New-Look Health Risk Assessments Employ a Social Strategy

By Rebecca Vesely

Feb. 20, 2013

The health risk assessment—that ubiquitous tool to gauge employee health—is getting a makeover.

And with this revamp in HRAs comes a new opportunity for employers to engage with workers to improve their health, experts say.

“We are trying not to use the [term] HRA anymore,” says Brian Dolan, chief customer solutions officer at Audax Health, a Washington, D.C.-based health technology company.

Instead, Audax Health is merging the assessment with social networking, mobile technology, games and behavioral psychology to build an interactive experience with individuals self-reporting on their health.

The strategy grabbed the attention of one major payer. In January, Audax Health signed a five-year agreement with insurance giant Cigna Corp. to roll out its platform to all 12 million Cigna customers, most of whom are in employer-sponsored health plans. Cigna’s global chief information officer also joined Audax Health’s board of directors. The Bloomfield, Connecticut-based insurer also made an undisclosed investment in the firm.

“A challenge we face in the industry is not everyone wants to engage by telephone, and continual engagement is difficult to do,” says Eric Herbek, vice president of product solutions at Cigna. “We think there is a real opportunity in digital health.”

Health risk assessments have been around for decades. Employees annually fill out a standard form on their health status, typically during open enrollment. The employer uses the HRAs to identify individuals at risk for certain health conditions and approach them with interventions.

“They’ve become more personalized over the past 10 to 15 years, but they are still limited to answering certain questions,” Dolan says.

Audax Health’s answer, called Zensey, is a Health Insurance Portability and Accountability Act-compliant online product that includes an HRA but combines it with a social network, medical experts, personalized recommendations and content, goals, challenges and rewards.

In its partnership with Cigna, Audax Health is taking the HRA Cigna currently uses for its members, developed by the University of Michigan, and putting it on the Zensey interactive platform.

“We take the questions and turn them into a graphical, nonthreatening and hopefully fun experience,” Dolan says.

For instance, a woman who identifies herself on the HRA questionnaire as a new mother would immediately have an opportunity to connect with other first-time parents and get help with specific issues.

Other HRA providers are also making their products more interactive and user-friendly, experts say.

“By itself, the HRA doesn’t cause people to change behavior,” says Ron Goetzel, director of the Institute for Health and Productivity Research at Emory University and vice president of consulting and applied research at Thomson Reuters. “It is a cornerstone to other programs to help you change your behavior.”

Goetzel says HRAs have evolved, and there are several dozen large companies competing in the space. “Nowadays, a lot of them have become more interactive, more graphical, more interesting and more engaging,” he says.

Cigna chose to partner with Audax Health in large part because of the online community offerings. The digital communities aren’t limited by payer group or employer but will include all individuals using the product. Anonymous IDs keep the system HIPAA-compliant. However, employers can set up rewards programs linked to communities that are only visible to their workers.

“We thought that was a very different approach than what we have seen in the industry previously,” Cigna’s Herbek says.

Audax also is developing a “people finder” tool that will allow those with similar health conditions or circumstances to connect with others, Dolan says. He offered the example of an asthmatic who lives with cats. That person might want to talk with others about strategies used to control their asthma in that sort of environment.

Dolan says Zensey is already showing results. In a pilot that began in January 2012 of a Medicaid population using the Zensey product, some 60 percent who self-identified with chronic conditions said they were not currently receiving treatment. And half of those on medications said they were not compliant with their prescriptions. Two-thirds said they would value connecting with people with similar health conditions, according to Audax Health.

Dolan says the results show that there is ample opportunity to intervene and engage with people on their health.

“For most people, the challenge around health is that it is too complex,” he says. “We want to simplify it for people.”

Rebecca Vesely is a writer based in San Francisco. Comment below or email

Rebecca Vesely is a writer based in San Francisco.

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