While health promotion and wellness programs at the worksite have become increasingly popular as a means of controlling health costs and utilization, so has the demand to build a program that not only works but also provides a return on investment for the employer.
Research and experience tell us that to build a program that works, we have to change employees’ lifestyle behaviors. So how do we begin to change and keep track of employees’ health behaviors?
Employers everywhere have turned to health risk appraisals as a first step. In fact, the health risk appraisal has become the hottest new tool in workplace wellness.
For more than 30 years, health risk appraisals have helped industries and companies of all sizes identify problems or target areas. Whether they are computer based or hand written by the employee, they vary from simple to elaborate in their use.
Employees complete a questionnaire ranging from 15 to 50 questions, with responses to questions about their health habits and histories. Most include questions regarding screening data such as blood pressure, blood sugar, height/weight ratios and lipid levels.
The vendor from whom the tool is purchased scores the answers based on information from actuarial statistics or national data bases; an individual confidential health risk report to employees and an aggregate report to the company is provided.
The data provided alerts individuals to their health risks and, by raising awareness, encourages participation in wellness activities and health promotion programs.
The aggregate data can provide valuable baseline information for future program design, implementation and evaluation. Done on an annual basis the health risk assessment allows employers to track the health of their employee groups and design focused worksite wellness and health promotion activities to help employees with lifestyle changes.
So what are the drawbacks of using health risk appraisals? Will the use of these tools add to the confusion and chaos of consumer health and wellness or will they serve as a valuable resource in jumpstarting a corporate wellness program?
In their most scientific form, health risk appraisals are a form of survey-based technology that provide a description of the odds or likelihood of death occurring within a group of people with certain characteristics.
Most data bases used for the statistical analysis of these tools reflect their use among white, middle class, middle-aged populations. Consideration should be given when applying standard, adult health risk appraisals to the young, elderly, lower socioeconomic status groups or non-white populations. Additionally, most health risk appraisals are only available in English.
A health risk appraisal should not serve as a diagnosis of disease, a medical history or a substitute for a medical exam. Nor is it a health promotion program in itself. Rather, the data should be used to make strategic decisions about what a business needs out of their health promotion efforts.
Choosing the right health risk appraisals
The most critical decision about using a health risk assessment is choosing the right tool for a population.
The length, reading and comprehension level, format and ease of use in the individual report are important considerations. Although the Internet has increased the use of health risk appraisals, a significant percentage of the population either does not have access to computers or are not proficient in their use. The sophistication of the employee group will have impact on the appropriateness of an online or paper assessment.
Health risk appraisals can be purchased, with a price range from $40 to $60 per employee, through local or national vendors. The tool should be quick and relatively inexpensive to implement. Vendors who coordinate the distribution and collection of the tool along with the biomedical screening data offer a plus.
Many organizations find the most challenging part of a health risk appraisal to be getting employees to participate. If only a small percentage, or even half of a population participates, valuable data will be lost – most likely from those with the highest health risks.
Providing cash incentives is one way to get employees involved. Based on the experience of a few local companies, $25 seems to be the right amount.
That is confirmed by Larry Chapman, chairman and senior consultant with Summex Corp., an Indianapolis-based health promotion firm, who says, "You can expect about two-thirds of your population to complete the health risk assessment if you give them a $25 incentive."
Offering cash in tax advantaged forms through flex plans, flexible spending accounts, 401(k) programs, consumer driven health plans, or health insurance premium reduction is also a tremendous incentive to engage employees.
Chapman also suggests making a health risk assessment part of an orientation program for new employees. "This doesn’t require an incentive and results in fairly high participation," he says. "Another way to get fairly high participation involves including the health risk assessment as part of the health benefits enrollment/re-enrollment process."
If implemented properly, the health risk assessment can be an invaluable tool in establishing an organizational culture for healthy lifestyles and health promotion. The key is to identify the right tool for your company.
Connie Roethel, RN, MSH, is president of Complementary Health & Healing Partners (CHHP), a corporate wellness and health promotion services company with offices in Mequon. She can be reached at 262-241-9947.
health risk appraisals
Staywell Health Management Systems Inc.
2700 Blue Water Rd. Suite 850
St. Paul, MN 55121-1400
Wellsource Health Assessment and Prevention Systems
15431 SE 82nd Dr.
PO Box 569
Clackamas, OR 97015
Society of Prospective Medicine
Janet Forester, executive director
341 Ritter Rd. South
Sewickley, PA 15143
P.O. Box 170925
Glendale, WI 63217
9853 North Range Line Road
Mequon, WI 53092
Feb. 20, 2004 Small Business Times, Milwaukee