Scorecard Quarterly Commentary

Every quarter, a HERO member is invited to comment on a particular topic derived from an analysis of the most current HERO Scorecard data. We’re pleased to share the most recent commentary from  Jessica Grossmeier, PhD, MPH Director, Research at StayWell Health Management

Employer investment in onsite screening services and “know your numbers” campaigns is on the rise.  A recent survey of employers indicates 54% of employers
provided biometric health screenings to their employees in 2010, which was an increase from 49% in 2009 (National Business Group on Health/Fidelity Investments Benefits Consulting Survey, January 2011).  One driver of this trend may be employers’ growing interest in outcomes-based incentives. Outcomes-based incentives provide financial rewards to employees for achieving specific targets for health screening measures such as blood pressure, cholesterol, and weight.

In addition to providing screenings as a way to support an outcomes-based incentive strategy, there are several other reasons why employers may choose to adopt on-site or near-site screenings. In addition to the obvious – helping employees to become aware of potential health risks – these include sending the message that the organization cares about employee health; supporting efforts to build an organizational culture of health; and generating employee excitement about employee health management programs. While anecdotal evidence suggests that offering screenings can produce these types of benefits for organizations, there is little hard evidence that screening programs reduce health risks or lower medical spending.

The purpose of this analysis was threefold: (1) describe employer use of health screening services; (2) compare the use of health screenings by high-scoring and low-scoring companies; and (3) for highest-scoring companies, compare program outcomes based on level of investment in screening services. It was based on a question in the HERO Scorecard that asked about provision of on-site or near-site screening services and use of awareness campaigns about the importance of screenings.
This analysis was based on HERO Scorecard responses provided by 624 organizations.  Of the employers represented, 19% were small employers with less than 500 employees and 81% were larger employers with 500 or more employees.
Across all respondents, 70% of organizations provided some type of support for screenings, either by offering actual on/near site health screenings or by conducting awareness-raising campaigns about the importance of screenings.

High-scoring organizations provided significantly more support for health screening than average or low-scoring organizations. Specifically, 47% of high-scoring organizations provided both on/near site screenings and awareness campaigns, compared to only 16% of average scoring and 5% of low scoring companies.

Of the 203 companies with the highest HERO Scorecard scores, 90% provided on/near site health screenings. Nearly half (47%) conducted both an awareness raising campaign and health screenings, while 42% conducted only on/near-site health screenings. An analysis was done to compare program outcomes for high-scoring companies with both components to high-scoring companies that provided only the on/near site health screenings. The small number of high-scoring organizations offering no support for screening or only conducting awareness campaigns was excluded from this analysis.
Awareness campaigns did not appear to influence participation rates in the health risk questionnaire or in screenings themselves. However, provision of both elements was directly related to higher participation rates in targeted follow-up programs (30% compared to 19% for disease management programs, and 30% compared to 22% for lifestyle coaching). Reported EHM health and financial outcomes were also substantially better when both elements were used:

• 37% of companies that provided both on/near site screenings and awareness campaigns reported significant health risk improvement compared to only 21% for those who did on/near site screenings but not offer  awareness campaigns.
• 34% of companies with both elements reported seeing a substantial impact on medical trend compared to
• only 19% of high-scoring companies with no awareness campaigns. 

It cannot be concluded from this analysis that the difference in these outcomes was due solely to providing an awareness campaign along with screening services, because organizations that offered both aspects of screening also differed in other important ways.

Companies that provided both elements of screening services had slightly higher overall HERO Scorecard scores (mean=143) than companies that provided on/near site screenings only (mean=136). These slightly higher scores appeared to be driven primarily by higher program section scores and to a lesser extent by higher leadership engagement, employee engagement, and measurement & evaluation scores.

ConclusionWhile final conclusions cannot be drawn from these descriptive statistics alone, they do provide preliminary support for the idea that screening services contribute to achieving EHM goals. The data demonstrates that organizations offering both on/near site screenings and awareness campaigns have better health and financial outcomes; however, these organizations also have stronger leadership engagement, program engagement, and measurement/evaluation. More rigorous analytic approaches that control for the presence of these other best-practice elements will be needed to isolate the independent contribution of screening-related services. As the HERO Scorecard database grows, these more robust analytic approaches will become more feasible.