14 Feb Are Screenings Worth the Investment?

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A recent article from Kaiser Health News nicely summarized one of the key debates in corporate wellness programs–do the benefits of annual workplace wellness screenings outweigh the risks?

What are the benefits?

The obvious benefits are seen when individuals who “felt fine” learn that that they have severe hypertension, diabetes or metabolic syndrome and are now able to take action. Additionally, employers report that many of these individuals will establish a relationship with a primary care physician to review their results and set a course of action. Once they have a primary physician, they and their family members tend to visit the doctor instead of the emergency room for other health issues resulting in a lower cost for the plan and the employee. Workplace wellness screenings can be a convenient tool that compliments primary care.  Wayne Riley, president of the American College of Physicians and a professor of medicine at Vanderbilt University School of Medicine in Nashville said, “[Screenings are] a patient empowerment tool and also helpful to help me guide the care of my patients.”

What are the risks?

For one thing, the economists will tell you that workplace wellness screenings and health risk assessments are a waste of money because many of the people screened are healthy and didn’t need to be tested. This is like saying that we should only give a flu shot to the people who were going to get the flu. It was a waste of money for the other people. If only our crystal ball was more clear…The more appropriate argument made in the article is the reference to medical guidelines and US Preventative Task Force recommended screening protocols.

It’s true that annual glucose screenings, blood pressure checks and cholesterol checks are not necessary for all adults. A blood pressure check, for example, is recommended every three to five years for adults age 18 to 39–UNLESS–they are high-risk. Who is considered high-risk? Individuals who already have high blood pressure, are overweight or obese, have a family history of heart disease, heart attack or stroke or are African-American. If any of these things apply, that individual should be screened annually. The same goes for cholesterol and glucose. Individuals should be screened annually if they have high blood pressure or family history of heart disease or diabetes respectively.

However, there are certainly those for whom an annual screening is not recommended. With GINA regulations that prohibit programs from even asking about a significant high-risk factor–family history–and other risks that ironically can only be determined by completing a screening, it seems most logical to error on the side of screening a person who may not have needed it.

The article also pointed out the possibility of false positives and false negatives. This is indeed a potential problem and a primary reason why many programs, especially those that tie results to significant financial incentives, have migrated from simple finger-stick tests to venipuncture tests. Although certain finger-stick devices and cartridges have documented high levels of accuracy, I’ve never heard of a prescription being written based upon an instant test result. High-quality exams with recommended follow up through one’s personal physician is the best way to minimize impacts of any inaccurate results.

So what’s the bottom line?

For those who learned of significant health risks and were able to eliminate them, they are thankful. Employers who are hearing the positive feedback and seeing their spending trend reduce, there is no doubt. Successful companies know their culture, their team and their challenges and most are metrics-driven. Like all programs, from the company pension plan to the dress code and vacation policy, all employees won’t love their employer’s decisions and all employees won’t equally benefit from what’s offered. But companies should be able to implement what works best for them and their employees and define success for themselves. Input from experts is always helpful and it’s healthy to challenge your key assumptions from time to time but make sure the advice you’re following comes from people who understand your unique organization and goals.

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