--One Care Street--assesses the answers, identifies those at risk and offers them one-on-one coaching. The coaching is by trained specialists who are available by telephone at an appointed time of the employees' convenience.

The program is voluntary. So far, the overall response rate to taking the survey is 53 percent, with 91 percent of those identified as high risk signing up for coaching.

If the state's experience mirrors that of private companies that have used the approach, it could save 30 cents for every dollar invested in the program the first year and lead to significantly lower health care claims in subsequent years.