On March 22, 2011, the Centers for Medicare and Medicaid Services (CMS) released "Interim Guidance for Health Risk Assessments." The guidance was submitted to CMS by the Centers for Disease Control and Prevention (CDC) and was developed from the report, "Guidance on Development of Health Risk Assessment as Part of the Annual Wellness Visit for Medicare Beneficiaries – (Section 4103 of The Patient Protection and Affordable Care Act)."
The CDC's guidance report emphasized that for HRAs to be successful in having a positive impact on employee health behaviors, they need to be implemented as part of a comprehensive wellness program and not as a stand-alone tool.
In essence, an HRA sets the foundation for your wellness program, but your program's ultimate success depends on adopting an "HRA Plus" approach to wellness. According to the CDC, this means using the HRA as a "gateway" to health improvement programs that follow up the health assessment and engage people in making needed lifestyle changes.
For maximum effectiveness, the CDC recommends that all wellness programs include:
- Multiple administrations of an HRA over time
- A participant feedback report that can serve as a personal prevention plan
- Ongoing health education programs provided through printed materials, videos, and interactive computer programs
- Motivational interviewing, counseling, and coaching (provided face-to-face or telephonically) to support behavior change and risk reduction
- Referrals to community resources, such as fitness facilities, self-help support groups, or neighborhood volunteer programs
- Referrals to local or national health promotion programs and services, such as smoking quit lines
When used in this way, HRAs are proven to be highly effective tools.
In preparation for publishing the above guidance, a task force led by Dr. Robin Soler was engaged by the CDC to conduct a systematic review of 51 studies of health promotion programs introduced by employers over the course of the past 30 years. The task force concluded that "HRA Plus programs, judged to be comprehensive, well resourced, and theory-based, do exert a positive influence on certain health behaviors, biometric measures, and financial outcomes important to employers." There was "strong" evidence HRA Plus programs can reduce rates of tobacco use, dietary fat consumption, seat belt nonuse, high blood pressure, total cholesterol levels, high-risk drinking, and worker absenteeism. The reviews also found improvements in participants' physical activity, overall health and well-being scores, and healthcare use, especially in terms of reduced hospital admissions and hospital days of care.
The CDC recognizes that HRAs play an important role in raising awareness of health issues and motivating behavior change by creating a "teachable moment" that inspires health improvement. Wellsource can help you develop your HRA Plus program through products such as our WellSuite® Portal – a dynamic, integrated online wellness portal.