The employee health risk assessment (HRA) remains a powerful tool for employers, but uncertainty over incentive guidelines
and frustration over participation rates can stall even the most innovative programs. The goal of an HRA is two-fold.
HRAs provide employees with measures of their current health status and future health risks as well as actions they can take
immediately to improve health. Additionally, employers can use the HRA information—aggregated and de-identified—to develop
a wellness strategy.
HRA CHECKLIST: Tailor health risk assessments to specific populations for better data results
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"Most employers recognize that you can't manage what you do not measure," says Michael Taitel, vice president, Alere Center
for Health Intelligence. "If you are trying to manage the health of your population, you can't achieve that goal unless you
have the data that shows the prevalence of health risks, chronic conditions, and absenteeism and presenteeism rates in your
population."
More data can be better when it comes to health measurement. Alere offers a Health and Productivity Assessment (HPA), which
analyzes the effects of specific health problems on work performance and absence. "For example, we ask them to indicate if they are missing work because of a health condition," Taitel says. "In another series
of questions, we ask them to rate and compare their performance to other employees. So simply looking at risks alone only
gives part of the picture."
For example, many HRAs assess the presence of depression.
"We understand that depression plays a key role in an employer's productivity losses, as well as overall benefit costs, so
we believe it is an important component to study," Taitel says.
Another feature of an effective HRA includes a link into personal health support interventions so that employees may be steered
into programs that can provide assistance. Employees who require assistance may also be identified for contact by a health
coach or for participation in special wellness or prevention programs.
DRIVING PARTICIPATION IN HRAS
According to "Wellness Programs, Survey & Sample Series," published in February 2009 by Brookfield, Wisc.-based International
Foundation of Employee Benefit Plans, only about 14% of employers have indicated participation rates in HRAs above 75%, while
18% of employers indicated participation rates of 51% to 75%.
Bryce Williams, director of prevention and wellness at Blue Cross Blue Shield of Massachusetts (BCBSMA), believes that
best-in-class participation begins at 80%.
"When [80%] of a population completes an HRA, the data becomes more meaningful and informative to future program strategy,"
Williams says.
LURING EMPLOYEES WITH CASH
MHE EXECUTIVE VIEW
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Incentives are the most popular tool to encourage participation, and there are a number of carrot-and-stick approaches, according
to Carl R. Mowery, managing director of SMART Business Advisory and Consulting LLC, a business advisory services firm based
in Devon, Pa.
"Some employers have even required employees, as a condition of participation in the healthcare program, to complete an annual
health assessment," Mowery says. "Others will give discounts on premiums for those who complete a health assessment, and others
will provide cash or gift certificates to the employees."
The Equal Employment Opportunity Commission (EEOC) issued an informal opinion letter stating that requiring employees to participate
in an HRA may violate provisions of the Americans with Disabilities Act (ADA). However, HIPAA had earlier outlined a recommendation
that noted the incentive can't be greater than 20% of the cost of the health plan. Most employers are currently following
the HIPAA guidelines.
Much discussion has taken place on how to apply incentives for completing HRAs. The company can opt to pay cash or the incentive
may be tied to reduced health insurance premiums.
"The important thing to keep in mind is that incentives do not have to be costly," says Taitel.
In CIGNA's experience, its clients with the best overall HRA completion rates have offered a reduced premium or cash payment.
"Incentives play an instrumental role as a mechanism to engage individuals to participate in HRAs and in other programs designed
to improve lifestyle behaviors," says Emelia DeMusis, CIGNA product manager. "Levels of participation in HRAs have been found
to vary significantly depending on the type of incentive that is used to motivate participation."
While DeMusis says that optimal participation rate is obviously 100%, she believes that "even at levels below 100%, such
as 20% to 40%, there can be medical savings."
