Revisiting the Value of Health Risk Assessments
Since writing and publishing my article Health Risk Assessments -A Waste of Time and Money in April 2011, I have received quite a bit of feedback. Much of the feedback has been very positive and some, not surprisingly has been completely against the position.
While I agree that a Health Risk Assessment (HRA) has been deemed as one of the foundational measurement tools of a wellness program, the actual value of the data the employer receives from the assessment as it relates to overall health improvement and return on investment of their wellness program is yet to be proven.
In addition to the health risk assessment, there are a variety of alternative measurement tools and data storage mechanisms that employers can utilize to measure the success of their wellness programs-- some of which include biometric screening data. One of the best ways for an individual to raise their health awareness and understand their major health risk factors is to engage in biometric screenings.
Biometric screenings do not have to include a complex panel of blood chemistries (after all, this is diagnostic in nature and should be an assessment ordered and evaluated by a primary care physician), but rather a set of discrete, easy-to- execute measures that address the four critical health indicators that drive 75 percent of today's costly chronic disease: blood pressure, cholesterol (full lipid panel), body mass index (BMI) and tobacco use.
There is medical evidence that would question cholesterol as a critical indicator, since 50 percent of heart attacks and strokes occur in individuals with normal cholesterol levels, but for now I will include this as part of the mainstream critical four. Individuals who have knowledge of these biometric indicators are more likely to improve their health awareness and take action about their health than if they were to only receive a report that provides generalized health risk information from a health risk assessment.
Once an individual knows their numbers, they can engage in appropriate wellness interventions that make sense for them based on their identified biometric risk(s). Biometric screenings offer individuals the opportunity to have that "ah ha" moment. Historically, employers who have implemented biometric screening alongside a health risk assessment.
However, a health risk assessment is unable to provide that tangible "teachable" moment that will most likely have the greatest impact on behavior change. Biometric screenings provide real-time data and therefore should be coupled with a health coach or professional counseling session that can address the individual's identified risk immediately and who can talk with them about creating a personalized plan that will drive them back to the programs and services of the employer wellness program as well as deliver other preventive health tips and education.
A successful employer wellness program is one that has sound measurements and uses benchmark data as part of its measurement process. While health risk assessments provide such data for employers, this data can easily be replaced with aggregate biometric screening data that provides relevant population health baseline (benchmark) and year over year measures to assist employers with understanding population health behavior change patterns as well as health risk mitigation.
The same four critical indicators can also be used to extrapolate psycho-social behaviors such as stress to understand and identify the need for additional interventional programming. Many large employers enjoy self-funding as part of their healthcare affordability strategy and have access to all of their medical cost data to assist them with benefit design and wellness program strategy.
It may be for this very reason that some employers are recognizing that an HRA as part of their overall wellness strategy IS a waste time and money; money that can and should be used for biometric screenings or other programming interventions. In fact, in a recent survey 50 percent of large self-insured employers said that they feel health risk assessments are a waste of money.
Perhaps the value of the HRA is better served for the fully insured employers who are unable to obtain the population data they need in order to formulate a comprehensive workplace wellness program for their organization. While proponents of the HRA speak to its integration capabilities with health coaching, I have seen limited engagement and limited significant outcome data that support this model.
Simple stratification of biometric data can also be integrated with health coaching, disease management and care management programs to promote effective and timely outreach and intervention. The good news is that the biometric screening information is reliable, valid (because it is not self-reported) and does not come from retrospective claims data.
This empowers the health coaches, nurses and care management teams to improve case acceptance rates and health outcomes. There are many who feel that the self-reported information obtained from an HRA is "good enough" because there are so many survey tools today that rely on self-reported information to gather data for research.
Additional arguments will defend the HRA as long as it is coupled with biometric data to support the reliability and validity of the responses. Does an organization really need to spend additional dollars on an health risk assessment AND biometric screening when biometric data alone will provide all the population health information they need to make appropriate decisions to craft an effective workplace wellness program?
I don't think so. As a healthcare professional and a health promotion subject matter expert for over 15 years, I understand the value of assessment and measurement tools. Measurement is a crucial part of determining success, but sometimes a deviation from the mainstream is not such a bad thing when there are other valuable measurement methods available to collect meaningful data that will achieve similar results.
The bottom line is that there are pros and cons to implementing a health risk assessment. Every employer needs to understand both sides of the value equation in order to determine if a health risk assessment is the right choice for their company, its culture and ultimately its budget.
About Simplicity Health Plans
Simplicity Health Plans is a transaction integrator that creates SaaS technologies for comprehensive consumer solutions that offer an "End-to-End" cure for rising healthcare expenditures, which includes the best implementation of a CDHP/HSA. Simplicity aligns the interests of the Provider, Employer, and Employee to provide a turn-key, fully integrated Consumer Directed Health platform.
The platform fuses unparalleled technology, point of service adjudication, real-time data, and anti-fraud controls. Our technology portfolio includes; the Health Index Calculator (Health2Cash App), the StayFit Plan wellness platform and the first of its kind and proven CDHP/HSA Point of Service Payment System for healthcare.
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 major healthcare organizations. Lisa is an accomplished wellness subject matter expert and President of the StayFit Plan administered by Simplicity Health Plans. Contact Lisa at 216.367.3092 or at firstname.lastname@example.org