Taking Health-Risk Assessments to the Next Level

The statistics are dizzying. The vast majority of health costs are generated by a very small number of employees. NCR, for example, reports that 10 percent of its employees drive 75 percent of the firm’s health costs, numbers that are typical of many companies.

    To deal with soaring health costs in new ways, the global technology company recently introduced a health-risk assessment, high-tech tools that help companies improve employee health on the basis of answers to voluntary health questionnaires. In the past three years, industry experts say, the number of employers making use of HRAs has been swiftly rising. Thirty years ago, employers assessed the health of their workers by looking at death rates. In the 1980s, they began asking questions about weight, smoking, nutrition and personal safety. Data was collected, but no one offered a way to change what seemed inevitable, given family histories of chronic deadly diseases and other health problems such as asthma attacks or obesity.

    In the mid-1990s, employees began receiving suggestions for improving their health based on HRAs, and new technology has since transformed the assessments to higher levels. Health surveys are now administered online and are usually handled by a third party to preserve privacy. Results are immediate. Employees identified as being predisposed to chronic diseases are given a concrete plan to head them off.

    Last fall during 2003 open enrollment, NCR began offering an HRA tool, CareSteps, which is owned by American Healthways, Inc., in Nashville. The program is administered and customized by Intracorp, a wholly owned subsidiary of Cigna. NCR, located in Dayton, Ohio, has about 11,000 employees in the United States in four major locations, and about 4,000 retirees still using its health-care coverage. Mike Kriner, director of compensation and benefits, says that annual health-care costs are about $72 million for active employees and another $40 million for retirees.

    CareSteps software is “smart software”–the more HRA questions an employee answers, the more specific subsequent questions become. “It’s decision-tree based,” says Lynne Harsha, senior product manager for health facilitation at Intracorp in Philadelphia. “For example, if I’m a 42-year-old female who smokes, I won’t get questions about my prostate. The software accounts for risk factors and current behavior,” Harsha says. “If I’m extremely fair-skinned, have red hair and light eyes, and answer that I wear 50 sunblock, it would ask me if I wear sunglasses.”

    In the past, HRA results included general statements about health such as “you should stop smoking” and ended there. Now, the HRA outlines a plan. For example, Wellsource, a company in Portland, Oregon, that offers clients a suite of tools for health assessment and management, gathers information from HRAs and prepares personal reports that flag individual health risks and suggest a course of action. Similarly, CareSteps makes recommendations for achieving better health that include specific instructions and hyperlinks.

    “If you’re a smoker, it would say that on your behalf, NCR has provided you with access to this smoking-cessation program. It may give a link to a Web site to enroll or a phone number,” Harsha says. Intracorp’s job is to follow up and make sure employees get to the disease-management programs. It uses more than 2,500 nurses for all aspects of medical management.

    Results at NCR after one year haven’t been overwhelming, but Kriner is still pleased. Ten percent of employees completed the HRA and the program, and 23 people were identified as high-risk and referred to disease-management programs. Thirty-one people referred themselves to company fitness centers. NCR declined to reveal the cost-per-employee for the HRA but says company analysis shows a saving of $2 to $3 in the long run for every dollar it spends on HRAs. Although costs are expected to increase initially because of referrals to disease-management programs, Kriner estimates that the company saved $23,000–about $1,000 per high-risk employee–which more than paid for implementation. “If we help someone avoid a middle-of-the-night asthma attack or a diabetes problem, in the long term we’ll have more productive employees and fewer hospital visits,” he says.

    Participation in HRAs is often accompanied by a financial incentive such as a reduction in an employee’s health-care contribution. Last year NCR held a raffle-type drawing for participants, but this year it may make contributions to a flexible spending account to help boost participation. Kriner predicts it will increase to 40 or 50 percent.

    Cynthia Burghard, a research director at Gartner specializing in medical management, says that incentives are the key to large-scale adoption of HRAs. “We still have a huge population that is obese, that smokes and drinks too much. I think you have to build in a financial incentive to get employees to use the HRAs and stay in disease-management programs,” she says. At Coors Brewing Co. in Golden, Colorado, employees receive $100 when they complete the Checkpoint program, which includes an in-person screening and an online health-risk assessment from the Mayo Clinic Custom e-Health Package. For those who complete wellness programs, such as smoking cessation or weight management, incentives are customized. “Employees pay $50 for the smoking-cessation program, but if they are smoke-free 12 weeks after their quit date, we give them back $100,” says Colleen Reilly Perkins, manager of health and productivity at Coors.

    Information from HRAs is usually aggregated and given to management at regular intervals throughout the year. Harsha says it’s rare that anyone in the industry would ever receive information about an individual employee. At Coors, the majority of participants in its Checkpoint program agreed to release information to the wellness staff for use in customizing intervention programs. “But the information would never be released to Coors management,” Reilly Perkins says. Despite these assurances and prevailing HIPAA regulations, privacy concerns are real.

    Burghard says Gartner’s most recent consumer survey, which asked questions about a variety of technology-related issues, showed high anxiety associated with having health-care information on the Web. “People are concerned that personal information could be hacked into,” she says. “That anxiety is heightened because of a tight economy. Even though it’s against the law to lay someone off because of a health condition, that doesn’t mean it doesn’t happen.”

    Beth Givens, director of the Privacy Rights Clearinghouse, a nonprofit consumer-advocacy organization in San Diego, says the issue is a real one. “Here is information about some employees with conditions that are costing the company a lot of money, and here is this compilation of sensitive data,” Givens says. “It creates a temptation for employers to try to access that data.”

    Thus far, Kriner has gotten few negative comments at NCR about the assessment and seen little concern among employees about privacy. Most seem willing to embrace health-improvement strategies and assessments, he says. Stephanie Pronk, senior consultant in the group health-care practice at Watson Wyatt Worldwide, says that acceptance and the increasing prevalence of HRAs are part of a continuing shift in the consumer mind-set toward taking more responsibility for personal health and health care. “Employers have often exhausted their options–such as trying different plan designs–to reduce health-care costs,” Pronk says. “Their employees know this isn’t a silver bullet, but it’s one strategy. There’s not much else left to do.”

Workforce Management, August 2003, pp. 83-84 — Subscribe Now!