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Health Risk Appraisals Address Employees’ Individual Problems

The programs aim to instill healthy habits. Some observers feel that the return on investment is $3 to every $1 invested after three years.

November 12, 2004
Related Topics: Health and Wellness, Compensation

More large employers are expected to ask employees to answer health-related questions as part of an appraisal process that can help gather useful baseline information as well as motivate employees to improve their health.

    "Ideally, the health-risk appraisal is the gateway to behavior change," says Cathy Tripp, the Minneapolis-based national practice leader for health and welfare technology for employee benefit consultant Watson Wyatt Worldwide.

    Generally, the goal of such programs is to identify employees' individual health-care needs, such as smoking cessation or obesity treatment, and steer them into programs that are tailored to their needs, interests and their willingness to participate, according to employers, consultants and vendors.

    "Senior management has begun to realize that cost sharing with employees can only take a company so far. They also need to address cost drivers" such as diabetes, obesity and smoking, says Helen Darling, president of the Washington-based National Business Group on Health.

    "Health-risk appraisals can be a very important baseline" for the individual, as well as a benchmarking tool for employers, she says. Employer benchmarking is based only on unidentifiable aggregated data, however, due to the statutory privacy protections for personally identifiable health information.

    "We've seen a real fundamental shift in the level of interest among employers from a wellness focus to health-risk appraisals as a strategic component to an overall health-care strategy," says David R. Anderson, vice president of program strategy and development at vendor StayWell Health Management in St. Paul, Minnesota, a division of Yardley, Pennsylvania-based StayWell Co.

    "If you manage the risks, you manage the costs," says Andrew Scibelli, manager of health-management programs for Florida Power & Light Co. in Juno Beach, Fla. The utility uses health-risk appraisals as part of its integrated health management for its 11,500 full-time employees.

    The return on investment from health-risk appraisals is $3 in savings for every $1 invested in the appraisals after three years, several observers say.

    Under a typical program, an employer hires a vendor and pays a per-employee fee to establish an appraisal program, primarily online, though paper versions are used for employees who lack computer access, says Kevin Wildenhaus, director of behavioral sciences for HealthMedia Inc. in Ann Arbor, Michigan.

    Costs range from about $2 to $6 for an online appraisal, while a paper-based one may cost $12 to $15, depending on several factors, including the sophistication of reports and the degree to which they are customized for an employer, says Stephanie Pronk, a senior consultant with Watson Wyatt and its Minneapolis-based national practice leader for health management.

    Nearly all vendors contacted declined to discuss program costs, although one did indicate that the total annual cost of such a program could be $40 to $100 per employee, depending on the services rendered.

    An employee participates in the appraisal by answering a list of questions about the condition of his or her health, typically at either the Web site of the employer or the vendor.

    The medically oriented questions are primarily designed to identify individuals with seven to 13 specific health-risk factors, Pronk says. Depending on the program, these can include smoking, asthma, depression, diabetes or obesity, vendors say.

    Some vendors' programs also ask employees about hobbies and interests. So, for example, an overweight man who enjoys bicycling may be encouraged to ride more frequently.

    An employee's responses are then evaluated, and he or she is given a health-condition status report. If the employee has a risk factor, such as for hypertension, he or she is then given information to learn about the problem and is often encouraged to participate in company-sponsored programs such as regular blood pressure screenings.

    While nearly all observers agree that some employees will lie in answering the questions, they believe the number is insignificant and not a serious concern. For example, men tend to overestimate their height and women tend to underestimate their weight, Pronk says.

    Some vendors offer more tailored services or address special needs.

    For example, WebMD Health, a division of Elmwood Park, New Jersey-based WebMD Corp., creates a personal home page for each employee that contains his or her appraisal results and has fields for an employee's personal medical information, says Craig Froude, senior vice president of the New York-based division. The results are also integrated with the employer's own benefit package, which may allow for specific offerings, such as medical discounts for specific types of prescriptions, he says.

    "It's pretty cool," says Florida Power & Light’s Scibelli, whose company uses that option.

    Blue Cross & Blue Shield of Minnesota recently launched a health-risk appraisal program that is structured to encourage employee participation, says Dawn Zerneke, market segment manager for the St. Paul-based company. In addition, the health program is "truly integrated" with other company programs, including disease management and prenatal care, she says.

    HealthMedia's program "is more employee-focused than traditional programs," Wildenhaus says. Information delivery is "individually crafted" by considering an employee's levels of confidence and motivation, so that suggestions for improvement seem possible and not overwhelming, he says.

    Such an approach might mean encouraging an overweight clerk with a low motivation level to take an extra 1,000 steps a day rather than join a lunchtime healthy eaters' group that might be too stressful.

    In addition, Aetna Inc. recently began offering an online screening program to help employees identify and cope with depression, says Dr. Hyong Yn, national medical director for behavioral health in Blue Bell, Pennsylvania. A free version of the program is available as a public service at

    The site addresses depression in various ways, including a questionnaire, library and online coaching. For example, the site uses cartoon characters in various situations, like an overwhelmed career woman, to let a viewer choose the character with whom he or she most identifies. The viewer then follows a sequence of questions designed to elicit the nature and depth of the viewer's feelings.

    That screening tool can be linked with other Aetna programs, including depression disease management, Yn says.

    While health-risk analyses are designed to provide targeted help to employees, getting them to participate in the initial screening and in subsequent follow-up programs can be a challenge for some employers.

    Employers and vendors say they used a variety of incentives, which are tailored to the workforce. While some work sites give away hats, T-shirts and gift certificates, others prefer a lottery for tickets to concerts or sporting events, a vacation or just a day off, they say.

    Several employers have found that reducing an employee's share of his or her premium contribution can also provide an incentive to participate, according to consultants and vendors.

From the November 8 issue of  Business Insurance. Written by Meg Fletcher.

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