Dr. Rajeshree 'Gina' Parekh
Practice Leader, Health & Benefits, Asia Pacific

Wellness programs have arrived in Asia. Though their progress trails behind the US and parts of Europe and the motivation for introducing such programs may be different, their place in the overall benefits environment is firmly secure. Employers, as purchasers of healthcare for their employees, have increasingly embraced disease prevention - in the form of programs aimed at reducing obesity, smoking, and other lifestyle risk factors - as a means of improving health and reducing medical costs.

This paradigm shift from treatment management to prevention underscores the important roles early identification and engagement play in the care management continuum. This shift toward prevention means that purchasers require even more effective tools to identify member's health risks before they culminate in medical events and claims. Thus, the need for a Health Risk Assessment (sometimes also referred to as a Health Risk Appraisal) has become increasingly critical.

What is Health Risk Assessment? 

A Health Risk Assessment (HRA) is a scientific tool designed to measure all the important factors that are known to affect current health as well as the risk of future illness. Even more importantly, it assists in identifying opportunities for lifestyle change to improve health and well-being.

Health Risk Assessments are not to be confused with health screening, annual health checkups, or biometric screening, which are not a new concept in Asia. Certainly data derived from health exams can also assist in the early detection of illnesses. However, these exams are limited in their use since they cannot predict the impact of poor lifestyle choices and behaviors on the risk of future illnesses. HRAs incorporate clinical test results into their evaluation criteria, but also solicit responses to an individual's lifestyle, such as data on nutrition, height, weight, exercise routine, family history, work history, stress perceptions and tobacco use history.

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The value of HRA  

HRAs facilitate a better understanding of the health status of their population by:

• informing individuals of their health risks and behaviors that increase the risk of disease.
• encouraging positive lifestyle change for the individual.
• engaging employees in an organization's wellness initiative.
• helping health professionals to identify high-risk individuals.
• providing a snapshot of an organization's health status.
• acting as leverage or a justification for the introduction of a wellness program.
• producing comparative data that can be measured over time.
• contributing to a meaningful analysis of productivity and return on investment (ROI).

In contrast to the US, where over 72% of employers provide HRAs; its use in Asia is mainly restricted to multinational companies. The reason for this low penetration may be due to a variety of factors, such as lack of awareness, language issues, and availability of suitable vendors. Aon Consulting has been offering on-line Health Risk Assessment for its clients through its wellness portal MyAonAssist for the past two years. Current participation rates range from 1-15%. 

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Implementing an HRA

Initiating an HRA involves a number of steps. Successful implementation is best achieved by planning carefully and establishing realistic timelines. For example, planning should be undertaken at least 12-15 weeks in advance of the desired launch date. HRA implementation needs to incorporate the steps outlined below:

1. Vendor selection

This is a critical first step toward the success of your HRA program. Presented below is a checklist to assist in vendor selection:

2. Branding and communication

Without question and without exception, the success of an HRA initiative will depend on your communication strategy. Communication must start early and continue often.

Communicating a wellness program effectively takes time, planning, effort, and needs corporate commitment to the long-term. Since the HRA is usually the first step to initiating a wellness program, consider this as a "grand launch". Internal branding of the initiative will help create interest and "buzz".

3. Participation

A successful HRA launch plan must have a defined audience. Should it be the entire employee population or only a sample? Should it start with employees and then include dependents or should it be open to all? Conventional wisdom is to include dependents, but they can be phased in gradually.

It is generally agreed that if 80% of a group participates in Health Risk Assessment, the data becomes valuable in identifying health promotion strategies. However, even a 20-40% participation rate can result in medical savings. The biggest challenge often lies in getting employees to participate. Incentives are important elements in the HRA process as they provide some necessary momentum in increasing participation. Incentives can be positive (e.g., gifts, cash, or premium reductions) or negative (e.g., a requirement for increased co-payments for medical care or reduced credits transferred into an employee's Healthcare Flexible Spending Account).

4. Manage behind the scenes logistics

HRAs can be administered in paper or electronic format. While the latter is preferred, the decision will be based on whether all participants have access to the internet. Your vendor can provide a checklist of administrative processes that an employer needs to follow (e.g., eligibility file, IT firewall issues, user guide, FAQs and trouble shooting). 

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Sample HRA

The HRA consists of a list of questions that cover health and well-being issues that are pertinent to both personal and business performance. The answers to the questions provide specific scores for 10 to 13 key health and well-being drivers, which in turn are weighted and amalgamated to provide an overall health status score. The key health and well-being drivers that underpin these questions are:

Based on the overall scores, participants are stratified into level of health risk.

An example of the result is given below:

The HRA takes no longer than 15-20 minutes to complete. An important point to remember and emphasize is that the results will depend on how accurately and completely participants answer each question. The personal bias in self-reporting adverse data needs to be eliminated through clear communications. All anxiety related to "discrimination over health risk" needs to be alleviated. 

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Outcomes of HRA

Personal Report –The report should include a profile of individual risk level for personal conditions or diseases according to age, gender, ethnicity and risk factors that were identified in the questionnaire. The report should clearly identify choices and behaviors that can lower the risk for each risk factor and recommend targets for improvements. The HRA report should also include references to resources that can help the member understand the Health Risk Assessment (HRA) results and assist the member in shifting to a healthier lifestyle.

Physician Summary – a one-page summary of risk factors for a participant to give to their physician.

Group Summary – provides graphical representation for nearly every risk factor, allowing you to easily view the prominent risk factors in your organization.

Trend Report – illustrates the impact of wellness efforts by showing changes and improvements from previous testing periods. 

Conclusion

Educated use of an HRA and a strong focus on health and wellness among employees can transform the wellness culture in a company -- not just physical wellness, but also mental and emotional well-being. The key lies in shifting our perspective of preventative health in the workplace from a cost center to an investment center. Successfully implemented HRAs possess the power to infuse renewed energy, creativity, higher productivity and savings in the workplace! 

Contact

For more information on HRA or health & benefits, please contact Dr. Rajeshree 'Gina' Parekh, Practice Leader, Health & Benefits, Asia Pacific at rajeshree_parekh@aon-asia.com. 

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