OBJECTIVES:   To combat rising healthcare costs, many employers are investing in wellness programs that target risk factors for chronic disease.  The purpose of this study was to determine the relationship between health risks and health care utilization/costs in an employed population.  METHODS: A retrospective cohort analysis of health plan members enrolled from 2008 to 2010 was undertaken.  The costs and utilization trends of members whose risk score increased over the study period (IR Group) were compared with those whose score decreased (DR Group).  Biometric screening data were used to determine health risks.  RESULTS: In total, 1095 members met inclusion criteria.  There was a net reduction in points for each of the risk factor categories among DR group members, while the IR group had a net gain in points for all risk factors besides tobacco use (within- and between-group differences for all factors besides tobacco, P <0.0001).  During the 3-year study period, approximately $700K more was spent on the IR group than the DR group ($1,744 per member).  Among IR group members, the compounded annual growth rate of medical dollars was 8.3%, nearly 3 times that of the DR group (2.6%). Overall, the DR group members tended to shift costs from inpatient care to outpatient care, whereas IR group members shifted costs from outpatient care to inpatient care and prescriptions.  CONCLUSIONS: The results of this study indicate that members with increasing risk factors tend to have higher health care utilization of expensive services and costs than those with decreasing health factors.  These findings support the efforts of an increasing number of employers who are investing in wellness programs to improve the health of their employees and contain rising health care costs.