HRA Follow-Up Involves Intervention And Monitoring, Survey Finds

The majority of wellness professionals involved in the administration of health risk assessments (HRA’s) follow up on the HRA results, according to the results of a workplace wellness management survey conducted by Wellness Program Management Advisor and Wellness Junction.

Almost 71 percent of survey respondents said they follow up on the HRAs while almost 16 percent do not perform follow-up services, according to the findings.

However, almost 57 percent of the wellness professionals respondenting to the survey intervene immediately and refer employees with serious health problems to physicians, emergency facilities and other care providers, the survey discovered.

Referral Process

Methods of referral to health professionals include onsite and offsite procedures, wellness managers said.

“At the time cholesterol and blood pressure are measured, a doctor’s referral is given to the employee, if needed,” said a provider of wellness services. “We follow up after two weeks to see if these employees actually did see their doctors.”

Others make direct contact with the physician to whom an employee is referred.

“If we refer an employee to a primary care physician (PCP), we mail the PCP a postcard and ask them to send it back if the employee has been seen,” explained a program coordinator. “We do the same thing with our outpatient wellness programs.”

High Risk Situations

Situations involving employees found to be in a high risk status usually prompt immediate action, according to the study.

“Employees determined to be at high risk for cardiovascular events or cancer are referred to their PCPs with a copy of our findings,” said a wellness program director. “Depending on how acute the risks are, we may even call the PCP in the patient’s presence and refer from that moment.”


“With the HIPAA guidelines, we have the participant read and sign an informed consent form that gives us permission to send copies [of the HRA findings] to their PCP and discuss their personal data with designated medical personnel,” a program manager explained.

“If the participant needs referral to outpatient wellness programming, the person is furnished with the name and phone number of the appropriate contact,” the manager continued. “But whatever the process, we are extremely mindful of confidentiality and privacy. There are times when we might even be overly cautious, but this is a very important and emerging area of concern.”


Wellness professionals primarily rely on the following resources for HRA referrals, the study revealed:

* Onsite nurse care managers.

* Health management summaries that explain aggregate results from HRA responses.

* Onsite medical departments that consist of physicians, nurses and wellness professionals.

* Contact lists of health insurance plan member physicians.

* Telephone counseling.

* In-person health education/behavioral change counseling.

Monitoring Success

Along with intervention comes the monitoring of success rates, and survey respondents track the HRA success rates in a variety of ways.

The use of employee participation and feedback was cited by most respondents, along with:

* Clinical test results.

* Lifestyle questionnaires.

* Onsite education.

* Administration of HRAs on a yearly basis to compare and monitor improvements in employee health status.

* Annual health management summaries that detail aggregate results from HRA responses (the results also are used to evaluate various company wellness programs).

* HRA updates performed at six-month and 12-month intervals.

* Comparison of HRA results to employee use of sick time, workman’s compensation claims, general health claims data and company HMO utilization.

* Baseline health screenings.

* Tracking the percent of employees identified as “at risk” for a serious health condition, along with the percentage who accept and follow through with subsequent referrals for further medical evaluation or care.

* Quarterly reports that measure increases in participation.

* Executive summary reports compiled before and after HRA administration.

* Estimation of cost savings from employees who have lowered their health risks by improving personal health, such as weight reduction, lowering blood pressure, and cholesterol and reduction of tobacco use.

* Sharing of experiences and personal success stories in wellness department newsletters.

“We can’t discriminate based on outcomes, so we monitor compliance,” noted a wellness program coordinator.

“For instance, if you are told to lose weight, we require that you attend eight sessions of Weight Watchers, for which the company pays,” the coordinator said. “But we don’t require that you actually lose the weight. Compliance is all we can legitimately require.”

Source: Workplace Wellness Management Leadership Survey conducted online at


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