Concerned that not enough employees would use wellness and preventive services when Bacou-Dalloz USA Inc. introduced its consumer-driven health plan last year, the Smithfield, R.I.-based manufacturer promoted the benefits as "free stuff," said Michael Vittoria, director of human resources.

"We used the language of consumerism and listed the wellness items that are covered at 100% and told them what things were 'free,"' Mr. Vittoria said. "Everyone likes free stuff. So we promoted wellness as being free stuff. That really got people's attention."

Well-child visits, routine checkups and gynecological visits, including related laboratory work, were promoted as "free" by the manufacturer of head, body and fall protection equipment.

Bacou-Dalloz also never used the term high-deductible health plan, Mr. Vittoria said. "Our employees don't know they have a high-deductible health plan. We call it an upfront deductible. We found people understand that a whole lot better. It also has a better connotation," he said.

Although the manufacturer does not yet have claims data for this year from its plan administrator to know if the promotion has been effective, "anecdotally, we've heard of lot of positive feedback from employees," Mr. Vittoria said.

To ensure that more CDHP members use wellness and preventive care services, a growing number of employers are turning to stepped-up communications and financial incentives.

Aside from 100% coverage of preventive care, typical incentives include reductions in employees' monthly premiums, contributions to employees' health reimbursement arrangements or health savings accounts, gift certificates and more. One health plan--Chicago-based Destiny Health--even offers discounted vacation packages to those who achieve a certain level of participation in its Vitality wellness program.

The incentives, which can be taxable income to employees if they are not directly tied to the health plan, are generally given to employees for enrolling in care management programs or for completing health risk assessments, although employers are increasingly making health risk assessments a required part of enrolling in health benefits, benefit experts say.

Stephanie Pronk, chief health officer at RedBrick Health, a CDHP education firm based in Minneapolis, said she is noticing a trend of using phased incentives, where payments are made to plan members at the beginning, middle and end of a care management program to ensure they follow through.

Experts say it takes several years for an employer to realize a return on its investment in health and wellness programs. Vendors say that return can be as much as $3 in health care savings for every $1 spent on preventive services.

While many employers are using incentives with CDHPs, some are adopting a more punitive approach, such as imposing penalties on plan members based on poor health habits.

Indianapolis-based Clarian Health, for example, is charging employees $5 per pay period more per factor if they smoke, are obese, have high cholesterol, uncontrolled hypertension or uncontrolled diabetes (BI, July 9). That maximum additional employee charge is $25 per paycheck.

Minnetonka, Minn.-based UnitedHealth Group Inc. also recently unveiled a CDHP that provides deductible discounts for plan members who meet one of four biometrics that include not smoking (BI, July 16).

"I think we're seeing employers testing the waters now," said Steven Noeldner, principal and senior consultant in the health and productivity management specialty practice of Mercer Health & Benefits based in Newport Beach, Calif.

However, Mr. Noeldner and other consultants advise their employer clients to choose the carrot approach over the stick.

"We encourage incentives over the penalties. However, one person's incentive is another person's penalty," he said.