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When vendors offer screenings that go beyond basics, HR managers should start asking questions
Is more really better when it comes to worksite wellness screenings?
While screenings for high blood pressure, blood glucose level and high cholesterol are often seen as routine, they may not be necessary for all employees every year. Whether wellness programs should perform additional diagnostic tests, such as those for prostate cancer and thyroid disorders, is even more questionable.
“There are some screeners who say, ‘While we are taking a blood panel, why don’t we look for X, Y and Z?’” said Stephanie Pronk, a principal with Aon Hewitt in Minneapolis. When an employer agrees to offer these additional tests, it opens the door to potential problems and risks having its wellness program move beyond the appropriate mandate.
For example, expanded screenings may not always adhere to accepted clinical guidelines regarding the age and circumstances in which patients should undergo specific tests. As a result, a 35-year-old employee may undergo testing and screening that is more appropriate for someone much older. “There needs to be a reason to look for those things,” said Pronk. “Employers need to ask a lot more questions about the value” of various tests.
This is particularly true if the screening program simply mails test results directly to the employee. “These people will get their tests results back and cannot have immediate conversations with a physician” about what to do next, said Pronk, who advised, “These tests need to be done under a physician’s care.”
The Cost of Overscreening
Some level of error is expected in the medical testing process, including a certain amount of false positives that indicate a patient has a specific condition when, in fact, he or she doesn’t.
“Screenings come with benefits and harms,” said Al Lewis, president of Disease Management Purchasing Consortium International Inc., a consulting firm in Waltham, Mass. “Most of what falls under the ‘harms’ category is overtreatment and overdiagnosis created by false positives.” And the more screenings that individuals undergo, the greater the chances for a false positive, he said.
When a false positive occurs, the patient must often have additional tests to confirm the first result. Patients can also experience complications from care they receive following a false positive test result.
Employers should ask about the rate of false positives for any given test and keep that rate in mind when considering the level of screening to offer in a wellness program, Lewis urged.
The Baby and the Bathwater
An argument in favor of worksite screenings is that they may be the only medical attention some employees receive. “Screenings are not the ideal substitute for employees without a source for regular primary care, but they can be a pretty good substitute,” said LuAnn Heinen, vice president of the Washington, D.C.-based National Business Group on Health.
Heinen pointed to an instance where some employees of a hotel chain had gone off their medications for high blood pressure because the co-payment for those drugs had increased. A routine blood pressure screening identified those employees, who were then offered help finding affordable medications. In such cases, employees get the care they need and employers avoid the high costs associated with complications that arise when chronic conditions go untreated.
However, when a wellness program vendor offers screenings that go beyond basics such as blood pressure, cholesterol and blood glucose measurements, HR benefit managers should start asking questions. “There is nothing preventing wellness vendors from simply screening for as much as human resource departments are willing to pay for,” said Lewis.
The most important questions to ask are:
• Why are these tests necessary?
• What are accepted clinical guidelines for when, and under what circumstances, to administer them?
“The concern should be whether a screening is consistent with clinical guidelines and whether it is really necessary for healthy people,” said Heinen.
Pronk also suggested that employers focus wellness screenings on those health conditions that employees can address through lifestyle changes—and leave more extensive testing to primary care providers.
Screenings Boost Rx Adherence for Some Conditions, Not Others
Biometric screenings appear to have a bigger impact on medication adherence for some diseases but not for others, according to a January 2016 report from the nonprofit Employee Benefit Research Institute (EBRI) in Washington, D.C.
Using health claims data from a large manufacturer that offered financial incentives for participating in biometric screenings, EBRI found that the screenings:
• Improved medication adherence for those with high blood pressure and depression.
• Had no impact on medication adherence for those with cholesterol problems (dyslipidemia), diabetes, congestive heart failure, and asthma/chronic obstructive pulmonary diseases.
Wellness programs may generate longer-term cost offsets and productivity enhancements for some chronic diseases, said Paul Fronstin, director of EBRI’s health research and education program, but “whether these future benefits outweigh the costs is an empirical question that needs a longer-term study and a greater number of wellness programs.”
Joanne Sammer is a New Jersey-based business and financial writer.
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