Executive health assessments, what to include and what they cost

What the evidence says about general health checks

Checking everything in everyone does less than many people expect. A Cochrane review of 17 randomised trials, 15 of them reporting outcomes for 251,891 participants, found that general health checks had little or no effect on total mortality or cancer mortality, and probably little or no effect on cardiovascular mortality. The authors concluded that general health checks are unlikely to be beneficial [1].

Those trials tested broad programmes offered to whole populations. A good executive assessment is narrower and more personal, built around the checks with evidence behind them, the person’s own history, the demands of their work and time with a physician who follows up what is found.

The evidence from employers is thin and observational. One bank that ran executive examinations for years reported that about 65% of eligible executives took part each year and estimated a return of 2.3 to 1, from a single employer without randomisation [2].

What a good executive health assessment includes

The United States Preventive Services Task Force grades screening by the strength of the evidence, and its A and B recommendations make a sound core for any adult assessment [3]. A physician then adds what the person’s history calls for.

• Blood pressure, for every adult aged 18 or over [3].
• Screening for colorectal cancer from age 45 to 75 [4].
• Mammography every two years for women aged 40 to 74 [3].
• Screening for depression, asked about plainly and in private [3].
• An assessment of cardiovascular risk, and a statin where a person meets the age and risk criteria [3].
• A full history, including family history, sleep, alcohol, medicines and the demands of travel.
• A written plan, and a named physician who follows up every result.

What scans add, and the risk of incidental findings

Imaging finds things, and many of them would never have caused harm. A meta-analysis of brain MRI in people without neurological symptoms found an incidental finding in one of every 37 people scanned, and a possible tumour in 0.70% [5].

The authors concluded that these findings do not justify screening healthy people without symptoms [5]. A finding can lead to further scans, specialist appointments, worry and sometimes procedures, and a whole-body scan carries the same trade-off. Anyone who chooses imaging should agree with the physician in advance how findings will be handled.

Cardiac CT and wider blood markers raise similar questions, and a good provider explains before the test what a positive result would lead to.

Who an executive health assessment is not for

An assessment is a review of a well person. Anyone with symptoms today, such as chest pain, breathlessness, a new lump or unexplained weight loss, should see a doctor now rather than wait for a scheduled check, and in an emergency should call the local emergency number.

Extensive imaging suits people less well if uncertainty would weigh on them, and a CT scan uses ionising radiation, so a cardiac CT should be chosen for a reason. A clear result is also no guarantee. False reassurance is a real risk when a person dismisses a new symptom because a check was clear months earlier.

What executive health assessments cost

Our executive physical is £2,995, a full day with one physician covering cardiovascular, metabolic and hormonal health, body composition and advanced blood tests, with results reviewed before the person leaves.

The Executive Foundation programme, at £6,995, adds a full-body MRI, a metabolic and hormone panel, DEXA and VO2max testing and a physician roadmap. The Executive Advanced programme, at £14,995, adds cardiac CT and cognitive testing to a wider set of biomarkers. The Executive Echelon programme, at £34,995, repeats MRI and DEXA every quarter and adds oncology markers, with 12 physician sessions over the year.

In the United Kingdom, one health screening or medical check a year provided by an employer is exempt from tax as a benefit [6]. Most firms begin with the executive physical for their leaders and add a programme for those who want more depth.

Questions to ask any provider

These questions separate an assessment that changes a person’s health from one that produces a report and stops.

• Which tests are included, and what evidence supports each one?
• Who reviews the results with the person, and how soon?
• How are incidental findings handled, and who arranges the follow-up?
• Does the same physician follow up through the year?
• What happens if a result needs urgent action after the person has left?
• What does the company see, and what stays with the person?

What The Wellness for teams does

The Wellness for teams is one membership for the whole firm, its leaders and their families, with inpatient, outpatient and dental care, diagnostics and health programmes in 13 cities. Executive assessments sit inside it, carried out by GMC registered doctors with registered partner clinics and accredited laboratories, and one concierge arranges everything.

The company receives one invoice, renewed once a year, and sees anonymised reporting only, with small groups left out, under a data processing agreement. Leaders can start in one morning.