Measuring Health Risk Surveys vs. Screening

When the city of Fort Worth, Texas, launched its wellness program in 2002, officials decided to take two different snapshots of their employees’ medical risk.

Since then, participating employees—54 percent of the city’s nearly 6,400 workers volunteered in 2010—have been asked to fill out a health risk assessment survey each spring. At the same time, they complete a battery of screening tests, including weight, blood pressure and cholesterol.

“One [screening method] without the other just is not as effective,” says Vicki Tieszen, the city’s wellness program manager. Without knowing an employee’s risk factors and willingness to change—all part of the health assessment—it’s difficult to make health recommendations, she says. Relying solely on a survey, though, also has its drawbacks, Tieszen says: “You won’t have any hard numbers in terms of looking at improvements.”

As employers ramp up or expand their wellness efforts, they frequently encounter this dilemma. Do they rely on what employees tell them about their weight, blood pressure and other risk factors? Or do they ask them to stand on a scale and roll up their sleeves?

Advocates for taking employee measurements, sometimes referred to as biometric screening, describe the data as critical to tracking employee health trends, along with allaying any worries about accuracy. Employees may simply not know their own blood pressure, they say, or may sugarcoat the memory of their most recent doctor’s visit. “We tend to give ourselves the benefit of the doubt,” says Adam Hobgood, manager of translational research for the Center for Health Research at Healthways Inc., which works with employers on wellness initiatives.

But not all experts agree—among them Dee Edington, one of the leading researchers in corporate wellness efforts. Based on Edington’s own experience with corporate initiatives, he describes self-reported risk factors as largely reliable, albeit not exactly precise. Individual reporting of weight, for example, is typically only one body mass index (BMI) unit off, say a 24 BMI versus a reality of 25 BMI, he says. That discrepancy translates to roughly seven pounds.

“What we’ve found is that if people trust that nothing is going to happen and they have a good trust in the system, that they are accurate,” says Edington, director of the Health Management Research Center at the University of Michigan. Plus, surveying health risk is far cheaper than hiring clinicians to measure it. Taking physical measurements can cost $20 to $60 per employee, depending upon the number of tests and the complexity of the testing involved, Edington says.

Reporting vs. numbers
Even so, some companies might benefit from biometric screening, if they can afford the additional cost, Edington says. As one example, he cites an employer with a disproportionate number of middle-aged men. Since that group is less likely to get routine preventive checkups, they’re more ignorant about their own risk factors and thus could benefit more from screening, he says.

At Devon Energy Corp., leaders decided that they needed more precise data about employee health so they could better tailor wellness programs and initiatives, says Sue Alberti, vice president of compensation and benefits for the Oklahoma City-based company. Some employees were a bit startled by the results, such as the reality of their waist size.

“Especially some of the men who have their pants-below-the-waist problem,” she says. “If it’s lying, it’s more like fooling themselves. The problem with fooling themselves is they are the only ones who are hurt down the line.”

Hobgood, the researcher at Healthways, co-authored a study published this year in the American Journal of Health Behavior that found sharp differences between reported and actual risk factors. As one example, 3.5 percent of 5,403 employees surveyed described their total cholesterol levels as higher risk—defined as 221 mg/dL or higher by the study. Nearly one in four employees—23.3 percent—actually fell into that group based on their cholesterol results.

But Fort Worth’s Tieszen doesn’t fret much about imprecise results. Employees can be sometimes startlingly forthright once they trust that their job won’t be affected, she says: “People will write down that they drink and drive.” An analysis of March 2010 employee data, provided by Tieszen, found only a minor discrepancy between several self-reported risk factors and actual measurements, with the exception of cholesterol levels.

For both blood glucose and blood pressure, less than 4 percent of employees who classified themselves as low or average risk actually fell within the high-risk category. For cholesterol, the split was greater. Twenty-four percent of employees, who described their risk as low or average, were considered to be high risk based on a total cholesterol count of 200 mg/dL or greater.

Weighing the bottom line
Prior to hiring Cooper Corporate Solutions last year, Devon Energy officials had primarily relied on health survey results, Alberti says. But the consultants at Cooper recommended that they attempt to boost the number of employees—less than 25 percent at the time—who also were getting weight and other risk factors measured.

In fall 2009, Cooper launched a series of on-site meetings, visiting some two dozen Devon Energy locations to tell employees about why they were doing the more intensive health assessment and to outline how employee privacy would be protected. “We stood in front of [employees] and said, ‘Look, it’s against the law for us to share your information,’ ” says David Atkinson, Cooper’s vice president of corporate wellness. “ ‘It’s against the law for us to use your responses in order to deny you employment or to change your employment status.’ ”

Employees also were notified that their health insurance premiums would be going up, but that the 2010 premium increase could be partially offset—by $30 monthly—for employees who did both the health assessment survey and the biometric screening.

More companies are adopting such financial incentives. By early 2010, 22 percent of large companies were offering an incentive for employees who completed both the health survey and the biometric screening, according to a survey conducted by the National Business Group on Health and Towers Watson & Co. An additional 19 percent were contemplating the move.

Officials at Devon Energy also took some steps to make employees comfortable with the health measurements, such as providing private screening areas, Alberti says. Following the measurements, employees received immediate feedback on the results. By year’s end, 90 percent of the energy company’s roughly 4,000 U. S. employees had participated, according to Cooper.

The biometric screening wasn’t cheap, costing $78 per employee, according to Alberti. But it was money well invested, she says, and the company’s senior leaders didn’t hesitate. “I didn’t have to make a big case,” she says. Now that data can be tracked moving forward to assess not only changes in health risk, but whether the company’s medical costs shift over time.

The city of Fort Worth, which also hired a third-party group to take employee measurements, spends nearly $98,000 annually for that staff time and related lab work, according to Tieszen. The health survey portion costs slightly more than $15,500, she says.

In calculating return on investment, Tieszen points to the city’s medical claims. In the last five out of six years, employee medical costs have fallen below the budgeted annual amount by at least $2 million and, at the outside, by as much as $18 million, she says.

Other factors likely played a role, including changes in insurance benefit design, she says. But heightened health awareness, tied to closer scrutiny of risk factors, is undoubtedly part of that equation, she says.

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