For years, companies have encouraged employees to get healthy, with mixed results.

Now major employers such as DTE Energy and DaimlerChrysler AG are taking a new tack--offering cash rewards, gift certificates and lower health care deductibles to workers who get health screenings and participate in wellness programs.

Such carrot-and-stick programs are taking hold as the nation's private employers face crushing health care costs that now top $330 billion a year.

"Employers have tried everything else and they're still seeing double-digit increases," said Gregg Lehman, president and chief executive officer of Franklin, Tennessee-based Gordian Health Solutions, which helps companies administer health programs. Gordian, which has 85,000 employees enrolled in health programs, has seen its business grow eightfold since 2003.

The goal is to catch people who are relatively healthy but at risk for developing serious--and costly--conditions. Employees who are overweight but don't yet have diabetes or those who have high cholesterol but haven't developed heart disease represent a major opportunity for savings.

When Foote Health System in Jackson, Michigan, began offering health care credits worth $190 a year to workers willing to be assessed for health risks and follow up with a plan to get fit, office manager Ruth Parsons jumped at the opportunity.

An initial screening showed her cholesterol count was high, at 248. Working with a nurse, Parsons, 62, created a workout plan that has her exercising five days a week instead of two.

Already a runner, Parsons now swims, does aerobics and takes spinning classes. Mixing up exercise routines makes for better results, she learned through the program.

The result: Parsons' cholesterol has dropped to 200. "This makes it so it's something you think about every day," said Parsons. "I learned so much, and whenever I have questions, there's someone I can ask." And Parsons' improved health could eventually save the hospital thousands of dollars.

So far, 800 of Foote's 2,500 employees are enrolled in the program. For those who participated, the cost of prescription drugs increased $179 a year between 2001 and 2003, compared to an increase of $551 a year for those who didn't. The program costs Foote about $600 per employee but is expected to drop as more people sign on, said Georgia Fojtasek, Foote Health System president and CEO.

DaimlerChrysler earlier this year began offering its 18,000 salaried employees up to $240 a year off health insurance deductibles to get a health screening that includes blood pressure and cholesterol checks and a blood test. Hourly employees aren't eligible because they pay minimal deductibles.

The automaker's annual health care tab has increased from $1.3 billion in 2000 to about $2 billion last year.

"We think just having an awareness is going to help address health issues early and prevent them from being more severe," said Dave Elshoff, a spokesman for DaimlerChrysler's Chrysler Group.

Cyndy Parker, a care-management administrator at Chrysler, was among the first to participate in the program. "It can save you a trip to the doctor," Parker said, adding that the results are confidential.

Detroit-based DTE offers its 11,000 employees $50 gift certificates to take a health-risk assessment, which determines how healthy a worker is, what their unhealthy behaviors are, and what they should do to get in better shape. Workers get another $50 to $75 to participate in a program that includes over-the-phone coaching from a nurse. About 3,000 people have signed up so far. DTE spends $100 million annually on insurance for its workers, officials say, and the cost has been increasing 10 to 15 percent a year.

The early success of these wellness programs is peaking interest in metropolitan Detroit. Blue Cross Blue Shield of Michigan found that few of its client companies were interested when it looked into incentive-based programs a few years ago, said Kathy Elston, the Blue Cross Michigan vice president of marketing and sales. Today, those same companies see incentives as an option.

"People are vitally interested in doing whatever they can to have a healthier work force," Elston said.

Success in curbing costs may bring relief to employees shouldering an increasing amount of their health costs.

About 61 percent of employers provided health coverage for their workers in 2004, down from 64 percent in 2001, according to a survey by the Employment Policy Foundation. And premiums paid by employees for employer-sponsored programs increased 11.2 percent in 2004 from the year before.

For employers, catching even a few workers before they develop costly diseases can save them big.

"The carrot on the stick works well," Gordian's Lehman said. "The employer is avoiding the train wreck when these people are out of control."