We continue to remind employees that
their plan is designed to pay 100% for eligible
preventive benefits to encourage their use.
And we tell them why — we’d rather spend
money now to keep them healthy later.
We highlight other plan features that are
designed to encourage wise
health care spending. Employees spend less for generic
drugs, and we encourage use
of mail order for maintenance
drugs because it costs less than
going to the local drugstore. We
have communicated our precertification services (which
are never popular) as a way to
help employees determine in
advance whether or not a treatment is medically necessary.
In addition, we invest heavily in our
wellness programs. Employees get a cash
incentive for completing an annual wellness
assessment and can earn even more if they
meet the requirements for the wellness program award. They can call a 24-hour nurse
line in advance of going to the doctor, maybe
avoiding the need to go at all. Employees
and their families may use online or health
coaching resources to lose weight, manage
stress or find self-care resources. Employees
with chronic conditions get help and support
from a disease management program.
Last year, we enhanced our tobacco cessation benefits and maternity care programs.
In our home office, we’ve got two fitness centers that cost $10 per month for an employee
membership. For those who work in our
other locations around the country, we just
added a financial reimbursement for health
Although I personally might not like all of
the 2011 medical plan changes when it’s time
to pay my doctor bills this year, the reality is
that if I have more at stake as a consumer, I’ll
be more likely to engage in purchase-of-care
decisions and benefit elections up front. No-
bel Prize-winning economist Milton Fried-
man said this about our human
nature: “Nobody spends some-
body else’s money as carefully
as he spends his own.” That cer-
tainly is true for me.
Practicing what I preach
So, how am I doing at prac-
ticing what I preach? Can I/will
I engage and make wise health
care purchase decisions? I re-
cently went to the doctor for my
annual preventive exam. This is
100% covered, and I appreciate that. It also
helped me earn points toward my annual
$200 wellness award — an added bonus!
But afterward, I needed to go back for a
follow-up visit, knowing full well the visit
would be diagnostic and not preventive.
But I made the appointment anyway. (It
cost me over $400.) I’ve been asked to come
back again in six months for a repeat check. I
might go, but not without talking to my doctor first to see if it’s really necessary, waiting
a few more months for my annual preventive
exam — and definitely not without finding
out what it might cost first. In my head, I hear
Joanie Greggains saying, “You grew it, you lift
it!” Of course, I do my best to comply. —C.B.
Contributing Editor Cindy Bucher is the benefits
and compensation manager for a Midwestern
financial services company and has been in her
current role since 2004. She and her staff serve
more than 2,500 active employees and 650 retirees, as well as their families. She can be reached
No more master key: Health risk
assessments unnecessary for
wellness plan design
By Andrew SykeS
Health risk assessments are used by most wellness program providers and employers as the key to opening
the door to employee health improvement.
These questionnaires usually consist of 15
to over 150 questions and ask the partici-
pant to record their exercise habits, eating
habits, alcohol consumption, biometrics
and a range of other health risk and habit
and providing guidance on how to mitigate those risks over time. They are sold as
the first step towards an effective wellness
program and the impetus for better health
habit choices for the individual. But are they
Because HRAs are voluntary, the information they provide is often a very biased
sample of the entire population. Unless participation is over 80%, the data they reveal
is almost certainly skewed. Worse, it is not
always possible to tell in which direction the
data is skewed. If the healthier people in the
population complete the HRA — as is usually, but not always, the case — the results
may look much better than they should and
For a non-biased picture of the health
risks in your company, you’re better off assuming you have the same general prevalence of health risks for similar people in
each state — data that are readily (and
freely) available from public resources such
as the Centers for Disease Control and Prevention.
Other factors, such as who is issuing the
HRA — insurance company, third-party
wellness vendor or the employer — company culture and recent events at the organization can all play a role in influencing
who will complete the HRA.
Even at high rates of completion, the information gained
is inaccurate because of the
way that people remember
and record their answers.
“right answer” for how many alcoholic
drinks you consume a week is:
Regardless of your personal truth, every-
one knows that either A or B is probably the
answer that will make you look the best.
Another confounding problem is that people
have very poor memories.
Research on poor eyewit-
ness accounts in the courtroom, where wit-
nesses are influenced by the suggestions of
experienced litigators, provides an example.
Simple suggestions about details of a crime
scene can be implanted into eyewitnesses’
memories by questions such as, “On the
night of January 23rd, can you remember
seeing the defendant, Mr. X, leaving the
bank in his red getaway car?”
Despite the question seemingly being
about Mr. X, by the next time the witness is
asked a question, they may well remember
seeing a red car, even though they never
With HRAs, the problem is worse, since
everyone knows what the optimal answers
should be. For example, do you think the
Other forces at work
Now add three other biasing forces. The
first is employees’ suspicion about what
their employers or insurers may do with
the information. These fears encourage employees to record answers that are safe and
that will not result in them being targeted
or subjected to disease management calls
or, worse, fired. Despite assurances about
privacy protections from HIPAA, many employees still mistrust HRAs and leave the experience feeling uninspired and targeted.
Second, when employers offer wellness
incentives for HRA completion or even
for mitigating risk factors, it sends a clear
message: Good-looking answers are best.
Many employers celebrate the seemingly
positive impact of their new incentive program on the health of employees, blind to
the fact that all they have done is pay people
to report answers that are more
Third, assuming you believe
in the honesty of your employees and that they would not be
swayed by incentives to misreport their health habits, consider
that mentally healthy employees
should misreport on their HRAs.
Psychiatrists tell us that one
of the symptoms of depression is
realism about one’s talents and
abilities. That is why more than seven out of
10 of us regularly answer that we are better
than average drivers, thinkers and workers,
and that we are better-looking than average.
It’s not (only) lying; it’s what keeps us going
when we face failure or disappointment.
Therefore, an overly generous depiction
of one’s own health habits is healthy, but
nonetheless provides an inaccurate picture
of our actual state of wellness.
Experience with comparing answers on
an HRA to answers that come from blood
tests (for example, a cotinine test for recent
tobacco use) often shows that as many as
50% of people who smoke say that they do
not. HRA supporters say that you can trust
(SEE HRAS ON PAgE 42)