HRA gateway to healthier workers, reduced costs

"Good health is good business"

When considering the components of your workplace's health promotion and risk management toolbox, think of the health risk assessment (HRA) as a kind of minesweeper, scanning for health risks that might not even be visible yet.

"Why do we do [HRAs]?" asks Michelle Reyna, RN, BS, program director for Texas Health Resources' (THR) Be Healthy THR wellness program. "Some people walking around are ticking time bombs due to weight, blood pressure, and other conditions. If we can [identify] people with modifiable conditions, we can greatly reduce the risk that they will develop serious illness."

HRAs are an important part of the award-winning Be Healthy THR program, says Reyna, because they are entry points to the activities, education, and incentives that the THR wellness program provides.

First step is participation

HRAs assess the level and nature of an individual's health risks and provide recommendations for improved health and well-being. The surveys have become a critical part of virtually all wellness programs, but every organization uses HRAs differently in their corporate wellness programs.

In the past, THR used HRA results to get employees involved in activities and nutrition challenges that earned them credits that could be cashed in for money at the end of the year.

"We are in the process of enhancing the program, changing it drastically for the better," says Reyna. "The [national] average for participation in employee wellness programs is 17 to 19%, and ours has been 30%. That's good, but we want 100%."

THR is using its HRA as a tool to identify people with hidden health risks, and get them into the increasingly holistic wellness offerings. One of the changes to the program has been paying in gift cards immediately when a component of the program is completed instead of the end of the year.

This helps with that critical first step of getting employees to actually take the health risk survey. The HRA is one component of the THR program, so employees who complete the survey are rewarded immediately just for doing the health questionnaire.

"[The HRA questionnaire] is a good tool because it identifies those employees and gets them into the programs, so that's why we made it a requirement to earn those credits," Reyna says.

HRA helps address cost drivers

Employers realized some time ago that cost-sharing is one way to save on health care-related costs, but that there is a greater need to address the cost-drivers of health care expenses, including chronic health conditions. Ideally, if a risk is identified, the employee can be motivated to take steps that might result in avoiding the chronic condition completely.

The return on investment from HRAs is $3 in savings for every $1 invested in the appraisals after three years, health care industry observers have said.

Kingsport, TN-based Eastman Chemical Co. has used HRAs administered by Health Fitness Corp. since the early 1990s as part of its health promotion and health risk management program offered through Eastman Integrated Health. Both Eastman and THR were recognized as Best Employers for Healthy Lifestyles by the National Business Group on Health for 2006.

"Health is a real important business issue at Eastman," says David Sensibaugh, director of Eastman's Integrated Health program. "These are not things we're doing just to make employees happy. It goes back to keeping them on the job they were hired to do, and minimizing time off.

"Good health is good business, and that's what we're trying to do."

Lloyd Herlong, Eastman's vendor relationship manager, who oversees the company's relationship with Health Fitness Corporation, says assessments of the health benefits to employees provide an indication of how HRAs help improve health and the company's investment.

"We do consistently see improvement on the back end," says Herlong. An assessment of health risks of employees who participated in the health risk management programs from 2003 through 2005 indicates that, on average, employees entered the program with two health risks, and left with 1.5 — a 25% reduction in risk that Herlong says is statistically significant.

Under a typical HRA program, an employer hires a vendor and pays a per-employee fee to establish an appraisal program, primarily online, though paper versions sometimes are used for employees who don't have access to a computer. Costs range from about $2 to $6 per on-line appraisal, and slightly more for paper-based ones.

Employee feedback a powerful motivator

Reyna says that in focus groups conducted as part of THR's wellness program redesign, employees asked for more feedback. In fact, HRA results are sometimes all a person needs to do an about-face on unhealthy lifestyle practices; so getting those results into employees' hands and helping them understand what they mean takes on added importance.

"We want to simplify the program, identify what the [employee's] issue is, give him or her access to predictive modeling tools, and quickly outreach to people and get them involved," Reyna explains. "We do biometric screenings, and counselors go through the labs with the person and help them understand what they mean and where they should go from here."

The most common finding that surprises many THR employees is news that they are overweight, and the one-on-one counseling informs them how their weight is affecting them now and will continue to impact their health.

Nearly all observers agree that some employees will not answer some questions honestly, but that the design of the surveys and the actual number of people who lie makes that an insignificant factor.

"Our risk assessment used to be paper and pencil, but we went on-line in 2004," says Herlong of Eastman Chemical's risk assessment process. "It does include biometric values that have to be collected, including blood pressure, lipid profiles, height, and weight. They get those through screenings on site or through their personal physicians, and [entering those values is on] an honor system. We don't police it."

Employees get an immediate summary of where they stand, healthwise, and are encouraged to share that information with their personal physicians. The company does not send results to personal physicians. The database is cross-referenced with Eastman's fitness center participation, demographic information, and other components of the integrated health system.

"[The HRA step] is a key part of our program, because we have built and integrated a system of providing wellness benefits to our employees, so all the other parties we work with are integrated with one another and make referrals among themselves," Herlong says.

"We are sure there are tangible benefits. We get incredibly positive feedback from people who have made some lifesaving changes."