"Keep in mind as you peruse the following HRAs and screens that medical societies—recognizing that America does not suffer from a shortage of diagnoses—are calling for less screening and the federal government recommends lipid screening only once every five years. A large-scale European study found population screening to be worthless, and entire countries are abandoning it.
"Nonetheless, the wellness industry is embracing more HRA/screening programs. Employers, egged on by their benefits consultants, are penalizing workers who refuse to partake in these completely non-cost-effective annual exercises in overdiagnosis, with penalties expected to increase in the future."
Lewis is correct; the majority of companies include a health risk assessment in their wellness program. In a survey conducted by the National Business Group on Health with Towers Watson:
37% of respondents said they structure employee contributions based on employees taking specific steps (like completing a health assessment or screening) and another 27% plan to do so in 2014.
54% require employees to complete a health risks appraisal or biometric screening to be eligible for financial incentives today and 75% plan to take this approach in 2014.
According to a separate survey by Fidelity and the National Business Group on Health:
15% of employers require employees to complete a biometric screening or health risk assessment (HRA) to be eligible for a company health plan.
Where I think Lewis goes astray in his full-on vendor attack is with his insistence that vendors alone are perpetuating an unhealthy use of these assessments while overselling their value. You need only consider two other well-known screenings to understand overscreening is an issue with our heath care system and not workplace wellness alone.
Over a year ago, the U.S. Preventive Services Task Force issued new guidelines about PSA (prostate-specific antigen test), recommending healthy men no longer get these routine tests. There was much debate and not a little outrage over the revised guidelines, and one respected voice, The American Urological Association, did not endorse them until last week.
The story of breast cancer screenings contains far more curves and turns. Two Sunday's ago, breast-cancer survivor Peggy Orenstein's article, Our Feel-Good War on Breast Cancer, reveals how breast cancer awareness campaigns and an understandable desire for safety and security led us to excessive screenings, unnecessary exposure to radiation, and unwarranted treatments, including mastectomies. One particular episode, not captured in her article, shows how loaded changes in guidelines can be. In 2009, the Obama administrationdistanced itself from newly issued guidelines that recommended women not start screening until age 50, and today you'll find a mammography screening every one to two years for women over 40 covered under PPACA.
These examples demonstrate how tricky it is to change our screening practices. There's much invested and riding on them, from the less laudable reasons Orenstein profiles in her piece to the more understandable ones emphasized in each personal testimonial that begins with "Early screening saved me."
Lewis et al. are intentionally inflammatory in their language, and their posts are drawing the desired attention. I wish, however, they used this spotlight to place the use of health risk assessments and screenings in their broader context and to advise employers on how to plot their way through this tricky terrain.
P.S. For two alternative takes, check out Bob Merberg's series on health risk assessments and this MedCity article reacting to Lewis's piece.
In addition to the pieces linked to above, I recommend:
When Your Boss Makes You Pay for Being Fat "Corporate leaders say they can't lower health-care costs without changing workers' habits, and they cite the findings of behavioral economists showing that people respond more effectively to potential losses, such as penalties, than expected gains, such as rewards."
Your Company Wants to Make You Healthy "Employers are experimenting with different models in hopes of improving employees' health, lowering claims costs and getting better returns on their wellness investments."
Kaiser Health Tracking Poll: April 2013 "Meanwhile, the April tracking survey provides continuing confirmation of the amount of confusion still surrounding the status of the Affordable Care Act, with four in ten Americans unaware that the ACA is still the law of the land and is being implemented."
Imagine knowing you need to run 11.2 miles to burn off a McDonald’s burger, coke and fries. Turns out you might make better food choices if you knew you had to run a McMarathon.
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