4 questions to ask before adding biometric screenings

A growing number of employers are adopting workplace wellness programs to improve employee health and subsequently lower their health insurance spend. As they do, benefit managers are tasked with vetting options that will deliver meaningful health and financial results for their companies.

This vetting process typically involves answering questions that range from which types of participation incentives their organization should offer to what type of wellness programs will yield the greatest health-improvement outcomes.

But there’s a problem: Very few benefits managers ask for details about wellness biometric testing, even though most programs are, at least in theory, designed around the information that screening provides. Biometric screening typically involves one or more laboratory tests as well as physical readings, such as blood pressure and body weight, to identify markers of health risks if not actual disease.

According to the Kaiser Family Foundation, 52% of large firms that provide employee health benefits offer workers the opportunity to complete a biometric screening.

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A healthcare aide checks the blood pressure of a patient during the Care Harbor Public Health Clinic event at the Los Angeles Sports Arena in Los Angeles, California, U.S., on Thursday, Sept. 11, 2014. Care Harbor, a nonprofit organization that aids the uninsured with large-scale free urban health clinics, will provide free medical, dental, and vision care to an estimated 1,000 patients each day during its 3 day event. Photographer: Patrick T. Fallon/Bloomberg

Just as workplace wellness programs are not all the same, biometric screening can vary. Failure to question the specific details of a proposed biometric screening program can lead to suboptimal results.

Before moving forward with biometric screenings as part of a workplace wellness program, benefit managers should pause to ask themselves certain questions. Doing so will enhance the likelihood of favorable outcomes — both for employee wellness and the financial bottom line.

1. Why should we screen?

It sounds simple, but setting clear goals for biometric screening is a step too many benefit managers overlook. This may be because they do not know how to anticipate the kind of actions that will be available to them and their employees given the results.

Based on my experience, the most compelling reason to provide biometric screening as part of a wellness program is to help individuals identify risks for several chronic conditions that, if caught early, may be prevented. With insights from a biometric screening, an individual may be better able to take steps to reduce health risks. Common goals may be to reduce body weight, exercise more or visit a physician for treatment.

Biometric screening often can reveal disease risks an individual may not otherwise know. A study published in the peer-reviewed journal PLoS ONE, for instance, found that one in three first-time participants in a company-sponsored, lab-based wellness program by Quest Diagnostics were not aware they were at risk for a serious medical condition, such as diabetes or heart disease, according to biometric screening results. Many of these individuals were in a health plan, suggesting that healthcare access alone does not guarantee preventive care to identify risk for common chronic health conditions.

Biometric screening also can help an employer identify programs to target at-risk employee segments based on type of risk with appropriate interventions. Reliable insight into disease risks for a workforce population may also aid prediction of future healthcare costs.

2. What should we screen for?

Ideally, biometric screening should provide enough information into disease risks for both individuals and the employer in order to take meaningful actions. Here, many employers miss the mark by implementing bare bones biometric screening options. The result is potentially misleading results — and missed opportunities to identify individuals at risk.

Take diabetes screening, for instance. A non-fasting fingerstick glucose screening really doesn’t tell us anything considering the variety of food individuals might have eaten, and how that may have affected their measurement.

A fasting fingerstick glucose test may help identify diabetes risk in some individuals, and be less costly to perform than a hemoglobin A1c test, which involves a venipuncture blood draw. However, a study from Quest Diagnostics found that some individuals in a workforce population with normal fasting glucose results were still at higher risk for diabetes, and a glycated hemoglobin (HbA1c) test identified them.

In a similar manner, many employers overlook screening for chronic kidney disease, one of the major causes of kidney transplantation. Eighty-nine percent of participants identified as at risk for chronic kidney disease did not know it, according to the aforementioned PLoS ONE study. The estimated glomerular filtration rate (eGFR) lab test can help identify this condition very cost effectively, but it’s often absent in biometric screening programs. Other conditions that laboratory tests can help identify include metabolic disorders, thyroid disease and colorectal cancer, among others.

3. How often should we screen?

Annual biometric screening reinforces the importance management places on employee wellness. It can also help identify health risks in individuals who are new to the organization. An annual program also provides a regular cadence of engagement that is not too onerous on employees while minimizing the confusion that can occur when screening happens less frequently.

Annual screening has an added benefit of allowing the employee to track her progress over time. Quest provides graphic charts that show changes in an individual’s numbers year over year. This is a powerful motivator for those who have adopted healthful behaviors to stay the course. And longitudinal changes also can reveal patterns, like modest annual weight gain, that the individual may otherwise dismiss until they see the cumulative effect.

4. How can we connect employees to care and intervention?

Screening is just one facet of a successful wellness program. Some individuals who identify health risks may proactively modify their behavior or consult a physician. But not all will. Employers can improve the odds of at-risk employees accessing the care they need following biometric screening.

Most employees in biometric programs receive a personalized report of their screening results. Additionally, many participants can consult over the phone with a third-party administered physician.

At Quest, for instance, we offer programs that help at-risk employees access behavioral change programs. If an individual’s screening results suggest evidence of prediabetes, that employee may participate free of charge in a 16-week, CDC-based diabetes prevention program that includes coaching and lifestyle modification. An individual with a problematic cholesterol result may be able to access a similar program for heart disease prevention.

Biometric screenings can be a powerful facet of an employee wellness program. Understanding the reasons to screen, which methods to use and how often to use them, and the paths to connect employees to care are key. Benefit managers who do this well will be rewarded with a wellness program that results in healthier employees and lower healthcare costs over time.

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