New Paths to a Healthier Workforce, Part 1:
HRAs Are All Grown Up Now

By Lynne Harsha

A new generation of Health Risk Assessments has come online. They offer immediate feedback to employees and huge potential for cost-efficient integration with other employer funded programs.

Health Risk Assessments have been around for well over three decades, but the modern versions date from about 10 years ago. There are currently 40 or 50 available, many in the public sector and essentially free. Some that are particularly strong on quality of life issues have been very good tools for population and outcomes research and are highly validated, but they've rarely been used to interact with employees. Does the new generation of HRAs have more direct applications for employers? The answer is definitively, "Yes."

On the net and interactive

Before the Internet explosion, distribution had been one of the biggest barriers in HRAs. They'd get lost in the mail or people simply wouldn't open them. And even when people did complete the questionnaires, it would take three weeks to get a report back, so you'd really miss the window of opportunity to begin dialogue, when the employe's thinking about health. You can't let someone's attention wander and hope to get it back again.

The new HRAs are not just electronic. They're interactive. They're branching. In other words, the answers you give to one set of questions will send you on a specific route, tailoring the next set of questions. Fifteen years ago, for instance, an HRA might have been gender-neutral, asking men about having breast exams or women about prostate cancer. That just doesn't work. Branching makes modern HRAs much more powerful.

Personalized action plans

Generic recommendations have limited impact. Don't expect action if you simply tell smokers, "You ought to stop smoking." They know that already. Some older HRAs just pointed out risk factors without taking into account what people were doing about them. For instance, if you were blonde, blue-eyed and fair-skinned, they'd give you a whole paragraph on being careful about skin cancer. The newer HRAs ask not only if you're blonde, blue and fair, but also what you're doing about it. Do you wear sunscreen and a hat when you go out? By taking into account people's behaviors, you can really fine-tune your recommendations. And that's what connects with people — telling them something specific that they didn't know before or ought to focus on in the future.

Some HRAs deliver what's called point-of-need information that is specific not only to the person, but also to the company. For instance, telling somebody who's obese that they need to lose weight is no big deal. Giving them more information about what they can do would help, but it's even more powerful to tell them, "Your company has a $200 credit for a weight reduction program, and here's how you can sign up."

When people tell you about themselves, you have their attention — and a perfect opportunity to take them to the next step. If you lose that, you've not only wasted an opportunity, but oftentimes you've turned the person off to your entire set of wellness programs, because their experience didn't lead them anywhere. Most people who are trying to change behaviors have been through that too many times.

Group reporting and accountability

The real opportunity with the new HRAs, however, is that if you get those aggregate results, you can actually do something with them. You can really target what you spend on health care.

One of the big issues in disease management is that even the best program is useless if no one participates. The trick is getting to the people who need the help. Medical and pharmacy claims and lab data won't always show you who has a particular disease. It's true that people are self-reporting on HRAs, and that can be tricky. People don't always know how to answer the questions, or they don't tell you truthfully what their condition is. But when somebody gives you a bunch of indicators that they're diabetic, and you can combine that with data from claims and pharmacy, you certainly don't want to squander that opportunity.

You don't have a lot of opportunities to talk to employees in an efficient manner about what concerns them in health care. When people open up to tell you about themselves, that's a real chance to aggregate those who have a concern and start a dialogue with them, whether it's through the Internet or some other feedback system. You give them recommendations, places to go, resources and then follow up to see what they're using. You really focus your efforts on those who need your help, and track your progress from year to year. Ultimately, you can even establish benchmarks for population management.

Lynne Harsha provides strategic direction for product development and distribution for Intracorp's nurseline services, including traditional and Web-based solutions. ( www.intracorp.com ). This article was based on a presentation by Gene Huang (formerly vice president of Health Care Management at Intracorp), and Mike Kriner (director of benefits at NCR Corporation) at the Washington Business Group on Health conference in March 2003.

Feedback, Fast and Furious

Michael Kriner, benefits director of NCR, recalls a close encounter with an HRA:

"I'm going to tell a true story. When we were preparing to roll out our HRA program, I got online for my own little test drive. I hadn't weighed myself in about 15 years, so I went down to the basement of the NCR building and got on the scale, and found that I'd gained nearly 20 pounds over the years. I went back up and put in my numbers. All of a sudden, there was a little red exclamation point with the warning: ‘You have morbid obesity.'

"I did not like this, but it was an ‘Aha!' moment. It made me stop and think and it gave me a list of websites where I could learn more. This was about six months ago. I started watching what I eat and lost about 15 pounds, but I would not have done that without that nudge from the HRA. That red exclamation point and ‘morbid obesity' really sent a message to me. That's the power of getting an instant response — useful information just when you're thinking specifically about your health."

More Business & Health Articles About This Topic:

New Paths to a Healthier Workforce, Part 2: Seizing the Right Moment for Change (June 15, 2003)

Lessons from a Health Promotion Victory (September 2000)

Union Pacific . . . On the Right Track  (November/December 2000)

America's Healthiest Companies: Scaling the Heights of Good Health (March 1, 2000)

Arm Yourself for a Shootout on Executive Row (March 18, 2003)

Resource Links:

American Healthwayshttp://americanhealthways.com

The Wellness Councils of Americahttp://www.welcoa.org

The Washington Business Group on Health Center for Prevention and Health Services http://www.wbgh.org/programs/cphs/

Intracorphttp://www.intracorp.com

Lynne Harsha. New Paths to a Healthier Workforce, Part 1: HRAs Are All Grown Up Now.

Business and Health

Jun. 15, 2003;21.