Health risk assessments have become the new entry point for health and wellness strategies
For decades, group insurers have used a form of health risk assessment (HRA)—the underwriting questionnaire, a confidential survey to identify an person’s predispositions to future health problems—to consider an individual’s eligibility for excess or optional amounts of insurance coverage, or a late applicant’s request to join a benefits plan. Even Independent Medical Examiner and Medical Information Bureau reports could be considered a form of advanced HRA, assessing an individual’s past medical events and present lifestyle circumstances.
But today’s HRAs go even further, determining an individual’s susceptibility to future health issues and then communicating that information back to them. They’re now accessible directly by employees and their families in a secure, transparent way, usually using technology.
For example, the eventual outcome of the underwriting questionnaire is to either accept or decline insurance coverage, with the objective of assessing and managing the insurer’s risk. Recently, however, some insurers have begun to provide feedback when they make their decision to help individuals—and, by extension, their employers—address potential health issues.
This new generation of HRAs is really the starting point for an individual’s journey to well-being, as well as the entry point to an employer’s health and wellness strategy, contributing to a healthier, more productive company.
Within most employee groups, there’s a continuum of individual health levels— from healthy, engaged and productive employees to employees who are currently disabled and unable to perform their usual duties. Within this range, there will be some employees who are predisposed to health problems that haven’t yet manifested, and some with diagnosed health issues that are being managed with varying degrees of success.
Healthy employees today may have a potential health hazard looming. Or, those receiving income replacement for an illness or disability may have a secondary condition that could emerge in the future and exacerbate their current situation. So, every employee should have the opportunity to complete an HRA and should be encouraged to participate.
Return on Investment
The HRA doesn’t produce any benefits plan cost reductions or efficiency gains on its own, but it’s the first step in that direction.
Employers will earn some goodwill from employees for sponsoring the HRA process and demonstrating interest in their employees’ well-being. However, the tangible return on investment (ROI) is a byproduct of the followup actions and, ultimately, the favourable effects of lifestyle changes (e.g., diet, exercise, sleep, stress reduction) as employees work to improve their own risk profiles.
This enhances the aggregate health of the workforce and can contribute directly to employee productivity. It may also help insulate the company’s health plan costs from future inflationary trends—which, if left unchecked, will undoubtedly creep back into double digits.
One HRA provider estimates that, for every $1 spent on a wellness strategy, the ROI could be $3, based on reduced absenteeism costs or reduced medical costs. While these savings are unlikely to be realized exactly as advertised, depending on the company’s baseline health and its level of commitment to a comprehensive health and wellness strategy, an HRA is still worth implementing.
The ROI may not be realized until months—or even years—after the HRA’s initial implementation, so expect some reasonable amortization of savings. Also, some savings could conceivably evaporate if employees who are engaged in the wellness initiative and have contributed to the cost reductions leave the company.
Implementation Considerations
What should an employer do before implementing an HRA?
First and foremost, guarantee each individual employee’s anonymity and confidentiality. Employees may be sensitive about sharing personal information, such as their medical details, with their employer. Group-level results and analysis may help employers offer remedial support for employees in aggregate. For example, it could identify trends pointing to localized issues, such as organizational (e.g., unhealthy corporate culture) or environmental (e.g., ergonomic deficiencies) problems.
To increase the credibility of aggregate findings, employers need to maximize employee participation. Higher involvement levels mean greater value for the greatest number of employees and will also ensure the most meaningful results. These results will present opportunities for corrective actions, with benefits for both the employees and the employer. There’s limited value if only the very healthy employees participate—and even less value if only a handful of assessments are completed.
A high level of participation will also alleviate employees’ concerns about anonymity and confidentiality because there is inherently some comfort, or perceived safety, in large numbers. Also, without a certain number of respondents, the HRA vendor may not be able to provide feedback based on the employer’s own population and may be required to supplement the data with results from similar organizations.
Employers can provide incentives to increase participation, including cash payments, additional flex credits, health-related merchandise, such as pedometers, or random gift draws.
Talking Points
Another key to a successful HRA is a thoughtful communication campaign aligned with the company’s culture and objectives. Opinions vary on what a successful campaign looks like, but there are a few common traits of HRA rollouts that contribute to successful levels of participation: executive sponsorship, clarity on employee incentives, acknowledgement that an HRA will also benefit the company and use of technology to simplify the process (see “4 Key Communication Tips,” above).
After the HRA is completed, employees must be able to navigate and consider a range of resources supporting the development of a personalized action plan to change the behaviours that may be increasing their health risks (e.g., inactivity, unhealthy diet). At the same time, they must be encouraged to continue the positive behaviours identified.
The online resources available to employees are critical to the success of the overall assessment, education and change process. Employees have easy access to a wide range of online resources and health libraries available today. These resources are endorsed and promoted by the employer but are generally accessible through a vendor’s secure website.
Finally, make sure the HRA provider embraces a complete wellness strategy, including an HRA, for its own workforce.
HRA 3.0
What will future generations of HRAs look like? Perhaps they’ll be able to correlate HRA results with actual claims usage data interactively, modelling the potentially favourable impact on an individual’s own benefits costs if he or she improves health. Or perhaps they’ll allow for optimistic but thoughtful selection of a plan option that has a lower price tag, with the opportunity to divert credits or contributions elsewhere within an employee’s broader financial plan.
Some experts suggest making genetic testing available to HRA respondents to help them assess their health risks. Given the newness of this idea in Canada—and the sensitivities around communicating genetic test results—it will be some time before providers, employers and employees are comfortable including genetic testing in any grouplevel initiative. But, even without it, HRAs are a critical first step toward individual and organizational health.
Rick Holinshead is a member of the Benefits Canada advisory board.
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