Health Risk Assessment Participation Research Articles

Generalizability and accuracy of IBM MarketScan health risk assessment instrument data for augmentation of commercial claims data.

We evaluated the generalizability and accuracy of the IBM® MarketScan® Health Risk Assessment (HRA) data to assess its suitability as supplement to linked claims data. We identified adult private insurance enrollees in the IBM® MarketScan® Commercial Claims & Encounters (CC&E) and HRA databases between 2012 and 2017. In the claims data, for each enrollee, we sampled the first calendar year with continuous enrollment indicating full capture of claims data and extracted linked HRA survey data if available. We compared HRA participants and non-participants considering demographics, prevalences of chronic conditions, and healthcare utilization. Including the subsample with HRA data only, we estimated the negative predictive value (NPV) of obesity and smoking reported in the HRA against diagnosis code in the claims data. Between 2012 and 2017, 2 693 444 and 31 450 000 of HRA and non-HRA participants were included in the study, respectively. Chronic diseases were similarly distributed between the two populations, with hypertension and hyperlipidemia representing the highest prevalence difference (1.4%). The two samples showed similar healthcare utilization. The proportion of false-negatives for obesity and smoking information when relying on the HRA data compared to patients with positive diagnosis based on claims data was low (<1%). Prevalence estimates of both variables were similar to national estimates. Our findings suggest that the overall HRA population may represent the overall claims population and HRA provides certain data elements with satisfactory accuracy.

Messaging, monetary incentives, and participation in wellness programs

PurposeMany companies in the USA have corporate wellness programs but are having trouble encouraging employees to take part in these programs. Even with monetary incentives, many employees do not join. The purpose of this paper is to consider whether timely reminders combined with monetary incentives improve participation in health benefit programs.Design/methodology/approachEmployees of a large manufacturing company across multiple facilities were encouraged to enroll in a messaging service. Once a week, members received an SMS or e-mail reminder to complete a Health Risk Assessment (HRA) and Health Action Plan (HAP). The authors segmented employees based on prior year health insurance plan choice and HRA participation to analyze current HRA and HAP completion, with and without intervention.FindingsThe intervention increased completion rates 6 percent for subgroups that completed the HRA in the prior year and 34–37 percent for those that did not.Practical implicationsCorporate wellness programs should develop good communication channels with employees. The effectiveness of such programs will depend also on employee engagement.Originality/valueWith better communication, companies could raise participation in corporate wellness programmes and potentially reduce some of the monetary incentives that they currently offer.

Association of Wage With Employee Participation in Health Assessments and Biometric Screening.

To understand differences in health risk assessment (HRA) and biometric screening participation rates among benefits-enrolled employees in association with wage category. Cross-sectional analysis of employee eligibility file and health benefits (wellness and claims) data. Data from self-insured employers participating in the RightOpt private exchange (Conduent HR Services) during 2014. Active employees from 4 companies continuously enrolled in health insurance for which wage data were available. Measures included HRA and biometric screening participation rates and wage status, with employee age, sex, employer, job tenure, household income, geographic location, and health benefits deductible as a percentage of total wages serving as covariates. Employees were separated into 5 groups based on wage status. Logistic regression analysis incorporated other measures as covariates to adjust for differences between groups, with HRA and biometric screening participation rates determined as binary outcomes. Participation rates for HRA and biometric screening were 90% and 87%, respectively, in the highest wage category, decreasing to 67% and 60%, respectively, among the lowest wage category. Employee wage status is associated with significant differences in HRA and biometric participation rates. Generalizing the results generated by modest participation in these offerings to entire populations may risk misinterpretation of results based on variable participation rates across wage categories.

Determinants of participation in a cardiometabolic health check among underserved groups

Cardiometabolic diseases affect underserved groups disparately. Participation in health checks is also lower, widening health inequalities in society. Two-stage screening (non-invasive health risk assessment (HRA) and GP consultations for high-risk individuals) seems cost-effective, provided that drop-out rates are low in both steps. We aimed to explore the process of decision-making regarding HRA participation among underserved groups (45–70 y): native Dutch with a lower socioeconomic status (SES), Turkish, Moroccan, and Surinamese participants. We conducted a cross-sectional questionnaire study. The questionnaire comprised the following determinants: a self-formulated first reaction, a structured set of predefined determinants, and the most important barrier(s) and facilitator(s) for HRA completion. We used univariable and (stepwise) multivariate logistic regression analyses to assess which determinants were associated with HRA completion. Of the 892 participants in the questionnaire, 78% (n = 696) also completed the HRA. Moroccans and patients from GP practices with a predominantly non-Western population less often completed the HRA. A lower SES score, wanting to know one's risk, not remembering receiving the invitation (thus requiring a phone call), fear of the test result and/or adjusting lifestyle, perceived control of staying healthy, wanting to participate, and perceiving no barriers were associated with completing the HRA. We conclude that our ‘hard-to-reach’ population may not be unwilling to participate in the HRA. A more comprehensive approach, involving key figures within a community informing people about and providing help completing the HRA, would possibly be more suitable. Efforts should be particularly targeted at the less acculturated immigrants with an external locus of control.

Identifying determinants to predict intention to complete a health risk assessment

Purpose – The purpose of this paper is to determine which constructs (factors) will significantly predict and influence the intention to complete a health risk assessment (HRA) in a hospital employee population. Design/methodology/approach – The authors used a cross-sectional design using the theory of planned behavior to design a questionnaire to determine the variables associated with intention to complete an HRA. From a sample of those who completed (n=17) and those who did not complete (n=16) the HRA, the authors used elicitation inquiry to determine the leading factors associated with the intention to complete an HRA. The authors used the responses from this inquiry to develop a questionnaire for a hospital population (n=1,550). A total of 503 hospital employees completed and returned this questionnaire. Using the returned questionnaire data, the authors used logistic regression analysis to determine the best fit model for predicting intention to complete an HRA. Findings – The predictive model was statistically significant at the p &lt; 0.001 level. Discriminant analysis correctly verified the predictive model classified intenders and non-intenders the majority (84 percent) of the time. These study results indicated that perceived behavioral control factors such as having time to complete the HRA, confidence in completing the HRA and trust that the information divulged in the HRA would be kept confidential had the strongest influence (OR=5.39) in predicting participation in taking an HRA. Research limitations/implications – Potential limitations of this study include; response and selection bias, homogeneity for age and sex and generalizability. These results help to identify key behavioral-related factors predicting hospital employee participation to complete an HRA. Practical implications – Administrators of worksite health promotion programs can systematically explore means of addressing identified participation barriers for the purpose of increasing overall HRA participation success beyond financial incentives. Originality/value – The HRA has become a widely accepted assessment tool used to help mitigate the rise in chronic disease. However, HRA completion rates are reported to be low to moderate with very limited research focussed on factors predicting HRA participation.

Response and participation of underserved populations after a three-step invitation strategy for a cardiometabolic health check.

BackgroundEthnic minority and native Dutch groups with a low socioeconomic status (SES) are underrepresented in cardiometabolic health checks, despite being at higher risk. We investigated response and participation rates using three consecutive inexpensive-to-costly culturally adapted invitation steps for a health risk assessment (HRA) and further testing of high-risk individuals during prevention consultations (PC).MethodsA total of 1690 non-Western immigrants and native Dutch with a low SES (35–70 years) from six GP practices were eligible for participation. We used a ‘funnelled’ invitation design comprising three increasingly cost-intensive steps: (1) all patients received a postal invitation; (2) postal non-responders were approached by telephone; (3) final non-responders were approached face-to-face by their GP. The effect of ethnicity, ethnic mix of GP practice, and patient characteristics (gender, age, SES) on response and participation were assessed by means of logistic regression analyses.ResultsOverall response was 70 % (n = 1152), of whom 62 % (n = 712) participated in the HRA. This was primarily accomplished through the postal and telephone invitations. Participants from GP practices in the most deprived neighbourhoods had the lowest response and HRA participation rates. Of the HRA participants, 29 % (n = 207) were considered high-risk, of whom 59 % (n = 123) participated in the PC. PC participation was lowest among native Dutch with a low SES.ConclusionsUnderserved populations can be reached by a low-cost culturally adapted postal approach with a reminder and follow-up telephone calls. The added value of the more expensive face-to-face invitation was negligible. PC participation rates were acceptable. Efforts should be particularly targeted at practices in the most deprived areas.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2139-x) contains supplementary material, which is available to authorized users.

Opportunities for Cancer Prevention Using Employee Wellness Programs

Background: The utility of employee wellness programs (EWPs) in cancer prevention and control is not well established. Purpose: This project is to determine the potential value of EWPs in preventing cancer by examining the characteristics of EWP participants and their prevalence of cancer risk factors. Methods: A secondary data analysis of health risk assessment (HRA) participants' data in the 2009 Kansas state EWP. Results: Among the 60,006 eligible participants, 9,202 (15.3%) completed an HRA. The prevalence of cancer risk factors were 59.7% for family cancer history, 7.7% for smoking, and 69.7% for overweight or obesity. Non-adherence rates in colorectal cancer screening, breast cancer screening, and cervical cancer screening were 28%, 12.2%, and 12.6%, respectively. Discussion: Overall, 94.4% of all HRA participants had at least one cancer risk factor. The majority of HRA participants were at risk for cancer, indicating the potential high impact of EWP-based cancer prevention programs. However, the low HRA participation rate and related self-selection bias of healthy workers severely undermines the utility of EWPs in cancer prevention. Translation to Health Education Practice: More health education and intervention programs should be implemented in employee communities to promote higher HRA participation rates to reduce this bias and realize the full potential impact of EWPs.

Medical Cost Savings for Participants and Nonparticipants in Health Risk Assessments, Lifestyle Management, Disease Management, Depression Management, and Nurseline in a Large Financial Services Corporation

To compare changes in medical costs between participants and nonparticipants in five different health and productivity management (HPM) programs. Quasi-experimental pre/post intervention study. A large financial services corporation. A cohort population of employees enrolled in medical plans (n = 49,723) [corrected]. A comprehensive HPM program, which addressed health risks, acute and chronic conditions, and psychosocial disorders from 2005 to 2007. Incentives were used to encourage health risk assessment participation in years 2 and 3. Program participation and medical claims data were collected for members at the end of each program year to assess the change in total costs from the baseline period. Analysis . Multivariate analyses for participation categories were conducted comparing baseline versus program year cost differences, controlling for demographics. All participation categories yielded a lower cost increase compared to nonparticipation and a positive return on investment (ROI) for years 2 and 3, resulting in a 2.45∶1 ROI for the combined program years. Medical cost savings exceeded program costs in a wide variety of health and productivity management programs by the second year.

Participation in a workplace web-based health risk assessment program

Web-based health risk assessment (HRA) programs can be effective in primary prevention of cardiovascular diseases (CVD). Insight into determinants of participation could improve implementation in the workplace. To evaluate determinants of participation and reasons for non-participation in a web-based HRA offered to 5125 employees at four Dutch financial and information technology services companies. The study consisted of a questionnaire to compare sex, age, self-rated health, smoking, current work ability and sick leave between participants and non-participants in the HRA program, as well as reasons for non-participation. HRA participation rate was 37% (1907/5125) and 14% of the non-participants (423/3102) completed the non-participant questionnaire. There were no differences between participants and non-participants in sex, education level, smoking, and current work ability. Compared with non-participants, participants were older (44 versus 41 years, P < 0.001). Among participants, 85% rated their health as 'good' or 'very good', compared with 78% among non-participants (P < 0.001); 88% of the participants reported fewer than 10 days sickness absence in the previous year, compared with 86% of the non-participants (P < 0.05). Reported reasons for non-participation included lack of time (39%) and not being aware of the opportunity to participate (11%). Evaluation of demographic, health-related, and work-related determinants of participation in a web-based HRA showed differences between participants and non-participants in self-rated health and absenteeism. Implementing a less time-consuming HRA process and providing adequate information to employees prior to inviting them may be necessary to reach larger proportions of employees, including those with less favourable health and work characteristics.

Employee Health and Frequency of Workers' Compensation and Disability Claims

To assess the relationship between self-assessed employee health risk status and future workers' compensation (WC) and short-term disability (STD) claims. A historical cohort study linking Health Risk Assessment (HRA) survey data with subsequent WC and STD claims. HRA participants who developed a WC or STD claim in the subsequent 12 months were identified as cases and compared with HRA participants who did not develop a claim in the subsequent 12 months. High-risk participants had higher odds of filing a WC claim, when compared with low-risk participants (OR: 2.99, 95% CI: 1.22 to 7.32) despite adjustment for demographic factors including job type. Medium-risk participants had 1.5 times higher odds, when compared with low-risk participants to file for STD (OR: 1.45, 95% CI: 1.15 to 1.82). Other relationships trended similarly but did not reach statistical significance. Self-assessed personal health risk does impact future lost productivity in WC and STD claims even after adjustment for demographic, health factors, and job type (WC only). Employers wishing to reduce the impact of lost productivity should consider a worker's personal health risks as predictors of future lost productivity and may want to address this in broad risk reduction programs.

The Role of Incentive Design, Incentive Value, Communications Strategy, and Worksite Culture on Health Risk Assessment Participation

To examine the impact of financial incentives, communications strategy, and worksite culture on health risk assessment (HRA) participation rates. A cross-sectional study design was used to examine factors that influence employee participation, including incentive value, incentive design, communications strategy, and worksite culture. Large private-sector and public-sector employers. Thirty-six employers (n = 559,988 employees) that provided financial incentives to promote employee HRA participation. Organizations implemented the HRA as part of a more comprehensive worksite health promotion strategy that included follow-up interventions and a variety of other components. The primary outcome of interest was employee HRA participation. Information on program design and structure, as well as on HRA eligibility and participation, was collected for each organization via standard client report and semistructured interviews with account managers. General linear regression models were used to examine the extent to which factors influence HRA participation independently and when controlled for other factors. Incentive value (r2 = .433; p < .000), benefits-integrated incentive design (r2 = .184; p = .009), culture (r2 = .113; p = .045), and communications strategy (r = .300; p = .001) had positive bivariate associations with HRA participation rates. When all factors were included in the model, incentive value (p = .001) and communications strategy (p = .023) were significantly associated with HRA participation. Variance accounted for by all factors combined was R12 = .584. This study suggests that incentive value, incentive type, supportive worksite culture, and comprehensive communications strategy may all play a role in increasing HRA participation.

The relationship between health promotion program participation and medical costs: a dose response.

The purpose of this research was to determine whether participation in the health risk assessment (HRA) component of a comprehensive health promotion program has an impact on medical costs, and whether the addition of participation in interventions has an incremental impact. Program participants (n = 13,048) were compared with nonparticipants (n = 13,363) to determine program impact on paid medical costs. Overall, HRA participants cost an average of $212 less than eligible nonparticipants. As HRA participation increased, cost savings also increased. Additionally, although participation in either an HRA or activities alone resulted in savings, participation in both yielded even greater benefits. The findings indicate that there is an independent benefit of each of these elements of participation, and that the sum of the elements provides a greater benefit than the impact of either of the individual elements alone.