Behavior is hard to change.

We get up at the same time, drive the same route to work, do the same job, eat the same food, head home at about the same hour and spend the night doing the same things.

Change can jolt a daily routine.

But change in behavior is exactly what health officials and insurers are betting on to make health insurance available at lower costs to more small business owners and their employees.

“Employers want everything they have now, and pay less. It isn’t going to happen. I hate to break it to you,” state Health Insurance Commissioner Christopher F. Koller told a group of small-business managers.

“You and your employees have to look ahead and see where health insurance is going…Every year it goes up…The bet is when you change the behavior, you change the trend.”

Koller spoke to the group during a traveling road show he’s been running to roll out a new health insurance plan, called HEALTHpact, that is designed to help small businesses cover employees.

The plan is complicated, but is based on a simple idea that if employees commit to a healthier lifestyle — largely by stopping smoking and losing weight – the cost of their insurance should be less. They will also use less medical care, so the cost of insurance should go down. Similar “wellness” programs began at larger companies several years ago.

Koller makes it clear that HEALTHpact is not a massive effort to turn the system upside down. It’s not the universal or national health care plans talked about by the candidates for president or the comprehensive overhaul being tried in Massachusetts.

Rather, HEALTHpact is a small-business experiment that nibbles at the corners of the health insurance crisis to find out if people will change their behavior to get healthier, and perhaps save money. Promoted by Koller and state officials, Blue Cross & Blue Shield of Rhode Island and UnitedHealthcare both offer the new product, but have capped membership at 5,000.

Representatives from the two insurers joined Koller last week to explain the health-care challenge to a morning meeting of 30 small-business managers and representatives at the Greater Providence Chamber of Commerce.

After Koller pointed out that health care costs have been rising 10 percent to 13 percent a year, Laurie White, the chamber’s president, said 90 percent of the Chamber’s members say the availability and cost of health insurance is their number-one concern.

One quarter of the small businesses in a recent Chamber survey do not offer health insurance, while 70 percent in the last year have increased the employee contribution. More companies are dropping coverage. About 62 percent of small businesses that do not offer health insurance say it has a serious effect on recruiting and retaining employees.

Koller explained that HEALTHpact was created, at the direction of Governor Carcieri and the General Assembly, as an alternative to high-premium, high-deductible, reduced-coverage health insurance that small-business owners have shunned.

It requires managers and workers to be more engaged in the process of buying health insurance.

To qualify for the least-costly policy under HEALTHpact, a worker must complete a “health risk assessment” that includes a pledge to lower body weight, stop smoking and participate in disease/case management. After that, there are regular assessments, and if the employee does not comply with the requirements, the deductible goes up — significantly.

There are many variables in the plan that will affect employers and employees differently. Insurance brokers have been trained to help companies figure out if HEALTHpact is a good fit for them. There’s a Web site, healthpactplan.com, with more information.

During last week’s session at the Chamber, the small-business representatives had several questions: Does an applicant have to choose a doctor? Yes. Do sole proprietorships qualify? Yes. Are there periodic health assessments? Yes. Do the plans have a fixed network of providers? Yes. What’s the average individual premium? $320.69, according to a Blue Cross quote. What could be the range of premium increases after the first year? Uncertain, but probably up or down by up to 10 percent.

Since HEALTHpact became available on Oct. 1, only 102 employers and 248 individuals have enrolled. But Koller said he doesn’t expect a gangbusters response until more employers become aware of the product and decide to try it.

A small-business manger leaving the Chamber meeting still had a lot a questions about HEALTHpact and whether it would be good for his business and his workers. But he said he’d take a look.

Good.

The health-insurance equation has to be rebalanced.

Will HEALTHpact work? I don’t know. But it won’t have a chance unless people commit to changing their behavior. And that’s not easy.

jkostrze@projo.com