While health risk assessments (HRAs) have been around for decades, utilization remains a challenge. According to Health Information Network research, only 17% of users complete 80% or more of a typical HRA.
Generally, an HRA is a systematic approach to collecting information from individuals that identifies risk factors, provides individualized feedback, and links the person with at least one intervention to promote health, sustain function and/or prevent disease.
According to Theresa Stenger, an employee benefits consultant with Trion Group, the typical HRA format itself may be one contributing non-completion factor.
“Think of it like any survey; if people are asked the same questions over and over there is a high likelihood that they will not engage,” she says.
Stenger says the HRA can be a “teachable” moment, however, so if it’s just being used to gather data, it will be a missed opportunity to promote available tools and resources that may actually lead to long-term behavior change.
“By getting the data in an easy-to-understand, even fun format, employees are more likely to engage not just once annually, but throughout the year,” she says.
For example, one emerging strategy for HRAs is gamification. Stenger says there is a significant push to engage the participant through games. She explains that some employers believe if you can leverage games and the social media tools, they may be able to increase overall engagement in wellness programs.
Rally Health, for instance. offers user friendly tools that help participants calculate their “real age” based on their lifestyle-based risks, as compared to, say, current tools that provide the standard language on how we need to eat better, lose weight and stop smoking, etc.
Other firms are trying to get through the barriers to improvement by asking more intrinsic focused questions. For example, an employee whose child is suffering from Autism may be prioritizing that issue above their own health. If employers keep asking the same questions on the current state of health and willingness to change, engagement will drop.
“We need to understand what barriers exist and determine what tools can be offered to help remove them,” she says.
Stenger says most vendors are using technology to tie the HRA data to biometric data, with the more advanced wellness companies also include medical, pharmacy and even disability data to stratify the risks and target high-risk plan members.
“Employers who achieve the highest participation rates require completion of the HRA as part of the overall Wellness strategy,” she says. “So in order to receive the reward [such as premium reduction] they must complete the HRA, biometric screening and other programs.”
These companies pull in the biometric data already, so two issues with the HRA are addressed. First, self-reported data is replaced with actual employee information, which helps with risk stratification. Second, if an employee does not “know their numbers” they will skip or overestimate their current health status.
“We also find that no matter what the incentive may be, approximately twenty percent of employees will not engage in completion of an HRA,” she says. “This could be driven by a fear of the employer using their personal data.”
KI Furniture, which manufactures furniture and architectural wall system solutions for education, healthcare, government and corporate markets, is one employer with a long history of success using HRAs. The employee-owned company, headquartered in Green Bay, WI., has been using HRAs since 1991, and enjoys a 93-96% participation rate with both employees and spouses.
Jodi McWilliams, KI Furniture’s Benefit Manager, says the company’s HRAs are a combination of a questionnaire and blood draw and are done by a third party vendor, Healics, a wellness and health testing firm in Milwaukee, WI.
“Our employees have been doing HRAs for so long through Healics that we never hear about data-privacy issues or concerns,” McWilliams says. “Healics a reputable company, and our employees know they get the full report sent to their homes, and KI gets their name and score.”
McWilliams says KI has a long, positive history of being wellness-oriented, with HRAs being just one step in the process. As incentive, KI ties HRAs to the premiums employees pay.
“We also offer health coaching for those that have results that are in the high-risk categories,” she says, “and a lot of employees use their HRA results as part of their annual exam with their family doctors.” They show what their results were and the blood work that was done through the HRAs.
“It's another great tool to be able to have that conversation with their doctor,” McWilliams says.
KI and Healics partner to keep up on any healthcare categories that might need updating on the testing, according to national standards. For example, if cholesterol numbers change nationally, KI would look at changing its scoring table.
Even with the new healthcare laws and the ever-changing healthcare world, KI wants to offer this testing to employees and spouses,” she says. “We believe it’s very beneficial.”