How to choose an employee wellness program with blood testing

Why the blood test is the easy part

A large randomised trial of a typical US workplace wellness program ran at 160 BJ's Wholesale Club worksites in 2015 and 2016. It combined health screenings with 8 modules on nutrition, physical activity and stress, delivered by registered dietitians. Employees completed an average of 1.3 modules. After 18 months, more employees reported exercising regularly and actively managing their weight, but there were no significant differences in 10 clinical markers, including cholesterol, blood pressure and body mass index, or in medical spending, absenteeism or job performance.

The lesson for buyers is that a blood test on its own rarely changes anyone's numbers. What happens after the result matters more. The EEOC's wellness rule under the Americans with Disabilities Act makes the same point: a program that collects health information without giving participants results, follow-up information or advice designed to improve their health is not reasonably designed to promote health, unless the data is actually used to design a program for at least some of the conditions it finds.

What is tested

KFF's employer survey describes biometric screening as a health examination of key metrics such as cholesterol, body mass index, blood pressure and blood glucose. Ask every vendor for the exact list of markers, which ones the lab measures and which it calculates from others, and why each one is there.

Glucose deserves a close look. CDC's National Diabetes Statistics Report, updated 16 September 2026, estimates that 115.2 million US adults have prediabetes, and that 11.0 million adults have diabetes that has not been diagnosed, 27.6% of all adults with diabetes. That is why a glucose marker such as HbA1c belongs on any panel, alongside a full lipid panel.

More markers are not automatically better. Each extra test adds cost and another result that may need follow-up. A clinician can add tests for an individual when their history calls for it.

How blood is collected and who runs the lab

There are three common routes: an on-site screening day with a phlebotomist, a visit to a lab, or a self-collection kit used at home. On-site days are simple to run but miss anyone who is off shift, travelling or remote. Home kits suit dispersed teams but depend on each person completing the step on their own. KFF's 2025 survey found that 61% of firms with a biometric screening program let employees complete it remotely.

Whatever the route, the lab matters. CLIA, the federal program run by CMS, regulates laboratory testing performed on humans in the US. Ask for the lab's CLIA number, which collection device is used and whether it is FDA-cleared, and what happens when a sample cannot be processed: who pays for the repeat, and how it is sent.

Who reviews results, and what happens next

Ask who reviews each panel before an employee sees it, and what licence they hold. Then ask what happens to someone whose results are out of range: a conversation, a referral to their own doctor, or only a PDF.

RAND's analysis of 10 years of data from a Fortune 100 employer shows why follow-up matters. Employees in the disease management part of its program, which supported people who already had a chronic condition, generated savings of $136 per member per month, driven in large measure by a nearly 30% fall in hospital admissions. That part returned $3.80 for every dollar spent. The lifestyle management part, aimed at risks such as smoking and obesity, returned $0.50. RAND's advice is to be clear about the goal: lifestyle programs can improve health and reduce absenteeism, but the financial return came mainly from supporting people with existing disease.

• Who reviews results, and are they licensed to act on them?
• How many live, personal contacts does each participant get after the test, and with whom?
• How are urgent results handled, and how quickly?
• Are participants encouraged to share results with their own doctor?

Privacy: what the employer sees

Under the EEOC's ADA rule, medical information from a wellness program must be kept in separate, confidential medical files. It may reach the employer only in aggregate terms that do not disclose, or are not reasonably likely to disclose, the identity of any employee, except as needed to administer the health plan. Participation must be voluntary, and employees must get a notice explaining what is collected, why, and who will see it.

HIPAA adds its own rules when a program is part of a group health plan. HHS says that where an employer offers a wellness program directly, not as part of a group health plan, the information collected is not protected by HIPAA, although other federal or state laws may apply. Ask every vendor how its program is structured, which rules it follows, and for a sample of the exact report you will receive. This is general information, not legal advice: check the details with your benefits counsel.

Participation, measured outcome and cost per participant

Participation is never universal, and the people who join are rarely a random slice of the company. In the Illinois Workplace Wellness Study, which offered screening rewards of $0, $100 or $200 and paid time off, over 56% of eligible employees took part. Participants already had lower medical spending and healthier habits than non-participants before the program began. In the BJ's trial, 36% to 45% of employees at program sites took part in the surveys and screenings. Ask a vendor for completion rates, not sign-ups, and how it reaches the people who would benefit most.

For outcomes, insist on a re-test of the same markers, reported for the group as a whole, so you can see whether the numbers moved. Be wary of return-on-investment claims built by comparing participants with non-participants. The Illinois researchers showed that this kind of comparison, run on their own data, produced savings estimates in line with earlier observational studies, while their randomised result ruled those savings out.

For cost, compare the price per enrolled participant for the whole program, and check what it includes: the re-test, clinician review, the number of live sessions and any incentives. RAND notes that screening all employees and offering one-to-one counselling and coaching to those at risk is expensive, while measures such as healthier food choices and stair campaigns are not. A higher price per head can still be the better buy if it pays for the follow-up that a cheap screening day leaves out.