Health Risk Appraisals
- Considerations for Use in the Workplace
- What is meant by Health Risk Appraisal?
- What does your workplace want from an HRA?
- Why use an HRA?
- Are there other important considerations for HRA implementation?
- References
Considerations for Use in the Workplace
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The 1999 National Survey of Worksite Health Promotion Activities
indicated that among all companies, 35% offered health risk appraisals
(HRAs), either directly or through their health insurance programs; 57% of
companies with more than 750 employees offered HRAs.1 It is very possible
that this percentage has increased in the years since the survey; more
current data are pending the results of the 2004 National Worksite Health
Promotion Survey.
While HRAs are widely used in workforce wellness programs, the impact of
their use on health risk behavior change and related health indicators such
as body composition and cholesterol levels, is not well-understood
scientifically.
The Guide to
Community Preventive Services* is currently undergoing a thorough review
of the scientific literature to identify evidence for the appropriate use of
HRAs in the workforce. However, the most recently published literature
review on the use of workplace-based HRAs, conducted by D. Anderson and M.
Staufacker in 1996, found “suggestive evidence for the effectiveness of HRA
when it is used in a comprehensive worksite health promotion program.”2
What is meant by Health Risk Appraisal?
The Health Care Financing Administration (formerly HCFA, now Centers for Medicare and Medicaid or CMS) describes HRA as follows: “Health risk appraisal 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. A typical HRA instrument obtains information on demographic characteristics (e.g., sex, age), lifestyle (e.g., smoking, exercise, alcohol consumption, diet), personal medical history, and family medical history. In some cases, physiological data (e.g., height, weight, blood pressure, cholesterol levels) are also obtained.”3 The term health risk assessment is sometimes used interchangeably with health risk appraisal. However, Anderson and Staufacker differentiate the two: “…HRA formally refers only to the instrument whereas health risk assessment refers to the overall process (e.g., orientation, screening, interpretation, counseling) in which the HRA instrument is used.”1
What does your workplace want from an HRA?
Before selecting an HRA tool and implementing the appraisal among your employees, it is important to define objectives for doing so. Clearly-defined objectives can guide selection of an appropriate tool from the many commercially available HRAs, and help assure proper data collection and use. For example, an HRA specific to diabetes might be used as part of a health education or counseling program on lowering risks for diabetes, whereas a broader HRA tool would be required if an objective for implementing the HRA is to supply population data to guide the design of a comprehensive workforce health promotion program.
Why use an HRA?
Below are various reasons that employers might implement an HRA. It is possible that more than one of the following are relevant to your company’s goals.
Strategic Planning/Design of Workforce Health Promotion Program —
Assessing collective risk factors of the population and segmenting the
population by certain risk factors and conditions can help program planners
target often limited resources. Programs and incentives can be designed to
address the modifiable health risks factors that are most prominent in their
workforce and to achieve goals specific to employees at various risk levels
(e.g., maintenance for those with low-risk, helping those at higher risk
move into lower risk categories). HRAs can be part of the baseline data to
inform program design and can be repeated periodically to measure progress.
Cardiovascular Screening for Physical Activity Program Participation
— For safety and company risk-management purposes, employers with on-site
fitness facilitates sometimes require employees to participate in an HRA or
health screening prior to exercising at the fitness center.
Individual Health Awareness, Education and Intervention — An HRA
might be used to increase employee awareness of personal health risk factors
for making appropriate lifestyle changes on their own or with the support of
a workforce health promotion program or more intensive counseling services.
Repeated HRAs allow the employee to monitor their risk factors.
Identifying of Individuals for Disease Management Services — The
American College of Sports Medicine (ACSM) points out that, while the
primary objectives of workforce HRAs include identifying the health risks of
the population, “A more recent development in HRA programs is an emphasis on
individuals with chronic conditions or who are at risk for becoming high
medical care utilizers.”4 Through wellness programs and health benefit
plans, some companies offer personalized disease management services to
assist these employees in reducing health risks.
Guidance for Refining Health Plan Services — Population data
resulting from an HRA can be used in combination with other data, such as
health plan use, to help identify the need for targeted health plan services
for preventive benefits, disease management, or other key services that an
employer might choose to negotiate as strategies to decrease morbidity and
sick care costs.
Are there other important considerations for HRA implementation?
Yes,
in addition to selecting the right HRA tool to meet your company's
objectives, HRA planners should be aware of the following:
Ethics — Examples of ethical aspects of HRA are data security,
confidentiality, and proper employee communications to explain individual
results and the concept of risk. For more, see
Ethics Guidelines for
the Development and Use of Health Assessments by the Society for
Prospective Medicine.
Technical Features — Ask questions of the vendor to determine if the
HRA has technology and content that meet your specifications as defined by
your objectives. Examples include basis of and date of last risk protocol
update, report options for group data and participant reports, option for
sending reports to employees’ physicians, inclusion of biometrics and blood
test data, features such as Stages of Change measurement, inclusion of
individualized health education materials with participant reports, data
that include tracking of HRA results over time, level of customization
available, on-line capability, methods for preventing confidentiality
breech, and features included in the base price and those that cost extra.
Mode of Administration — Choices include personal interview,
telephone interview, paper-and-pencil tools (on-site completion/submission,
mailing for completion and submission from home), and online completion.
Implementation might be done by internal workforce health promotion staff,
an HRA vendor, or the employees’ health plan.
Incentives for HRA Participation — Employers that can and want to
provide incentives must determine what type and level of incentives are
appropriate to motivate HRA participation among their employees. Incentives
can range from one-time items such as water bottles or tee-shirts to ongoing
rewards that are integrated into benefit plan design. For the later,
employers might consult human resources and legal professionals who are
well-versed in Health Insurance Portability and Accountability Act (HIPAA)
regulations. Business health councils and coalitions can often be a resource
for guidance on incentives, HIPAA, and other health promotion topics for
their members.
Type of Feedback — HRA products vary in the design of the feedback
format and method (written reports, online reports, and instant
kiosk-produced reports) so it is up to the planners to select the one most
appropriate for their workforce. Feedback may be provided immediately or
might require processing time. The information could be provided by mail or
online delivery to the employee at home or work, personal interpretation
through meetings with each employee at work or at a physician’s office, or
group feedback sessions with employees following along in their
individualized reports.
Who Provides Participant Feedback — Deciding who will present HRA
results to employees depends on the level of follow-up being provided.
Options include health professionals, heath educators, or specially-trained
staff members. These individuals might be in-house, provided by the vendor
or contractor, or be health plan employees.
Level of Follow-up — This will vary based on the stated HRA
objectives: feedback only, feedback plus counseling, feedback plus health
promotion programs, or referral for individual counseling of high-risk
employees or those with existing chronic conditions.
References
1Anderson, D & Staufacker, M. (1996). The Impact of Worksite-based Health Risk Appraisal on Health-related Outcomes: A Review of the Literature. American Journal of Health Promotion, 10(6), 499–508.
21999 National Worksite Health Promotion Survey: Conducted by the Association for Worksite Health Promotion; William M. Mercer, Incorporated; and the US Department of Health and Human Services, Office of Disease Prevention and Health Promotion; 1999.
3Rubenstein L, Shekelle P, Tucker J, Maglione M, Morton S, Roth E, Chao B, Rhodes S, Wu S, & Newberry S. Health Risk Appraisals and Medicare. Evidence Report prepared for the US Department of Health and Human Services, Health Care Financing Administration, 7500 Security Blvd., Baltimore MD. 21244-1850, Contract No. 500–98–0281.
4Cox, CC. (Ed.). (2003). ACSM's Worksite Health Promotion Manual: A Guide to Building and Sustaining Healthy Worksites. Champaign, IL: Human Kinetics.
Please note: Some of these publications are available for download only as *.pdf files. These files require Adobe Acrobat Reader in order to be viewed. Please review the information on downloading and using Acrobat Reader software.
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Page last updated: May 22, 2007
Content Source: Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion
