Grant Description: What is the potential for Health Risk Appraisals (HRAs) to engage consumers in health improvement? HRAs are structured surveys designed to identify a wide range of health risks, including genetic predispositions to disease, poor health habits (e.g. smoking, overweight) and lack of adherence to recommended care for a chronic condition. HRAs allow health plans and employers to engage consumers in health management before acute events occur. Using data from Cigna HealthCare, the researchers addressed the following specific aims: 1) examine the overall rates of HRA completion in a privately-insured population; 2) examine the impact of a consumer financial incentive on HRA completion; 3) examine the characteristics of consumers who opt to complete an HRA; and 4) look for early effects of HRAs on utilization and health behavior. The objective of the project was to help employers and health plans better tailor their outreach programs, evaluate whether to offer incentives, and better understand the impact HRAs will have on enrollee behavior.
Policy Summary: Employers and health plans are increasingly looking to individual health behavior change as a means for improving the quality of health care and reducing its cost. The focus on employees rather than providers as the fulcrum for reform is concordant with the broader trend in health benefits towards enabling informed consumerism in health care. Health Risk Appraisals (HRAs), which ascertain information about health status, behavior, and health history, have been promoted as the entry point for many behavioral interventions and an element of consumer engagement. HRAs are widely used in the United States. One recent national survey found that 48 percent of large employers offered an HRA to employees; 20 percent provided them with a financial incentive to complete the HRA. In this study, the researchers explored the potential role of HRAs as a tool for managing health care quality and costs in employer-sponsored insurance using HRA responses and health care billing data from CIGNA HealthCare, one of the largest national health plans in the United States. They examine patterns of voluntary HRA uptake and then address whether those who complete an HRA (“HRA-takers”) change their health care utilization patterns differentially relative to a comparison cohort. The researchers’ analyses suggest that there are discernable patterns of self-selection among HRA-takers. In particular, women, enrollees of consumer-directed health plans and PPOs, and healthier people are more likely to complete an HRA. Individuals who completed an HRA were less likely however to have received recommended preventive or chronic care in the previous year, despite equal numbers of applicable care recommendations. They also found evidence of changes in health care utilization and quality for HRA-takers, including increases in cervical cancer screening, office visits, and participation in asthma and diabetes disease management. The researchers’ results suggest that HRAs can influence behavior among enrollees of employer-sponsored insurance plans, despite the fact that healthier individuals are more likely to complete them. While increases in office visits may not be unambiguously good from the payer’s perspective, increases in cancer screening and disease management are clearly in line with the goals of the HRA. Further analysis is needed to examine health outcome and productivity gains that might be associated with these behavior changes.