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Survey looks at impact of health risk assessments

The study found that 17% of employees taking an HRA discuss the results with a doctor.

By Pamela Lewis Dolan — Posted Oct. 6, 2008

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If employers have their say, your patients soon may become more interested in their health, turning to you for everything from stress management to healthy eating habits.

More than 83% of the nation's employers currently use health risk assessments to make employees aware of health risks as a way to encourage more prevention. A study released in July by Forrester Research Inc. showed signs that the assessments might have an effect on patient behavior, but the study's author says there's still a way to go before they have a measurable impact on health care costs.

The study, "What Consumers Do With Health Risk Assessments," found that 17% of employees who take the HRAs usually discuss the results with a physician and that 8% enroll in some type of structured wellness program designed to address a specific risk. The survey of 5,036 commercially insured people was conducted in October 2007.

Some experts say those percentages are good, given that more than two-thirds of the population is generally healthy. But study author Elizabeth Boehm, principal analyst in the Customer Experience for Healthcare & Life Sciences division of Forrester, said it could be better because "just about everyone has some behavior they could improve."

"The biggest issue is certainly the catastrophic health care costs, especially if you are large and self-insured," Boehm said. "But [employers] are also looking at issues such as productivity and absenteeism, and those are [affected] by fairly minor healthy behaviors like getting enough sleep or eating better."

Steve Arnoff, a researcher with business and benefits consultancy group Watson Wyatt, said that in the first year of an HRA program he would consider 10% taking action a great number, so he was encouraged by the fact that 17% were at least talking to their physicians.

Helen Darling, president of the National Business Group on Health, agrees and said she hopes HRAs will be a catalyst for discussions between physicians and patients, since many patients don't believe a danger exists unless the physician specifically addresses it.

Sometimes overweight people go to a doctor for an illness related to obesity, Darling said, but the doctor addresses only the specific disease and not the weight issue. The patients leave and never think they are dangerously obese, because if they were, the doctor would have said something, she said.

Arnoff said that's why it's key for physicians to get involved in the HRA process. He said physicians should ask patients if their employers do HRAs and, if so, to bring them to appointments.

The Forrester study found that 21% of employees don't know how to use the HRA results, and 16% don't understand them.

"HRAs are a very powerful way to educate the person, but that next step is for that person to talk to their doctor," Arnoff said.

As more employers adopt personal health records for their employees, it will make life easier for physicians, Arnoff said.

Ideally, he added, the HRA results will be placed in the PHR, which the doctor can access.

The American Medical Association supports the use of HRAs. It has policy encouraging health plans to offer HRAs and develop programs that encourage follow-up with physicians.

Boehm said employer incentives also could play a role in whether employees take the steps recommended by either the HRA or their physician. Studies have found a clear correlation between incentives and action.

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ADDITIONAL INFORMATION

Assessment follow-up

People who answered a Forrester Research study were asked how often they participated in follow-up activities after completing a health risk assessment.

Usually Occasionally Never
Read or file HRA with no further activity 33% 44% 23%
Look up additional information on a condition or medication 21% 46% 33%
Discuss HRA results with physician 17% 43% 41%
Enroll in a program (weight loss, smoking cessation, etc.) 8% 35% 57%

Note: Due to rounding, percentages may not equal 100.

Source: "What Consumers Do with Health Risk Assessments," Forrester Research, July

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Confusing results

Participants in a study on health risk assessments were asked about the level of understanding they gained from the HRA.

Statement Percent who agree
HRAs have helped me become more informed about my health 45%
HRAs provide me with useful information to discuss with my physician 41%
I often don't know how I should use HRA results 21%
HRA results are often difficult to understand 16%

Note: Respondents could give more than one answer.

Source: "What Consumers Do with Health Risk Assessments," Forrester Research, July.

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Incentives prompt action

Studies have found a direct correlation between incentives and participation in health risk assessments. According to a 2008 joint study between Watson Wyatt and the National Business Group on Health, companies with a higher enrollment in consumer-driven health plans are more likely to offer incentives.

CDHP enrollment
Incentive more than 20% less than 20% No CDHP
Financial reward to manage health risk levels 33% 24% 17%
Financial reward to participate in health improvement or disease management programs 60% 46% 35%
100% coverage of preventive services 70% 61% 41%
Integration of health care and time-off programs 20% 17% 13%
Onsite health care 37% 34% 25%
Health coach 71% 69% 52%
Integration of health care and health management programs 77% 79% 64%

Source: "The One Percent Strategy: Lessons Learned from Best Performers," Watson Wyatt and National Business Group on Health, 2008. The survey of 453 U.S. employers was conducted between November 2007 and January 2008 and reflect 2007 and 2008 health plan decisions. (link)

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