Customized HRA can focus clearly on health status
February 1, 1998 4 minutes read
Customized HRA can focus clearly on health status
An attempt to change culture, empower employees
Eschewing a more standardized measurement tool, Digital Equipment Corp. of Maynard, MA, has embarked on an ambitious project to design its own customized Health Risk Appraisal (HRA), to help determine the health status of its employee population. The instrument is part of Digital’s health promotion program, "A Healthy Balance."
Not surprisingly, the project has required the involvement of a number of different organizations, each with special expertise. These include Brookline, MA-based Harvard Pilgrim Health Care, one of Digital’s major HMOs, which designed the questionnaire and funded the project; Eris Systems of Indianapolis, which helped formalize the structure of the instrument; and Interactive Solutions of Boston, which built a Web site that offered electronic responses to the questionnaire.
"Digital had decided they wanted to change the corporate culture to focus more on corporate health and preventive health," explains Employee Health & Fitness reader Phyllis Goldman, MS, a health and wellness consultant with the Boston office of UniCare, who works with Digital to manage their health benefits. "It also addresses two other corporate initiatives: empowering employees to learn more about their personal health and therefore be better health consumers and integrating the new initiative with existing medical delivery systems. And of course, to improve health and productivity."
Goldman worked closely with the HRA team in developing the program and then integrating it into Digital’s managed care delivery system. (See related story, above.) Their key goal, understanding the health status of the employee population serves to advance all three of the aforementioned initiatives, she says.
The project was of great interest to Harvard Pilgrim Health Care, notes Marianne Gibbons, MBA, MS, director of Harvard Pilgrim’s Center for Employers Health Programs. "They are a large commercial customer, with about 13,000 to 14,000 subscribers, so this allowed us to get a good look at population health management," notes Gibbons, who says Harvard Pilgrim is the largest nonprofit managed care organization in New England.
When you use the term "customized" to describe an HRA, you mean just that, notes Gibbons. "As with any project, you want to find out what the customer’s needs are," she explains. "One of Digital’s needs was to identify existing or potential problems early and to link them to primary care. We wanted a tool that included medical history questions and some biometrics so it could actually serve to triage people into appropriate care, as well." A copy of the report can be sent to the employee’s primary health care provider, she adds, but only with the employee’s permission. If permission is not given, the employee simply receives a copy of their personal profile, which they can bring to their health care provider if they wish.
Goldman notes several other aspects of the customized HRA that make it unique. "It’s a much more complex instrument rather than three or four canned responses that tell you about your cholesterol, ours is able to produce over 300 responses that relate much more specifically," she notes. Other unique features include the following:
• The HRA addresses health-related areas that are more relevant to the Digital populations, such as staying healthy while traveling.
• It includes an assessment of the individual’s readiness to change, which is not found in a typical HRA.
• It offers two different delivery modes traditional pencil and paper or electronic.
• It is implemented with a greater effort to maintain confidentiality.
Since the HRA only became available to employees in the fall of 1997, it is too early to draw any conclusions, notes Goldman. Several of Digital’s strategic HMO partners stand ready and willing to provide proactive outreach to the employees who have given their consent.
"It looks as if people are not that willing to be contacted, from what’s come in, but we just closed enrollment right before Thanksgiving," says Goldman. "Our preliminary sense is that people really want to maintain control of their health. Plus, we still have the ability to look at aggregate populations, which will give us an indication of overall health status, and help identify major health problems."
"There is some positive anecdotal information," notes Gibbons. "We know that some high-risk people have been contacted and that a connection has been made. We will have more formal data in 1998."
A customized HRA, she adds, is not for everybody. "I think probably one of the biggest drivers is absolute resources because the financial requirement is considerable so they’re probably not for everyone, or even realistic for smaller companies," Gibbons observes. "But some of the things that go into customized HRAs are generalizable," such as absenteeism data.
Customized HRAs such as the one at Digital will also help thrust HMOs into a new, more pro-active role, Goldman asserts. "They won’t wait until an employee comes in with high cholesterol; they can contact the employee [if consent is given] and say, You have high cholesterol, here’s what we think you can do,’" she suggests. She realizes that the involvement of just a few companies won’t change overnight, "But this is a start."
[Editor’s Note: For more information about customized HRAs, contact: Marianne Gibbons, Harvard Pilgrim Health Care, Center for Employer Health Programs, 10 Brookline Place West, Brookline, MA 02146. Telephone: (617) 730-7342. Fax: (617) 730-7865.]
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