March 25, 2021
By Amy Amick, president and chief executive officer, SPH Analytics
Health Risk Assessments (HRAs) arm employers and payers with the meaty consumer health data they need to assess individual health status, prioritize engagement and to motivate behavior change. Historically, HRAs were leveraged to aggregate data, predict outcomes and costs and drive targeted engagement.
Yet no risk assessment in the world could have predicted that COVID-19 would wield such a huge impact on all patients, from the sickest to the healthiest. The coronavirus pandemic has led to more than 400,000 deaths in the United States alone, and a wide array of clinical and behavioral complications for survivors. It’s thrown a wrench into preventive care and as a result, clinical outcomes.
Within the framework of the pandemic, these risk assessments are more important than ever. They provide insight into the well-being and needs of a person, which is all the more important in an environment where people are foregoing preventative and elective care and spending less time in sensitive interactions with their providers. Industry stakeholders are realizing these foregone provider engagements also served as a valuable means to assess a person’s wellness and needs. Without consumer health data that historically was gathered through provider-patient engagement, providers, health plans and employers are less equipped to target engagement.
Now is the time to re-assess HRA strategies and ensure member-level assessments are well-timed, well-designed and capture of the right data.
Scrutinizing Your HRA: Where HRAs Fall Short
Before an organization can reach its 2021 goals, it’s important to revisit the 2020 HRA experience to identify any shortcomings. HRA programs are important as a ‘check the box’ requirement for Medicare Advantage plans and CMS requisites for annual wellness visits but have so much more opportunity to aid a health plan in driving health and wellness and managing costs through optimal engagement. A well designed HRA program excels at both the breadth of reach and the usefulness of information gathered.
With respect to breadth of reach:
- How broad is your outreach approach? As with Yelp reviews, often it’s only the most engaged, healthy, and satisfied individuals who are answering HRAs. This happens when assessments are only administered in one way (e.g., email). A more effective approach employs multiple modalities (e.g. mail, email, phone, etc) and profiles an individual to the most likely engagement model that will yield a completed HRA, verses a one size fits all approach.
With respect to usefulness of information, all data is not considered equal nor has the maximum usability. It is key for HRAs to leverage:
- Coordinated, data-driven approach. Skill, experience, and predictive analytics can be leveraged to ensure HRA outreach yields the highest completion rates, and the collected data can be used to its maximum potential.
- Optimized questions and survey construct. HRAs need to be long enough to identify risk factors for chronic illnesses like diabetes, while covering lifestyle factors (e.g. sleep, alcohol use, or stress levels), but not so long as to cause fatigue. Expert survey design, leveraging data science is invaluable. In addition, HRAs should be designed to flex based upon data collected for a person, such that the amount of information collected is directed by individual need. For instance, if initial questions determine that a person with complex health needs has a weak personal support system, the HRA can dynamically alter (when administered through modalities other than mail) and drill down into areas that assess additional needs such as transportation or other factors that influence access to care. Questions should be evidence-based, or in line with established medical practices. They should be written in a way that’s clear and understandable to all, and in a way that allows a health plan to identify risks and motivate behavior change.
- Target the right population. HRAs are only required by Medicare for wellness visits, and Medicaid providers must conduct an HRA with members within 90 days of enrollment. But HRAs can be used more broadly, and especially in the wake of so many provider – patient interactions being missed under COVID, they are a very valuable means to gather critical information. Repurposing some of the avoided expenses resulting from wellness and preventative visits, which many members have foregone, and applying them to more personalized and more robust HRA outreach can be money well spent. Furthermore, targeting incremental HRA efforts to targeted populations (eg members who have historically done wellness visits but have not in 2020 or members who have rising risk indicators). However, even when not required, an HRA is worth the investment to efficiently manage members’ care and control costs.
The bottom line: a well thought out, updated HRA strategy in the throes of COVID can create great value.
Fine Tuning Your 2021 HRA Strategy
Even if your previous HRA strategy was strong, consider the following changes for 2021. Here are four strategies to consider:
1. Confirm your breath of outreach is optimal.
Are you reaching the right population (e.g. members who have fallen out of compliance with wellness events)? And are you flexing modalities of outreach to best reach each targeted member? In addition to modality, is outreach timing optimal based upon the targeted member?
2. Tailor Outreach as Needed.
An HRA needs to capture a wide pool of data to identify gaps in care and emerging health and wellness needs. But engaging your target population to respond to an assessment may require adopting a new outreach strategy and a flexible survey design.
3. Supplement your survey to smartly reflect COVID.
Handle COVID Questions with care. Although COVID is now a part of our daily lives, your HRA doesn’t need to be packed with questions about the coronavirus. Asking limited questions pertaining to care, treatments and resources, such as mental health care, is sufficient to assess whether a target demographic has enough access to the tools and medications they need to stay healthy or improve other health metrics, such as weight or sleep quality.
4. Dive Deeper into Behavioral Health
The coronavirus hasn’t just taken a physical toll on Americans, but an emotional one as well, with a high number of individuals reporting increases in depression and anxiety due to the pandemic. HRAs should include behavioral health-specific questions, such as access to virtual support groups or willingness to undergo screening for mental disorders.
With HRAs, the goal isn’t just to administer an assessment, but to improve population health. If health care stakeholders can do a better job of assessing risks for adverse events, enhancing access to care, and ensuring vulnerable populations have the resources needed to treat current health conditions and reduce the risk of future health problems, everyone wins.