When they were first introduced in the 1980s, health risk assessments (HRAs) were positioned as an effective tool to educate and drive behavioural change among employees. They would achieve this by identifying the health risk factors prevalent in an organization’s employee population, gauging the willingness or readiness of participants to change and providing participants with a risk profile, a health score and appropriate health information.

However, while employers saw initial employee interest and participation in HRAs—especially if incentives were provided—many later discovered that the degree and sustainability of the impact were limited. Also, the expectation that follow-up assessments could “prove” that employee behaviour had changed and that benefit cost savings would be realized largely hasn’t materialized. As a result, many Canadian employers became disenchanted with the value of traditional HRAs in driving behavioural change.

HRAs can serve as a diagnostic tool of key indicators of health. But integrated data architecture—which can identify cause and effect such as behavioural changes resulting in modified claims use patterns—is limited in Canada. Furthermore, as a stand-alone tool, the impact of HRAs is also arguably limited.

The question, then, is how can we best design and integrate HRAs within a broader set of health management strategies, driven by fact-based diagnostics and actionable insights?

The new age of HRAs
Questions in traditional HRAs largely focused on trying to determine what’s “wrong” with participants, prompting them for information related to weight, lifestyle and biometric markers such as blood pressure and cholesterol. Consequently, upon completing an HRA, many participants didn’t walk away with the sense that their employer really cared about their health.

Research has shown that there is a clear link between modifiable behaviours and health risks. According to Health Canada, for example, of the more than 230,000 deaths annually in Canada, in 2002, approximately 17% were due to smoking. Behaviour, in turn, is driven by what employees do or don’t care about—and the ability of employers to strategically communicate and motivate based on these insights.

Today, HRAs place more focus on questions that better determine what employees actually care about when it comes to their health. For example, an HRA can help gauge if employees even value their employer becoming more involved in their health, and, if so, the nature of employees’ health interests and needs. The result is valuable “humanistic insights” that employers can strategically incorporate into their group benefits plan design, member education and wellness programs so that employees at all risk levels will value these initiatives. Ultimately, this means increased success of long-term risk management strategies.

In addition, much of the information that HRAs were traditionally intended to provide can now be obtained through other means. For example, increased sophistication in integrated claims analysis allows for efficient identification of disease and behaviour patterns—in turn, allowing modern HRAs to help manage those risk factors by providing supplemental self-reported risk factor insights and health information to participants.

Like many innovations, HRAs emerged as a tool of great promise, only to be viewed later with increasing disappointment when the desired results weren’t achieved. But with the benefit of experience, a greater understanding of how to use them more effectively and a new breed of design, HRAs are re-emerging as a powerful tool in a plan sponsor’s health management strategy.

Martin Chung is assistant vice-president, strategic health management, with Equitable Life of Canada. mchung@equitable.ca

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Copyright © 2019 Transcontinental Media G.P. This article first appeared in Benefits Canada.

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