By Anthony Vecchione
Biometric screening, a key component of an overall employee health management strategy, is growing in popularity. A recent Towers Watson National Business Group on Health Employer Survey revealed that 43 percent of employers provide incentives to encourage employee participation in biometric screening, and 30 percent offer incentives for workers to engage in healthy lifestyle activities in the workplace.
According to a 2013 RAND Corporation Workplace Wellness Programs Study, employer-based wellness programs often include screening activities to identify health risks. Most commonly, they involve the health risk assessment (HRA) and, either separately or in conjunction with it, biometric screening. These screenings can be conducted at the workplace, in occupational health or primary care clinics, or in partnership with health plans through employees’ regular physicians. The RAND employee survey suggests that almost two-thirds (65 percent) of employers with a wellness program use HRAs, and almost half (49 percent) conduct biometric screenings. The data also showed that individuals who participated in an employer biometric screening program and had at least two follow-up screenings displayed improvements in various biometric outcomes, including cholesterol levels.
A 2013 joint consensus statement of the Health Enhancement Research Organization, American College of Occupational and Environmental Medicine, and the Care Continuum Alliance states that the goal of implementing biometric screenings as part of an employee health management program is to reduce health risks, improve health status, reduce healthcare costs, and improve workforce productivity and performance.
The Centers for Disease Control and Prevention (CDC) defines biometric screening as the measurement of physical characteristics such as height, weight, body mass index (BMI), blood pressure, blood cholesterol, blood glucose, and aerobic fitness. The tests can be taken at the worksite and used as part of a workplace health assessment to benchmark and evaluate changes in employee health status over time.
What is the secret to a successful biometric screening program? As it becomes an integral part of employee health management, how can occupational health providers guide employer-clients to successful implementation of this valuable tool?
“Increasingly people are looking at biometric screens as a tool to arm their employees with the knowledge [they] need about their health risks and hopefully arm them with the motivation to do something about those health risks,” said Mark Russi, M.D., director of occupational health at Yale New Haven Hospital.
Dr. Russi said the key to a successful biometric screening program is having incentives associated with participation in addition to broad and open communication throughout the organization about it. “I think that part of that communication needs to include an assurance [the individual’s] data will be kept confidential, and employers will look at aggregate trends to [determine where the risk is for the population].” Dr. Russi said employees should have the assurance that their manager is not going to be looking at their blood pressure rate.
At Yale New Haven Hospital, in order for employees to receive the incentive, they have to go through the biometric screening process, receive necessary counseling, and go into a computer-based health risk assessment (a.k.a. a database) populated with their own biometric screening data. “And that’s [their] confidential computer-based health risk assessment that [provides] additional information about risks and interventions that could help their health profile,” said Dr. Russi.
Biometric Screening: A Growing Trend in Employee Health Management (Continued)
When discussing how occupational health providers can guide employer-clients to implement biometric screening successfully, Dr. Russi noted that occupational medicine professionals are offering a broader array of services that include both wellness and disease management.
“The workplace offers such an ideal place to carry out interventions where employees can learn about their overall health risks—not the risks they face from exposure in the workplace or from an injury in the workplace.” Dr. Russi pointed out that today most occupational medicine providers consider wellness one of the basic services they offer to employers and that they are in a good position to do so.
Dr. Russi asserted that it is important to educate people after a biometric screening so they know interventions are available. If you do biometric screening without having lined up programs and interventions for employees to act on the health information they’ve gleaned, you’re wasting your time. A successful biometric screening program, Dr. Russi said, depends on having counseling available immediately afterward as well as an array of programs you can offer to help employees mitigate their risks. “Immediately after someone has become aware of their biometric screening results is an opportune time to reach them, make a difference and say, ‘Here’s what we have that you can participate in that will help you modulate down some of these risks. Let’s do a screening again next year and we’ll see where you are.’”
Going forward, Dr. Russi said his program would continue to provide incentives, including discounts of up to $500 on health insurance premiums, to encourage people to take part in biometric screenings and health risk assessments.
Key To Success
Alison Sugg, strategic solutions consultant at Viverae Inc., said successful biometric screening programs use an in-sourced screening model.
“This is what you want to look for in a vendor, one whose biometric screening staff are their employees. They’re trained and certified and educated on the entire wellness program,” said Ms. Sugg. This is important because Viverae doesn’t simply look at the biometric screenings in a vacuum. “We want members to have an awareness of where their numbers are, but we want to take it one step further, and the Viverae in-sourced staff are trained in not only the appropriate processes to keep the screening safe, quick, and effective and easy to participate in, but they are also HIPAA compliant and can discuss the overall wellness program with the participants.”
Viverae is in the health management solutions business and provides companies a platform to tie their employees’ health behaviors to insurance premiums. Their biometric screenings are conducted by Viverae University-trained health assessment technicians and supervised by Viverae personnel. Viverae believes biometric screenings are the foundation of a successful workplace health management program. “Being aware of your population’s health is the first step toward a healthier culture and workforce,” and awareness of biometric screening results is crucial for the early detection of disease and other health problems.
Ms. Sugg stressed that occupational health is an important component of a wellness program. “The number one claim trend that’s coming in, musculoskeletal pain and chronic debilitation, is being recognized by the NIH as an ongoing chronic medical condition. We have an in-sourced, evidence-based medicine clinical model for managing chronic conditions.”
Roslyn Stone, M.P.H., principal and COO at Corporate Wellness, Inc. in Stamford, CT, said the keys to a successful biometric screening program include:
- an experienced provider
- adequate lead time
- real support of senior management
“I would like to see the CEO first in line at any health fair, at any flu shot event. It can’t just be lip service. It has to be real support,” said Ms. Stone. Top-down management support means communicating from the top down to every supervisory level. The message should be, “I expect you’re support [in this]. I expect you to truly encourage your employees to participate. It means something to the bottom line of this company.”
Biometric screenings are a core component of Corporate Wellness’s Innovative Wellness Solutions strategy along with HRAs, vaccinations, incentive solutions, and lifestyle management programs. “The big companies have been doing biometric screening for a long time. Small companies have a tremendous interest particularly under the Affordable Care Act (ACA). And they’re having a difficult time because it’s expensive. It costs just as much to do a biometric screen for a small company and the administrative part is the same,” said Ms. Stone.
According to Ms. Sugg, Viverae programs incorporate biometric screening data as a required component because it is validated data. “We also have self-reported data that [are] incorporated into program components.”
Due to the ACA, a number of employers are seeking health-contingent programs, Ms Sugg said. She explained that the ACA makes a distinction between participatory wellness programs (where none of the conditions for obtaining a reward are based on satisfying a health status factor) and health-contingent wellness programs. She said health-contingent wellness programs are further distinguished as being activity only (which requires the completion of an activity related to a health status factor to obtain a reward) and outcomes-based (which requires an individual to attain a certain health status factor to obtain a reward). To manage and run a health-contingent wellness program, employers need to have a baseline of accurate screening data on the employee population.
“We do recommend that our employer groups implement a venipuncture type of screening event if they want to implement a health-contingent program. There is a growing interest in biometric screenings because employers realize they need to start out getting a handle on the aggregate health risk status of their population,” said Ms. Sugg.
When it comes to gauging an ROI, Ms. Stone said it is not always easy. “We don’t have a lot of good data as an industry to support the cost-effectiveness of biometric screening.” There are geographic issues and more vendors available in certain communities, which makes them more economical. Ms. Stone said there are some remote areas where weather and other factors make biometric screening a challenge.
Ms. Sugg said Viverae uses claims analytics to compare the healthcare costs of participants in its programs with those of non-participants across several categories.
How do you pull off a successful biometric screening program? Ms. Stone suggests seeking out multiple proposals from experienced providers. “There’s not one pricing structure or the perfect one or the best one. You want to look at them and see how they match your organization’s needs.” Most call centers, for example, have very unique needs. Many operate around the clock with call counts or minimums. “In [that] case, you may want a vendor who understands that and is going to work with your needs because you might need increased staffing at shift change time.”
Screening Matters
According to the RAND study, workplace wellness takes advantage of an employer’s access to employees at an age when interventions can still affect their long-term health trajectory. The ACA supports this trend with several provisions on health promotion. For example, under the ACA, the Department of Health and Human Services will award $10 million from the law’s Prevention and Public Health Trust Fund to organizations working with employers to develop and expand workplace wellness activities such as tobacco-free policies, flextime for physical activity, and healthy food choices.
Meanwhile, section 2705 of the Public Health Service Act, as amended by the ACA, raises the permissible limit on rewards offered through a group health plan for participating in a wellness program that requires meeting health-related standards (i.e. health-contingent programs). This provision gives employers greater latitude to reward group health plan participants and beneficiaries for adopting healthy lifestyles in wellness programs that meet certain standards.
