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A HRA  is sometimes used joined with a health testing.  An HRA is a computerized assessment tool which looks at an individual’s family history, health status, and lifestyle.

An Health Risk Assessment (HRA) seeks to identify precursors associated with premature death or serious disease and quantifies the probable impact for each individual.

An Health Risk Assessment (HRA) instrument is derived from an understanding of the during a illness. Based on this understanding, useful prediction instruments can be constructed to assess the health risks of an individual. Person with a higher number of health risks tend to have more serious medical problems over time.

Drawing attention to their health risks can help customers reduce risk factors which lead to the onset of unnecessary illness and subsequent premature death.

The questionnaire covers lifestyle habits (such as tobacco use, seat belt use, and exercise) and physical measures (such as cholesterol, blood pressure (BP) levels, height, and weight).

For accuracy, it’s critical to obtain direct measures of blood pressure, cholesterol and HDL-cholesterol.  The Health Risk Assessment (HRA) also provides recommendations and indicates what risks are modifiable. Types of measures to assess health risks are discussed under Screening Programs.

The impact of a health risk appraisal is much greater when it’s given in-person, with immediate feedback to the patron. This also provides an opportunity to invite the patron’s participation in continuing health counseling and to gain their written consent to do pro-active outreach to them.

A health age can be computed based on the individual answers to the questionnaire and physiologic factors.  The health age may indicate the individual to be younger or older than their chronological age.

Health Risk Assessment (HRA) programs are one the most prolific kinds of wellness activities utilized by corporations. Continuing research on HRAs is examining the efficacy of this tool.

Among the big benefits of this tool is that it can provide an aggregate group report of a company and can be utilized as an analysis tool.

Detailed information is available from the Society of Prospective Medicine (www.spm.org/desc.html) who publishes a handbook on HRAs.

The most common screening performed in health promotion programs is heart health assessment.

The screening can include a written heart health test, blood pressure (BP) measurement, cholesterol/HDL-cholesterol test, glucose (blood sugar), weight, educational materials specific to diet, nutrition, exercise, cholesterol, tobacco use, and weight.

The health expert conducting the screening then provides a consultation and assists set objectives with the participant.

The backbone of wellness programming at the worksite is biometric testing. It’s the first major activity a business should do when first beginning a wellness program.

Health screening is often used in conjunction with the administration of a Health Risk Appraisal (HRA) .

The most effective way to screen is to utilize a health professional trained in wellness screening techniques and counseling to privately and individually assess participants.

This wellness professional takes a brief health history and measures blood pressure (BP) and cholesterol. With computerized cholesterol desktop analyzers, results are obtained in about four minutes.

Immediate feedback, consultation, and educational materials are provided. for those identified at-risk, follow-up appointments may be scheduled at this time.  The whole process takes about twenty minutes per individual.

The screening also provides an immediate opportunity to register participants in various health promotion programs based on their interests and identified health risks.

Medical screening may be done each year and used to monitoring health risks within the worksite.

A medical testing program needs to provide multiple opportunities for participation.  The service should be provided for all the various shifts of a corporation.  The screening program should be conducted in highly visible areas so the process can be observed.

Reluctant workers often like to be able to see what the wellness program is about before they participate. When wellness screeners aren’t busy, they ought to perform outreach going to areas where workers gather and try to recruit workers.

When well-planned and promoted, health testing can attract participation rates of 60% to 100%. These high participation rates have a positive impact on senior level management producing support for further wellness programming.

Goals are broad-based statements about what the health promotion program is expected to do.  The goal of the health promotion program is to enhance the health of the individual and the company. Goals like mission statements provide direction in a health promotion program.   

Objectives are specific and provide a means of measurement of the wellness program to determine effectiveness. There are two types of goals, process and outcome.    

Process objectives state the activities that need to occur to achieve a desired outcome.

Examples of process objectives are -

o  Number of participants screened

o  Number of participants in and completing health promotion programs

o  Satisfaction of wellness program participants

o  Number of participants who were medically referred and saw their physician

o  Number of promotional activities

o  Number of participants seen in follow-up

Example of outcome objectives are -

o  Number of participants who improved fitness level

o  Number of participants who reduced cholesterol level

o  Number of participants who lost weight, body fat

o  Number of participants who quit smoking

o  Number of participants with high blood pressure who decreased their blood pressure

o  Number of participants whose initial level of alcohol consumption put them at-risk who are no longer at-risk

o  Number of participants with risk factors who saw their doctor and are being treated for high blood pressure (BP) or cholesterol years later

Health Promotion committees are important in that they develop a sense of ownership in the wellness program, and facilitate various tasks involved in wellness programming at the worksite.

The committee should be composed of a cross-section of staff representing various occupations, levels, and subgroups with the corporation.

A common mistake is filling the committee with the most health/fitness-conscious individuals  in the company. Do not rely solely on volunteers to fill a committee. Be certain that your committee members have enough power in the company to run an effective health promotion program.

The wellness committee is made up of workforce from the workplace. It oversees the wellness program and assists carry it out.

The committee ought to meet about once a month to review the previous month’s activities and plan future ones. When the health promotion program is just starting, the committee may meet each week until things get going.

Committee members don’t carry out medical procedures, counsel patrons, or handle confidential health information. Health Promotion professionals perform these tasks.

In general, the committee’s duties fall into three areas –  planning, promoting, and helping to run wellness programs.

Developing the wellness programs can include -

o  Finding space for activities

o  Planning and organizing workplace-wide events such as contests

o  Assessing reports prepared by the health promotion program staff and making recommendations

Marketing the health promotion program can include -

o  Recruiting workers to participate in screening and wellness programs

o  Encouraging personnel to participate in follow-up counseling

o  Organizing promotional strategies using newsletters, signs, bulletin boards, computers, and other media available within the worksite

Helping to run the wellness program can include -

o  Establishing up equipment for various activities

o  Assisting to conduct worksite-wide activities

o  Monitoring all activities and analyzing  the performance of the specialist staff

o  Acting as wellness mentors to fellow staff members

The size of the wellness committee are going to be dependent on the size of the organization. Pick members by asking day management to nominate or appoint staff.

Make an announcement through flyers, memos, and meetings to recruit potential members. Explain the purpose of the committee, duties and responsibilities, and the time commitment.

Recognize your wellness committee volunteers. Allow them to participate in wellness programs at a reduced cost. Hold appreciation breakfasts/lunches/dinners.

Print names of committee members on organization communications about the wellness program.

Buy special T-shirts, caps, and buttons for them. Write letters to supervisors saying that you appreciate the member’s service. Create awards certificates for members.

The following could be used as a guide for committee size –    

o  Less than 300 employees   2 to 4

o  300 to 1,000 employees   4 to 6

o  1,000 workers or more   6 to 12

Effective health promotion programs recognize the importance of building a supportive cultural environment.  The workplace culture includes shared values/heartfelt beliefs about what is important. It includes social standards of expected and accepted behavior called “cultural norms.”

It includes colleague support from family, friends, and colleagues. This support can help one adopt healthful life choices. Tools are available to audit a company.

The long-term success of any health promotion program is dependent on the corporate culture.

Some healthful culture signs in a corporation are -

o  Employees communicate openly

o  Leaders support diversity and opinion

o  Staff Members have fun

o  Policies support wellness

o  Workers are encouraged to grow

o  Staff Members work together as a team

o  Employees’ skills and talents are matched to their jobs.

o  Flexible work schedules are available

o  Businesss consider staff as their most valuable asset

Effective wellness programs try to create healthy worksite climates. A healthy worksite climate is one which encourages teamwork, cooperation, and empowerment of the individual.

People  have a sense of community, a shared vision, and a positive outlook. Policies promote and support wellness efforts within the workplace.

o  Effective wellness programs identify ways that business policies and organizational traditions encourage wellness.

o  Effective health promotion programs work at the group and organizational level to build support for healthful lifestyle options.

o  Effective health promotion programs set clear target objectives and objectives for the health improvement of the worksite.

An initial biometric testing can include a recent survey of employees’ interests as part of the assessment. Successful wellness programs are designed to meet the needs and interests of the workers.

The information you need to get from a recent survey depends on the scope of your wellness program. A sample survey may be acquired in the HOPE Publications Web site.

If you plan to adapt this sample survey or develop your own survey, keep the following hints in mind -

o  Ask mostly closed-choice questions, in particular when you’ll be sending the survey to a big number of workforce. Closed-choice questions provide specific choices and are easy to tabulate. You may want to use a computer for data entry and analysis.

o  Invite comments, suggestions and recommendations, or ask open-ended questions after the survey. Open-ended items are more difficult to summarize.

o  Include a brief explanatory cover letter with the survey with the signature of the company president. Make sure to include a statement about confidentiality and anonymity.

o  Ask a group of representative personnel to review the survey before it is distributed. Find out when the questions will be understood by personnel and won’t be objected to.

o  Include demographic information at the starting or end of the survey. Consider various ways that you could analyze the responses by demographic characteristics (gender, age, shift, site, department, etc.).

When considering who ought to get the survey, a simple rule is if you’ve under 500 personnel, everyone ought to receive one.  The public relations benefit of everyone receiving a recent survey could be significant.

Over 500 personnel, a sample of the work population will suffice. A sample saves on costs and time. You may want to consider consulting with a statistician to determine an appropriate sample size for your worksite.

Needs surveys are confidential and anonymous; they don’t request information that may identify a individuals.

Getting support from executive management is critical to the success of the wellness program.

One way to do this is to survey managers (see forms) and conduct interviews with decision-makers in the company. You can use the surveys here or make up your own.

When you decide to do your own, keep the survey short. It shouldn’t take more than ten minutes to complete.

The interview process can also serve as a means of educating management. Provide concise fact sheets on the advantages of health promotion programs for management.

When surveys and interviews are completed, tally the surveys and write brief summaries of the interviews. Provide these reports to management.

Once completed present a brief executive summary to management. Highlight a few fascinating findings that can be used immediately to make decisions about the health promotion program.

Utilize charts and graphs to make your points. Prepare a detailed report for wellness committee members itemizing each response. Give a short article about the survey in the business newsletter.

The higher the response the more valid and reliable the results. A minimum response of 40 percent to 50 percent is acceptable.

Robust health promotion programs involve all workforce, deal with all major health risks, offers choices, and target both the workforce and the worksite environment; provide periodic examination of its results.     

Robust health promotion programs emphasize follow-up and offers support for the worker since he/she is employed. Studies have shown this approach to be highly successful. Key components are planning, implementation, and examination.   

Planning extensive health promotion programs involve performing a needs and interest assessment, appointing a wellness committee, choosing  wellness providers, setting goals/objectives for the health promotion program, advertising and marketing/promoting the health promotion program, and establishing procedures to ensure confidentiality.   

Implementation of extensive wellness programs consist of five major tasks –    

1   Medical testing and referral

2   Follow-up and counseling staff

3   Follow-up with physicians

4   Health betterment programs

5   Organizing worksite-wide activities.

Analysis involves monitoring wellness programs to find out if it’s working and to help you refine it. Measuring success shows what you’ve achieved, assists justify costs, and provides information for senior level management to support continued wellness programming.   

Comprehensive health promotion programs involve all staff, deal with all major health risks, offers choices, and target both the staff and the workplace environment; provide periodic evaluation of its results.     

Comprehensive wellness programs emphasize follow-up and offers support for the worker as long as he/she is employed. Studies have shown this approach to be highly successful. Key components are planning, implementation, and examination

Developing robust wellness programs involve performing a needs and interest assessment, appointing a wellness committee, selecting  wellness providers, setting goals/objectives for the wellness program, marketing and advertising/promoting the wellness program, and establishing procedures to ensure confidentiality

Implementation of comprehensive health promotion programs consist of five major tasks -

o  Health screening and health risk assessment

o  Follow-up and counseling employees

o  Follow-up with doctors

o  Health improvement and illness prevention programs

o  Organizing worksite-wide health promotion program activities.

Analysis involves monitoring health promotion programs to figure out if it is working and to help you refine it.

Measuring success shows what you’ve achieved, helps justify costs, and provides information for upper management to support continued health promotion programming.

Initially introduced by Halbert Dunn in the 1950’s, wellness became a well-liked buzzword during the late 1970’s and received considerable academic attention in the 1980’s.     

Wellness programs for employees became more widespread during the following decade, and credible evidence for their economic viability began to be published.     

There have now been over 100 published studies on this topic and a number of systematic reviews.

Health risks increase costs.  Medical and health insurance costs escalate with both age and number of risks present.8,10   the number of risks is also strongly related to sick leave absenteeism, Employee’s Compensation costs, short-term disability, and reduced productivity (”presenteeism”).

Early staff member health promotion programs were relatively basic and generally produced a Return On Investment of less than one dollar for every dollar spent operating the health promotion program (Return On Investment = <1 - 1).8

Such wellness programs might  be characterized as “fun-oriented”.  Participation is entirely voluntary, and there is no particular focus on the reduction of in particular identified high risks.

Interventions and activities aren’t personalized, and there is no emphasis on the management of healthcare costs.  These wellness programs are generally site-based only, lack options to address all of the major behaviorally-related health risks, and lack multimodal presentation.

Minimal or no incentives are provided to workforce for participation, and services to spouses and family members aren’t available.  Most such wellness programs lack meaningful investigation.

More conventional wellness programs are “activity-oriented” and have shown an Return On Investment of between 1 – 2.5 and 1 – 3.5.8 These wellness programs might have a greater emphasis on health and risk reduction, although the efforts are relatively broad and not personalized.

They may have some generalized emphasis on healthcare cost management, although not necessarily aimed at specific high risks.  Most are site-based and voluntary, with spouses included only rarely.

Modest incentives may  be utilized to encourage participation.  Formal analysis may  be weak.

The newest and most economically viable health promotion programs are “results-oriented” and exemplify the health and productivity management model.  These health promotion programs consistently produce return rates of 1 – 4 or greater within a 12-24 month period.8

Such wellness programs are strongly focused on the reduction of namely identified high risks and the management of medical costs. They are typically voluntary, but use strong financial and other incentives to promote participation.

They are multi-component in nature (address all major risks), and have both on-site and virtual modalities of operation.  The interventions are highly targeted and individualized, and offered to spouses in addition to workers.

For businesses, the cost of providing medical insurance for their workforce is of excellent importance.  Those costs have been increasing at annual rates between 6% and 14%.

Chapman’s 2007 systematic review7 announced an typical reduction in health care costs of 26.5 percent so of staff member wellness programs.  His review covered 60 of the most scientifically accurate studies, with an typical of 3.77 years of study.

Absenteeism because of disease is another cost driver.  Chapman’s review7 reports an typical reduction in sick time of 25.3%.   Cost for Employee’s Compensation was lowered by 40.7%, and disability costs by 24.2%.

There is also an emerging literature on the costs of presenteeism (reduced productivity).11,13  In one study, every risk decreased through a health promotion program yielded a 9% reduction in presenteeism (and a 2% reduction in absenteeism).11

A number of corporations have achieved a zero% increase in health care costs across at least brief periods of time.10  Doing so requires 90-95% participation of the worker population in focused health promotion programs, with 75%-85% of the staff falling into the low risk category.10     

Although extensive efforts to lower the risk status of those in moderate or high risk categories ought to be made, the needs of currently healthy employees ought to be addressed as well to avoid increases in risk-status.   

Given the size of the federal workforce, meaningful cost savings in the government’s contribution to health insurance premiums for workforce can be achieved if a majority of that population were participating in active wellness programs.     

In like manner, improvements in absenteeism, worker’s compensation, disability, presenteeism, and turnover as a result of robust staff member wellness programs would yield substantial fiscal benefits for the government.   

References   

1   Aldana, Steven G.  (2001)   Financial Impact of Wellness Programs –   A Robust Review of the Literature.   Am J Wellness 15(5) – 296-320.

2   Chapman, Larry.  (1998)   the Role of Incentives in Wellness.  The Art of Wellness  2(3) – 1-8.

3   Chapman, Larry.   (2003)   Biometric Screening in Health Promotion –   is it Really as Important as We Think?  the Art of Health Promotion  7(2) – 1-12.

4   Chapman, Larry.  (2005)   Meta-Examination of Corporate Wellness Economic Return Studies –  2005 Update.  The Art of Wellness, July/August, 1-15.

5   Chapman, Larry.   (2006)  Staff Member Participation in Company Health Promotion and Health Promotion Programs –  Exactly how Important are Incentives, and Which Ones work Best?   North Carolina Medical Journal   67(6) –   431-432.

6   Chapman, Larry, Lesch, Nancy, and Passas Baun, Mary Beth.   (2007)   the Role of Health Promotion Coaching in Employee Health Promotion.   the Art of Wellness, July/August, 1-12.

7   Chapman, Larry.  (2007)   Proof Positive –   an Analysis of the cost-Effectiveness of Employee Health Promotion.  Northwest Health Management Publishing, Seattle, WA.

8   Chapman, Larry.  (2007)   an In-Depth Look at the Economic Evidence for Rewarding Health Behavior Change.   Workshop presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Companys” Conference, Orlando, FL, January 23-24.

9   Edington, Dee.   (2001)   Emerging Research –   A View from One Research Center.  American Journal of Health Promotion 15(5) –  341-349.

10   Edington, Dee W.  (2007)   Health Management as a Serious Business Strategy.  Presentation at the World Research Group “Rewarding Healthy Behaviors for Health Plans and Employers” Conference, Orlando, FL, January 23-24.

11   Pelletier, Barbara, Boles, Myde, and Lunch, Wendy.  (2004)  Changes in Health Risks and Be certain to work Productivity.   Journal of Occupational and Environmental Medicine, 46(7) –  746-754.

12   Pelletier, Kenneth R.  (2005)   A Review and Analysis of the Clinical and Cost-Effectiveness Studies of extensive Health and Illness Management (DM)Programs at the Workplace –  Update VI 2000-2004.  JOEM 47(10)1051-1058.

13   DeVol, Ross, Bedroussian, Armen, et.  Al.  (2007)  an Unhealthy America –   the Economic Burden of Chronic Disease.  Report released by the Milken Institute.   www.milkeninstitute.org.

14   Partnership for Prevention.  (2008) Investing in Health –   Proven Wellness Practices for Worksites.   http – //www.prevent.org/images/stories/2008/investinginhealth_finalfinal.pdf.