Though the fate of healthcare reform is unclear, stakeholders can agree on one thing: the need to reduce costs. The issue is particularly urgent for insurance companies: According to one major insurer, 50 percent of medical expenses stem from a handful of chronic conditions, including obesity, high blood pressure, high cholesterol, and diabetes. So as costs spiral — and payment transformation moves slowly — insurers have been experimenting with programs that spur members to take care of their own health. These patient engagement tools and incentives range from small financial rewards to comprehensive wellness coaching systems.The jury is out on how effective these programs will be in the long run. But many in the industry are committed to trying.“We've had a fair amount of experimentation," says William Winkenwerder Jr., M.D., MBA, former CEO of Highmark, one of the country's largest diversified health insurance companies. The goal, he says, is "to get to a place where we have some evidence — good evidence — of the impact."