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"Health Risk Assessment: A Waste of Time and Money Published April 2011 in Healthcare Reform Magazine"

By Lisa M. Holland, RN MBA

When an employer is interested in beginning a wellness program the first thing that comes to mind is the implementation of a Health Risk Assessment (HRA). After all, an HRA has been introduced by the wellness community as one of the foundational data collection tools necessary to ensuring program success. The fact is an HRA is a needless investment that consumes employer resources, costs employers an enormous amount of money (i.e. incentives) and provides no meaningful data that would drastically change the fundamental health issues facing employers today.

A Health Risk Assessment (HRA) is a self-reported survey comprised of at least 15 to 45 lifestyle and behavior questions. The tool asks individuals pertinent health questions as well as questions about an individual’s family medical history, readiness to change, mental health and personal safety. The HRA outcomes are meant to support and assist employers with targeting health risks of their population so that they can use this information to craft a wellness program strategy. Employers are committing tremendous resources via benefit and human resource professionals in terms of implementation campaigns and monetary resources for incentives to attract participation. In most instances, even with a linked incentive, employee participation is limited and the aggregate results provide the employer with no real value.

The following factors substantiate the notion that HRA’s provide little value and offer employers significant rationale for eliminating an HRA from their wellness program strategy:

1. The 2008 Genetic Information and Non-Disclosure Act (GINA) legislation prohibits employers from asking pertinent family history questions in an HRA when the employer links incentives to HRA completion. Family history can be an important piece of information that can support medical trend forecasting of a population. The elimination of these questions significantly reduces the value of the outcome aggregate data.

2. Self-funded employers have access to all of their non-identifiable employee medical, pharmacy, worker’s compensation and other related data points that can be compiled and analyzed to provide a real snapshot of employee medical trend. This data can be extrapolated in order to target, design and implement an appropriate wellness strategy that will impact the health of the employee population.

3. HRA’s are self-reported tools. As such the reliability and validity of the outcome data is questionable. Generally, the best way to validate HRA data is to include biometric screening in conjunction with an HRA campaign, then crosswalk the outcome data against the employer medical trend reports. This method improves validity but adds administrative burden and costs more because the employer now must fund incentives and biometric screening.

4. Lastly, there is significant and readily available data that concludes that roughly 75% of all chronic disease can be prevented or delayed by changing certain lifestyles and health behaviors. Additionally, the CDC continues to release alarming evidence on the obesity epidemic in the United States. This information alone assists employers with easily targeting interventions and programs without the use of an HRA.

There is no need for employers to spend thousands of dollars on HRA campaigns and incentives to achieve a successful wellness program. So what do employers really need to begin their wellness program? The answer is simple, implement a Consumer Directed Health Plan (CDHP).

A consumerism model is “wellness by design” and has proven to promote health and change individual health behaviors by as much as 25%. Secondly, initiate health campaigns that address the “Big Three”; diet, exercise and tobacco cessation. These three factors address the 75% of today’s chronic disease. By targeting these critical health factors employers will begin to impact population health trend and support employees with achieving optimal health and well-being. To monitor and measure program success use the following biometric screenings: Cholesterol (full lipids), Body Mass Index, Blood Pressure and Nicotine screening (Tobacco Use). Each of these measures contributes directly to the total health of an individual. When these measures are maintained within established clinical ranges optimal health can be achieved and chronic disease and illness can be prevented, ultimately equating to improved population health and healthcare affordability.

Don’t waste another day or another penny on an HRA. Employers can achieve a successful wellness program through a Consumer Directed Health Plan and appropriate biometric monitoring without spending additional dollars, exasperating your benefits team and annoying employees.

About the Author
Lisa M. Holland, RN, MBA has been in the healthcare care industry for over 18 years and held senior level positions within the largest healthcare organization in the US. Lisa is an accomplished business development professional with a superior healthcare skill set that includes benefit plan design, sales, marketing, technology development, data analytics and project management. Lisa's passion, strength and knowledge are in primary prevention as well as Health and Productivity Management. Lisa’s professional objective is to use her knowledge and expertise to encourage and promote the appropriate utilization of healthcare services and solutions that empower healthcare consumerism and impact national healthcare affordability. To learn more you may contact Lisa Holland at 401-487-1450.