Employers have long used incentives such as gift cards and premium credits to lure their workers into wellness programs. Now that some are moving in a more punitive direction, the industry is pondering just how far it should go to force the issue.

CVS Pharmacy recently created a firestorm when it asked employees to submit their weight, body fat, glucose levels and other vitals or pay a monthly $50 fine. Those who agree to the testing pay no more for their health insurance, but those that don?t pay an extra $600 a year. One employee of Broward County, Fla., which uses a similar program, thought such fines were illegal and sued the county for charging him an extra $40 a month for his insurance after he refused to get a health screening. The employee lost the suit. In 2010, Broward County charged $40 a month to employees who did not agree to a biometric screening, which included a finger stick for glucose and cholesterol, and an online health risk assessment. It used the information to identify employees with asthma, hypertension, diabetes, congestive heart failure or kidney disease, and asked them to participate in a disease management coaching program as well as offering copay waivers for certain medications.

While sticks are growing in popularity, a new study shows that carrots still remain the main strategy for employers trying to pry medical information from employees or to get them to participate in wellness programs. An Aon Hewitt survey released last week of nearly 800 large and mid-sized employers in the U.S. found that only 5 percent are utilizing a consequence while 79 percent are offering incentives in the form of rewards. Another 16 percent are offering a mix of both.

But there's evidence that what CVS and Broward County are doing will grow. Nearly 60 percent of respondents in the Aon Hewitt survey said they plan to impose consequences on participants who do not take appropriate actions for improving their health.

The impetus for employers is clear. In order for them to properly manage the health of their population and implement programs that target their most at-risk populations, they must have data. With the healthcare reform law's emphasis on population management, the public will have to get used to having medical information shared through a growing number of sources: electronic medical records and claims data that inform physicians on how best to coordinate care, and health information exchanges that can help hospitals prevent readmissions. Now employers may have access to medical data, also (although not with an individual name attached to it).

While many might think of Big Brother when employers possess information such as body weight and glucose levels, the flip-side is that somehow employers have to find ways to stem the tide of rising healthcare premiums. If they can do that by slicing and dicing data on high-risk employees and incentivizing them to change their behaviors, everyone will pay less in the long run.

Follow Jenny Kerr on Twitter @ JennyKerrHLI

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