The gap is measurable. According to CDC researchers publishing in Preventing Chronic Disease, only 67.4% of screening-eligible U.S. adults were up to date on colorectal cancer screening in 2023, and among adults ages 45 to 49 that number dropped to 37.1%.
Free doesn't mean used: what preventive care utilization looks like
Preventive care is one of the few things employers fund at 100%, and it's still among the least used. Covering the cost removes the price tag, not the effort. Getting screened still costs a phone call, a PTO request, a commute, and some quiet dread about the result.
According to a study by Agency for Healthcare Research and Quality researchers published in Health Affairs, as of 2015 only 8% of U.S. adults age 35 and older received all of the high-priority preventive services recommended for them, and nearly 5% received none at all.
Availability is the other half of the story. According to KFF's 2025 Employer Health Benefits Survey, among firms that offer health benefits, 22% of firms with 10 to 199 workers and 43% of larger firms give employees the chance to complete a biometric screening.
Most small and mid-market employers are behind on availability before participation is even a question. And offering screening is a different project from getting it used, the split behind every employee wellness program cost conversation.
The four behavioral barriers behind low screening participation
Four barriers explain most of the gap: no regular doctor, no trigger, no time, and no clear next step. None of them are solved by covering the cost. All four are solvable with program design.
Why one-off screening events don't raise participation
A single screening event is a moment, not a system. It reaches the employees who were already going to show up and misses everyone else. How you prompt people matters far more than whether you prompted them once.
According to the Community Preventive Services Task Force, client reminders increased mammography screening by a median of 14.0 percentage points. Enhanced and telephone reminders produced a median increase of 15.5 percentage points, while written reminders alone produced just 4.5.
That's roughly a threefold difference between a reminder system and a flyer in the breakroom. The event isn't the intervention. The sequence around it is.
Incentives don't close the gap on their own either. According to KFF, 62% of large firms with a biometric screening program already use incentives or penalties, so incentive presence is table stakes, not a differentiator. For the mechanics, see Avidon's guide to wellness incentive design.
What actually raises preventive screening uptake
The interventions with the strongest evidence share one trait: they reduce the number of decisions an employee has to make. Bring the test to them, prompt them more than once, book it for them, and put a human on the follow-up when a result comes back abnormal.
According to a 2025 cluster randomized trial published in JAMA Network Open, mailed fecal immunochemical test kits plus patient navigation raised colorectal screening completion from 4.5% to 11.8% among rural Medicaid enrollees, a 7.3 percentage point gain. The same paper notes that systematic reviews of mailed kit programs have found increases of 22 to 28 percentage points.
| Tactic | Why it works | What it looks like |
|---|---|---|
| At-home test kits | Removes travel, PTO, and scheduling | Ship to home addresses, prepaid return |
| Multi-touch reminders | One prompt is a notice; three is a system | Advance notice, invite, two reminders |
| Pre-booked appointments | Defaults beat blank calendars | Assign a slot they can move, not book |
| Off-shift screening windows | Matches the schedule people actually work | Nights, weekends, shift changes |
| Navigation after abnormal results | Turns a number into an appointment | Live outreach within five business days |
| Coaching handoff | Screening pays off only if something follows | Route flagged employees to coaching, not a PDF |
That last row is where most programs leak value. A screening that flags high blood pressure and hands over a printout has produced data, not health. Routing those employees into structured support is what links screening to chronic disease management ROI.
Avidon's own screening data makes the same point about repetition. In a multi-year outcomes study tracking more than 1,500 individuals through annual biometric screenings, with Avidon as the only intervention, participants who reported two consecutive years of data improved roughly twice as much as those who participated for a single year. Of 879 year-one participants, 324 came back with a second year of results.
That is the argument against the one-off screening event. The employees who benefit most are the ones who show up again, which means your job isn't a high turnout in October. It's a returning population.
How to measure biometric screening participation properly
A single participation rate hides the problem. Track who participated, who followed up, and what changed. Three numbers tell you whether the program works or just runs.
- Participation by segment. Split the rate by shift, location, gender, and tenure. A 58% average often means 80% in the office and 30% on the floor.
- Follow-up completion after an abnormal result. Almost nobody tracks it, and it decides whether screening changes anything.
- Repeat participation year over year. First-time participation is a marketing result. Repeat participation is a behavior result, and a better predictor of long-term health and well-being outcomes.
How Avidon Health approaches screening engagement
Avidon treats screening as the start of a behavior sequence, not a compliance box. Our platform uses cognitive behavioral training, the same evidence-based approach used in clinical behavior change, to move employees from a result to a routine.
Follow-through is the part that's measurable. In a controlled Avidon study of 300 non-incentivized participants, program completion ran 17% with no coaching, 28% with live coaching alone, and 36% with coaching plus technology.
A screening result only matters if somebody finishes what it points them toward.
In practice: personalized prompts instead of blanket emails, small repeatable actions instead of annual goals, and coaching that picks up where screening leaves off. Our explainer on how habits work covers why cues and repetition beat one-time education.
