The big wellness question: To test or not to test?

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Today, there is an open debate on whether biometric testing and health screenings promoted by wellness programs are adding to a culture of over-testing in healthcare. Employees have more responsibility than ever for both the cost and control of their health, yet they are getting confusing guidance about how frequently they should be assessing their health risk. Over the past year, the United States Preventive Services Task Force (USPSTF) has called for more conservative or less frequent screenings for breast cancer, blood pressure and colon cancer. But we’re not getting any healthier:

· 27% Americans are living with some form of cardiovascular disease, according to the American Heart Association.

· 47% of Americans have at least one of the three key risk factors for heart disease: high blood pressure, high cholesterol, and/or smoking, says the Centers for Disease Control and Prevention.

· 50% of Americans have either diabetes or pre-diabetes, according to the American Diabetes Association.

· 69% of American adults are either overweight or obese—increasing their risk for cardiovascular disease, diabetes, and many other chronic conditions, according to the CDC.

· 12% of women will develop invasive breast cancer over the course of their lifetime.

Critics argue that wellness programs that test everyone every year are massively over-screening people, potentially leading to false positives, unneeded medications and inflated costs. In order for this to be true, the presumption is that we are a mostly healthy population, where chronic disease is the exception, not the rule. But the facts about our disease-ridden society speak otherwise.

On the other hand, a simple blood test can detect whether you have — or are at risk for — the most common chronic conditions. In addition, a $50 biometric test that reveals cholesterol, BMI, blood pressure, and blood sugar readings provides essential — sometimes lifesaving — knowledge. This knowledge empowers every person. Each can know what diseases they may be susceptible to, so they can learn their medical options and decide if and how they will take action.

The bottom line is that one out of every two people in America has at least one chronic condition according to the CDC, and many more are at risk for developing one.

The bottom line is that one out of every two people in America has at least one chronic condition according to the CDC, and many more are at risk for developing one. Many of these men and women do not know they are living under the shadow of sickness. By not testing for disease, we may be taking a costly risk — perpetuating a “culture of chronics”— and choosing ignorance over knowledge.

Most people don’t know the basics about their own health — 83% of people don’t know their blood sugar level, 81% their cholesterol level, 79% their BMI, and 68% their blood pressure.

Looking at the economics of testing versus living with chronic disease, there’s no simple mathematical equation on either side. Yes, screening comes with a cost — although notably this is going down every year — and can lead to further testing, treatment, and drug prescriptions, which also carry associated price tags.

By not testing for disease, we may be taking a costly risk — perpetuating a 'culture of chronics' — and choosing ignorance over knowledge.

Complicating a simple calculation further is a healthcare marketplace where doctors are still compensated for treatments rather than outcomes. Factor in the incentives that many plan sponsors layer on to drive screening completion. Additionally, remember that screening and detection alone do not move the needle; health risk actually needs to be reduced to make the screenings worthwhile. Wellness aims to achieve this through programs including fitness, nutrition, smoking cessation, disease management and more.

On the other side of the coin, the average healthcare costs for someone who has one or more chronic conditions are five times greater than for someone without any chronic conditions. Chronic diseases account for $3 of every $4 spent on healthcare. That’s nearly $7,900 per year for every American with a chronic disease. Multiply that by the nearly 160 million Americans with chronic conditions. It adds up to $1.2 trillion.

Which is more expensive: Over-testing or over-screening? We don’t have a definitive, quantitative answer. But let’s make sure we are asking the right question. The goal is to motivate, educate and inform Americans to know everything they can about their own health so they can maintain or improve it. Then, the war will be won.

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Wellness programs Outcomes-based wellness incentives Biometric testing Healthcare benefits