I keep hearing about how my colleagues are mandating the completion of health risk assessments as a condition for coverage in the employer's health plan. Through HRAs, they're able to gain all kinds of aggregate information that is useful to their wellness planning.
Our health insurance carrier offers one, and it's actually pretty cool. An employee can take it online, and it will return a report that graphs his or her health on a bell curve. It also provides very helpful information that is intended to improve one's general health, no matter where one falls on the curve.
Mandating the completion of the HRA as a condition for obtaining health coverage is a bit of a stretch in a union environment, but I was quite convinced that this nifty and helpful tool would draw its own crowd at the County. I was wrong.
In our local government setting we're not all office workers, and therefore we're not all on our computers every day. But if common statistics are correct, 75% (three out of four American adults) actually own computers now, and even if some of those adults count themselves among the computer illiterate, certainly there's a fourth grader somewhere who can teach them how to log on.
As for the County, our carrier recently informed me that 52% of the employee population had logged on to the carrier's Web site. So we certainly should be a population that would take the time to fill out the HRA. But it simply isn't happening.
The first year we offered the HRA, we took a considerable amount of time explaining how the data would only be obtained in the aggregate, and how the program would not be tracking individual information to be used for coverage decisions (or any other decisions for that matter).
We knew not everyone would automatically know their current cholesterol and blood pressure numbers, so we scheduled biometric screenings for employees to not only determine those numbers, but also their triglycerides, BMI and body fat percentages. The events were offered during work hours and for free. During the events, we even promised the participants that they'd receive a free pedometer if they took the time to complete the HRA.
The biometric screenings were popular. But the resulting HRA completions were a disappointment. Only 97 of our 5,000 insured employees went online and took the assessment.
Fast forward one year. This time I knew I'd get them to fill out the HRA. I convinced our carrier to provide (under their contracted annual contribution to the wellness program) eight Nintendo Wii Fit games to be awarded as a raffle for employees who completed the HRA. The prize included not only the game, but the game console. This would entice them!
After the annual open enrollment communication push, I anxiously awaited the numbers. Thirty-eight. A reduction from last year of more than half!
If the surveys are correct, employers offering HRAs on a voluntary basis are able to attract 10% to 20% of their employee population to take them. It seems the employers with the best voluntary participation rates are those that offer cash incentives - specifically, premium reductions.
However, if an employer heavily subsidizes health premiums to begin with, as is typically the case in a local government setting, further subsidies will not substantially impact an employee's wallet and will therefore likely not result in a greater number of participants.
More importantly, though, studies show that continued employer engagement in wellness offerings seems to be the key to impacting lasting changes in employees' healthful behavior. Perseverance is the key to success.
The solution for poor voluntary HRA participation for two years running is not to pack up our toys and go home. Rather, we'll keep offering and promoting the HRA. We'll keep tweaking our wellness program until we see the desired return on investment in our plan and in the well-being of our employees.
As we reflect on 2009, we were able to boast participation of over 2,000 employees in some level of wellness program participation. We consider the year a success, but the lesson learned is that the program must consistently be reviewed for that right custom fit to the population it serves.
We consistently review our wellness offerings and look to 2010 with anticipation as we attempt to implement a 12-week fitness challenge in the spring. This year's walking campaign will take on an Olympic theme, as we cheer on our American heroes in Vancouver. We'll lose 10% of our collective body weight as we compete to be the County's "Biggest Loser," and as success stories make their way to the water cooler, we can only hope that inspired co-workers will make their way to their desktops and fill out that HRA. It will be there, waiting for them.
Contributing Editor Nancy L. Bolton is the director of risk management for the Palm Beach County Board of County Commissioners in West Palm Beach, Fla.
