The ShapeUp employer survey found that employers are increasingly skeptical about health risk assessments. An evocative infographic summarizing the survey results shows that, if employers’ wellness budgets were cut in half, HRAs would be programs they’d be most likely to cut. Three times as many respondents would eliminate their HRAs, for example, compared to those that would eliminate health coaching. Approximately 50% of respondents “do not believe in HRA.”
But some of the survey respondents’ comments — as well as much of the employee wellness literature — reveals that employers are evaluating HRAs with a narrow lens.
Employers question whether HRAs improve health. It’s the wrong metric.
There may be some employees whose health has benefited based on some feedback they got on an HRA, but not enough to warrant the investment you are making in the HRA (that investment includes your organization’s money; your time; and, perhaps most importantly, your participants’ time, energy, and goodwill). But don’t listen to me. Your employees will also tell you that your HRA doesn’t make much difference to their health. That’s why some employers pay employees up to $500 just to complete an HRA.You wouldn’t have to pay employees to complete a simple form if they actually saw any value in it to begin with.
This series of blog posts about HRAs, a branch off the series about the ShapeUp survey, has deconstructed HRAs with an eye toward better understanding their value or lack of value. Here are the cliff notes:
- The conventional framework of employee wellness programs is predicated on the principle that improvements in the health risk profile of a population can lead to reductions in healthcare costs and improved employee productivity.
- HRAs are techniques or processes of gathering information to develop health profiles, using the profiles to estimate future risks of adverse health outcomes.
- HRAs are dependent on self-reported data, which is valid for effective use in population health management intervention, although it’s value at the individual level is questionable.
- Importing clinical screening values — such as blood pressure and cholesterol — to an HRA does not add much validity to the HRA on an individual basis, but, like the self-reported data, should be sufficient to measure the health risk of a population.
- HRAs may help steer individual’s towards more intensive programs based on the position of the individual in the strata of the population’s health risk and predicted health care costs.
These findings point to the same thing: Health risk assessment is a population health tool. HRAs’ primary utility is in helping employers identify the health risks that deserve the most attention in order to achieve positive health and financial outcomes. The same tool can then be used to measure a program’s success in shifting the health risk of the population. The HRA can also be used to project the financial impact of shifting the population’s health risk.
Unfortunately, employers have been using HRAs, a population health measurement instrument, as a behavioral intervention. No wonder you are disappointed! Be honest with yourself and with your employees: The HRA is for you — a potentially useful tool in the administration of your program. It’s not an employee benefit, and your employees know it.
Part of the reason employers have mistaken HRAs with a full-fledged health intervention is that vendors have marketed them as such. As a measurement tool, you should reassess whether your HRA is worth what you are paying.
But don’t rush to throw the baby out with the bath water. If you decide that your HRA’s capacity to measure risk in your employee population justifies its use, your next step is to reconsider whether you truly need to have all your program participants complete an HRA every year. Your vendor doesn’t want to hear it, but you may be able to realize the measurement potential of your HRA more cost effectively by having a sample of your employee population complete it every two or three years.
I’m not making a case for or against health risk assessments, just encouraging you to make a well informed and critical decision. What do you want your HRA to do? What does your HRA do? Is your organization getting its money’s worth?
Great summary post, Bob, of your HRA series.
I remember being at the annual National Business Group on Health disability/health conference five or six years ago and GE’s medical director gave a presentation essentially saying that HRA data was not cost effective. HRAs didn’t change GE employee behavior and the employer found out everything they needed about their population’s health profile via other data analysis.
I think assessments such as Ron Kessler’s Health and Productivity Questionnaire (HPQ) or Debra Lerner’s Work Limitations Questionnaire (WLQ) may be more useful because they consider relationships between health and employee performance.
For global employers, HRAs can be useful outside of the U.S. because population summary data about health conditions is largely not available to employers – unless they offer private medical insurance in addition to the government-provided coverage.
Warm regards,
Carol
Great points, Carol. I certainly think an employer should question the cost effectiveness of an HRA. Most of the major HRA’s I’ve recently seen incorporate either HPQ or the WLQ, sometimes as a “buy-up.” I can’t say I share your enthusiasm for them. I’d consider them on par with typical HRAs, but I don’t think they are telling employers what employers need to know. It’s great business sense to assess health and health risk based on productivity — but it’s not great health promotion.
Do you happen to know how GE found out everything they needed about the health and health behaviors for employees who were not on their medical coverage? Was it through one of the productivity assessments?
Great blog post…and great discussion also! I agree with you Bob; fundamentally an HRA is a population health management tool, however I think we have done a poor job in the industry of making HRAs engaging and meaningful to the individual. Typically they are created by academics and clinicians for their own needs, rather than thinking about the user’s experience. They take a long time to complete, are text heavy and often incomprehensible to the average person. The reports that get generated are also very text heavy and not action oriented. Most people who smoke, drink too much or don’t exercise know that it’s bad for them, they don’t need to be told this again. What they need is specific information on the local resources and initiatives that are available to them to help them improve their health.
For those who are interested I recently published a paper on how to create a more consumer focused and engaging HRA: http://shortreports.rsmjournals.com/content/2/9/71.full.pdf+html
An example of this approach can be found at http://www.whittingtonhealth.com
Thanks, Peter. I see your point about HRAs telling people what they already know. In fact, presenting at a recent conference, a prominent HRA developer acknowledged that he’d spent the last 25 years telling participants what they already know.
By the way, Peter… You may have missed it, but I linked to your article and discussed it at greater length in one of my posts in this series, “What Is An HRA (Supposed to Be)?” If you have a chance, I’d certainly be interested in any feedback you have on that post. I consider myself a kindergarten student of HRAs and was challenged at times to fill in the holes in my understanding of the HRA development process. I’m sure that readers of this blog, and I, can learn a lot from you.
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