If you look closely, you’ll see them everywhere. From smartwatches to wristbands to clip-on gadgets, fitness trackers are monitoring people’s steps, caloric intake and other health metrics while doubling as fashion statements. And now, the wearable-device trend has moved into the corporate wellness market.

Spurred by wellness incentives that are part of the Affordable Care Act, more companies are offering employees activity trackers from providers such as Fitbit, Jawbone and FitLinxx as part of their wellness programs. Others are piloting devices that measure blood glucose, heart health or even brain activity.

According to a 2013 study by New York-based ABI Research, over the next five years 13 million wearable devices with wireless connectivity will be integrated into corporate wellness plans.

“What the latest wearable devices provide to wellness programs is an easy data feedback loop that wasn’t available before,” says Jonathan Collins, a principal analyst with ABI Research. “The easier these devices become to use, and the more seamless the data tracking, the more employees and wellness administrators will want to use them.”

An Integrated Approach

Some organizations tie use of wearable devices into online wellness platforms to encourage a more holistic approach to health. At the State of Colorado, one challenge was meeting the diverse wellness needs of a large government workforce, says Kathy Nesbitt, executive director of the state’s department of personnel and administration.

“We have a large geographic area to cover, so we wanted a unified platform that was easy for people to access and use, regardless of their health plan, and would contain all the wellness resources to meet personalized needs,” she says. Participation is voluntary.

The state tapped a wellness platform called CafeWell from vendor Welltok of Denver. Employees use the site, which is delivered in a platform-as-a-service model, to upload step results and access personalized health itineraries and educational resources on smoking cessation, diabetes care, dietary issues and stress reduction.

An employee using a pedometer might create a goal of averaging 60,000 steps per week as part of a weight management effort, then upload the results to the platform, where he or she can watch related videos, read articles and receive support from a health coach.

How does Nesbitt measure the payoff? “Health care costs have gone down for us in some aspects,” she says. “We’re also seeing less utilization of benefits with certain vendors.”

One of the biggest hurdles to widespread use of next-generation pedometers can be their cost. The devices retail for about $100 each but come much cheaper when purchased in bulk. Still, for some companies, it’s a significant expenditure. “The good news is that, like any technology, the cost will come down with time,” says Alan Kohll, founder and CEO of Total Wellness, a wellness services provider in Omaha, Neb.

Legal Matters

Employers that offer fitness tracking devices should ensure that all aspects of wellness programs they design comply with the Health Insurance Portability and Accountability Act (HIPAA) and the Americans with Disabilities Act (ADA).

Under HIPAA’s nondiscrimination provision, for example, employers must offer alternatives to employees who aren’t able to use activity trackers. “If it’s considered reasonably difficult or medically unadvisable for someone to use an activity tracker, HIPAA states that you either have to waive that requirement and offer them the same reward for participation regardless, or give them some other way of participating,” says Alexandra Devendra, an associate in the labor and employment group at the San Francisco office of law firm Nixon Peabody.

Sizing Up Fitness Trackers
Fitbit One Clip-on Steps, distance, calories burned, stairs climbed, sleep $99.95 Compatible With: Most Android, iOS and Windows devices. Includes Bluetooth Low Energy connectivity	Jawbone UP Wristband Steps, sleep, nutritional information $79.99 for UP; $149.99 for Bluetooth-enabled UP24 Compatible With: Amazon Fire Phone, many devices running Android 4.0 and later and iOS 5.1 and abov
Nike + FuelBand SE Wristband Workout intensity, steps, sleep $99 Compatible With: Many iOS and Android devices. Bluetooth 4.0 available with iOS 6.1 and above and Android 4.3 and later	​ FitLinxx Pebble+ Clip-on Steps, distance, activity time, calories burned $59.95 Compatible With: iOS 7 devices. Android support later in 2014

As for the ADA, the act prohibits medical exams except under narrow circumstances—so the question would be whether the use of such trackers could constitute a medical exam. However, the U.S. Equal Employment Opportunity Commission has stated that disability-related inquiries and medical examinations are permitted as part of voluntary wellness programs.

Employers also need to ensure that they maintain the confidentiality of any personal health information generated by wearable devices, Devendra says.

Brain Trackers?

Some pioneering organizations are going beyond step, heart and sleep trackers to test one of the biggest underlying causes of poor health in the workplace: chronic stress.

At Reebok in Canton, Mass., Chris Palmer, program lead in the organization’s wearable fitness electronics group, recently conducted a pilot test of Muse, a brain-sensing headband from vendor Interaxon that claims to sense brain activity much like a heart rate monitor detects heart rate.

Muse users engage in three- to 12-minute training sessions to track how active or calm their minds are, with EEG sensors detecting activity and sending real-time feedback to smartphones or tablets. The goal is to help people learn to settle their overactive minds to improve focus and enhance resilience in times of stress.

Palmer recently tested Muse with 10 people over a two-week span, asking each individual to use the device at least once a day. He is currently analyzing results.

“It’s grounded in strong science around signals processing,” he says, “and we’re looking at it in terms of its ability to improve cognitive awareness, resilience and relaxation.”

Rewards and Incentives

One of the obstacles to success is getting employees to use the devices long term. To keep people engaged and enthused, many organizations turn to challenges, rewards and incentives.

At Houston Methodist hospital, employees can use their Fitbit devices to accumulate credits to apply toward prize drawings. Averaging 5,000 steps per day each month earns one credit, with each additional 2,500 steps earning an additional credit up to the maximum of eight—which makes employees eligible for a $10,000 annual prize, says Janay Andrade, director of benefits at the hospital.

To date, 6,500 of the hospital’s 17,000 employees have purchased fitness tracking devices, which come in three versions and can be clipped to the user’s body or worn on the wrist. The hospital subsidizes a portion of employees’ costs, and buying in bulk generates a discount. The devices not only measure steps taken but also distance traveled and calories burned. Newer models feature sensors that gauge elevation, and some also track sleep quality using a dashboard that indicates the number of times users wake up and how long they sleep.

In Colorado, state employees receive discounts toward their health care premiums through certain activities. For instance, they receive a $10 monthly discount for logging on to use the wellness platform and another $10 discount for completing a health risk assessment. Qualifying employees can receive a maximum yearly premium reduction of $250.

Improving Traction

Creating a strong wellness culture starts with senior leaders walking their fitness talk. At Houston Methodist, a “CEO step challenge” awards additional credits to any employee who can out-step the top leader of each local unit in monthly events.

“It’s proven harder than it seems,” Andrade says about the employee effort to subdue their competition in the contest. “Our senior leaders are doing a great job of demonstrating wellness leadership.”

Experts believe employers are only scratching the surface on use of wearable technology in wellness programs. “I think more and more wellness tools will eventually be integrated into tomorrow’s smartwatches,” says Kohll of Total Wellness.

Collins of ABI Research agrees, noting that “If you can wear it on your wrist and it has other functionality in the workplace, such as access control to computers or buildings, I think that drives adoption.”

Dave Zielinski is a freelance writer and editor based in Minneapolis.