What is a health risk assessment?

A health risk assessment (HRA) is a questionnaire that evaluates an individual’s health risks and quality of life. Typically, an HRA includes:

·        Question section

·        Risk score

·        Report with feedback on areas of improvement

Questions cover topics such as:

·        Nutrition

·        Fitness

·        Biometrics (body measurements like blood pressure and cholesterol)

·        Stress

·        Sleep

·        Mental health

Reports indicate risk of chronic conditions like heart disease, diabetes, cancer, and obesity. Health risk assessments are widely distributed among workforce and health plan populations.

What is the history of health risk assessments?

The origin of the health risk assessment can be traced all the way back to the late 1940s, when Dr. Lewis C. Robbins began to document patients’ health hazards in an effort to not only treat disease but also prevent it. For the next 20 years the idea of a health hazard chart for physicians’ use progressed to a complete health risk assessment including a patient questionnaire, health risk computation, and feedback strategies.

This concept was featured in Robbins’ (along with Dr. Jack Hall) 1970 guide for physicians, How to Practice Prospective Medicine.

In 1979 our very own Dr. Don Hall (no relation to Jack Hall) created the first computerized health risk appraisal in the U.S. The following year the Centers for Disease Control and Prevention (CDC) released publicly available HRA software that included a self-administered survey to calculate adult health risk. This led to widespread use of health assessments in the workplace.

What is the difference between a health risk assessment and health risk appraisal?

Essentially, these terms are synonymous, as they both collect and measure lifestyle factors and health risks. Most wellness and population health managers use the terms health risk assessment and health risk appraisal interchangeably.

Populations that are required to use a health risk assessment

The Affordable Care Act directed the Centers for Medicare & Medicaid Services (CMS) to require an HRA be completed as part of the Medicare Annual Wellness Visit (AWV). The Annual Wellness Visit informs care plans with the intention of reducing costs of care. CMS recognizes the value in identifying risk factors for disease and injury to help personalize care plans.

Medicaid providers must conduct a health risk assessment within 90 days of enrollment for all new enrollees in order to identify and stratify risk.

The value of self-reported data for improved health outcomes

Health risk assessments collect self-reported information that is used by health and wellness professionals to identify risks, segment populations, design and implement interventions, and measure outcomes. The downside to self-reported data is that it is subject to bias. For example, individuals may not accurately recall their blood pressure or could under-report their weight or how much alcohol they drink. Clinicians around the world are familiar with the potential inaccuracy of self-reported data, but must rely on the recall and honesty of individuals when asking individuals about their mental health, dietary habits, or pain levels. And that might not be a bad thing. Recent research shows a high correlation between subjective and clinical weight measures and supports the reliability of self-reported well-being. Asking individuals about their habits and feelings—including their change readiness—gives health professionals insight into an individual’s risk of chronic diseases and which unhealthy habits an individual is ready to improve.

The Community Preventive Services Task Force recommends the use of health risk assessments that provide individuals with feedback when they are accompanied with health education programs, “with or without additional interventions.” The taskforce’s recommendation was based on a systematic review of 51 studies that looked at a range of outcome measures which concluded there is strong evidence of the effectiveness of improvements in a number of health areas, including alcohol, seatbelts, tobacco, blood pressure, cholesterol, and sick days.

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