Health screenings – put to the test

Health screening options come in all shapes and sizes. So what should healthcare consultants look for when advising employers on bringing healthcare screening into their employee benefits offering? John Greenwood investigates

When it comes to workplace health, wellbeing and engagement, health screenings appear to tick lots of the right boxes. Assessing the physical health profile of both individuals and an entire workforce, providing a reliable benchmark for health and wellbeing measurement, demonstrating a commitment to staff and identifying problems before they become more serious – it seems the range of benefits that health screenings can bring to employers and employees alike should push them towards the top of the crowded benefits agenda.

Recent changes to salary sacrifice have made screenings taken through flex more expensive, although new entrants into the market are creating competition that should push down prices say advisers. So how and why should a consultant introduce health screenings into an overall benefits package?

For PES head of workplace happiness Debbie-Kleiner Gaines, screenings are becoming ever more important. She says: “There are so many positive elements. Firstly, realising ‘oh God, my blood pressure is way too high’, then ‘wow, my employer really cares about me’, and thirdly, it gives the employer early warning signs as to what they should do to improve their employees’ experience.

“Wellbeing, engagement and happiness are all buzzwords, but from the health perspective you need a physical check to enable you to benchmark what you are doing. The health check is part of the line in the sand that informs the wellbeing strategy. And you can do a check a year later and see what changes have been made as a result of the strategy and justify the spend on it.”

Health screenings were the second most commonly offered health promotion amongst respondents to last year’s Chartered Institute of Personnel & Development (CIPD) Absence Management survey, with 29 per cent of organisations polled offering screenings to all employees and 9 per cent offering screenings depending on an employee’s paygrade or seniority. Public sector employers were far more likely to offer health screenings, with 45 per cent doing so compared to just 21 per cent across private sector services.

Company-paid screenings are tax-deductable for employers, and, unlike group PMI, do not attract a P11D benefit in kind charge for the employee. However, health screenings bought through flex will become more expensive as a result of the changes to salary sacrifice, which took effect this April with the introduction of the Optional Remuneration Arrangements (OPRA).

OPRA is the new term for salary sacrifice, and introduces the concept of Type A and Type B arrangements. Type A benefits remain eligible for salary sacrifice, benefiting from tax and NI efficiencies, and are limited to pension, cycle to work, give as you earn, childcare vouchers and holidays. Benefits selected through flex before April 2017 will remain unaffected by the changes until the following year, unless a change is made by the employee.

For other ‘Type B’ benefits, which includes health screenings along with some life insurance, mobile phones and home technology, employees will be taxed on the higher of the current benefit-in-kind charge or the amount of salary that has been sacrificed.

Polls from an Aon briefing in March and a webinar in April showed that 40 per cent of employers are adopting the short-term stance of locking down flexible benefit choices until next renewal, while 25 per cent are capturing the changes via P11D and dealing with offline communications. A further 5 per cent will absorb the HMRC debt at the end of the year, and another 5 per cent are bringing forward the tax charge. Just 25 per cent are catering for changes.

Bluecrest Health Screening managing director Peter Blencowe believes the change in the tax treatment of health screenings purchased through flex could lead to greater competition around price. A higher rate taxpayer who last year flexed a £500 health screening, would have paid around £290 last year, but will see the cost rise to the full £500 this year.

“People will see the cost of their screening go up and may decide to shop around and go with a lower cost provider,” says Blencowe. “We have seen uptake of employees taking screenings through flex increase by 500 per cent where we have replaced a more expensive provider.”

Livingston agrees that competition is coming to the market and is going to drive down prices. “Bupa and Nuffield have had a grasp on the market for some time, but with new providers coming in, we should see pressure on costs,” she says.

One such player is cash plan provider Health Shield which recently launched a proposition that targets health screening services at the entire workforce. Health Shield’s most affordable screening costs £35 and its top-end option is £300. Benefits include tailored diet and lifestyle advice, immediate test results, personalised follow-up reports, telephone advice post screening and a report for the individual’s GP, if a follow-up is advised, with full technical data and reason for referral.

Health Shield chief executive Jonathan Burton says: “We use point of care health screening equipment, meaning that we only need a finger prick to get a blood sample. Not only is this cheaper, the method we use also means that all results are available to the practitioner during the assessment and, as such, specific, immediate advice can be provided to the participant rather than them having to wait for a full report. In addition to the obvious cost saving of a cheaper health screen, there are also hidden cost savings. Providing health screenings that are based in the workplace means that the cost of an employee being absent from their job is limited to the time spent in the appointment rather than losing up to half a day in attending a clinic. It is also a convenient option for those who may find it difficult to get to a clinic or a hospital.”

Bluecrest’s core offering is £129 per employee, and can be carried out on site or at 2,000 locations nationally. Checks includes artery health, heart rhythm/resting ECG, body composition, biochemistry test for liver disease, kidney function, cardiovascular health, diabetes and gout. Its executive plan costs £249, and offers haematology screening, while its £269 plan incorporates an early cancer risk review.

Sector giant Nuffield Health recently revamped its offering with a new series of bespoke lifestyle focused health assessments for UK businesses. The four new personalised health assessment options focus on weight management, fitness, building resilience and cancer risk prevention. Existing tests such as blood pressure checks, glucose, cholesterol and body composition remain part of its signature Lifestyle, Female, 360 or 360+ health assessments. Employees also receive expert support and coaching in the option of their choice, helping individuals identify risk, set goals and support behaviour change.

Nuffield’s revamp was informed by research it conducted on over 2,000 participants which found the top three health concerns were being overweight, fitness and emotional wellbeing, stating stress and depression as the two key factors. The consistent future concern across both men and women surveyed was the risk of developing cancer, which resulted in Nuffield offering a cancer risk prevention module.

This modular approach works where individuals are selecting their own level of cover, but in company-paid arrangements where everyone receives the same benefit, other challenges persist.

Secondsight head of group risk and wellbeing Morag Livingston says: “Generally speaking people want to catch things earlier – but you will always have some people who do not want to engage. Younger and older workers will not be interested in the same tests. And it is important to ensure that there are follow-ups to the tests. If someone has a screening which identifies certain changes that need to be made, then unless there is follow-up action to make that happen, the potential health improvements will not be achieved.”

This is precisely the approach being promoted by Bupa. Bupa Health Services head of clinical sales James Willis says: “The modern employee doesn’t need to be told they are unfit or overweight – they want us to help empower them and provide them with the tools and support they need to make lifestyle changes that will improve their health, wellbeing and productivity.  As a result we transformed our range of health assessments at the start of 2016 so that they are tailored to the individual and it also includes access to our interactive wellbeing app, Bupa Boost.

“The app captures users’ wellbeing goals from the moment they book, to the moment they attend, so when someone arranges a health screening we ask them to download and use Bupa Boost ahead of their appointment.  This helps our health advisers to personalise each appointment to the individual, offering them information and tests that are most appropriate for them.

“Our health assessment also includes calls with a lifestyle coach six and twelve weeks after the assessment to offer support and achieve their wellbeing goals.  Data from the coaching calls reveals over a quarter of people who say that they would like to give up smoking have done so by the time of their twelve week follow up call which is a great success rate.

“The gamification element of Boost has also helped employees to stay on track with their goals as they can compete with against other colleagues rather than having to wait until their next health check to see whether they met their goals. The high take up and employee engagement of Bupa Boost  which increases after a health assessment  has also empowered us as we have been able to harness the anonymised data and use it  to create a holistic wellbeing strategy designed specifically for each company we partner with.”

Livingston agrees that gamification, wearables and other low cost tech solutions can help engage the employee with after-screening follow-up actions. “There are a number of ways that people can bring wearables and other health tech into their life. League tables, virtual races, rewards for completing monthly distance targets, these can all help people engage with their health issues over the longer term.”