Best Practice #3: Collect Data To Drive Your Health Efforts
How to Collect The Right Health Data
Health Risk Appraisals, Health Culture Audits, and Personal Interest Surveys Should Be The Core of Your Data Collection Efforts
by David Hunnicutt, PhD
In building a results-oriented worksite wellness program, it is essential to collect data. From our perspective, data collection is a serious undertaking that is crucial to the overall population health management process and a task that U.S. companies are just now beginning to embrace.
When it comes to collecting data, it’s important to understand that there are several types of data that need to be gathered if your company’s wellness program is to thrive. While there are many forms of data that can be collected, it is absolutely essential to gather data from three primary sources—an employee health risk appraisal, a company-wide health culture audit, and an individual interest survey.
By having data from these three sources, worksite wellness practitioners will have at their disposal rich forms of information that can be analyzed and utilized to build a solid foundation for a results-oriented worksite wellness program.
In the paragraphs that follow, we will discuss each of these important forms of data.
Data Source #1: Employee Health Risk Appraisals
The first primary source of data that needs to be gathered comes from the administration of an employee-based health risk appraisal. For the uninitiated, a health risk appraisal is an electronic or hard-copy health questionnaire that is utilized to gather important information about employee health behaviors and risk factors.
Overview of HRAs
There are now a number of excellent health risk appraisal tools available to employers. Generally, a health risk appraisal will consist of approximately 85-100 questions. The questionnaire can be delivered electronically or in hard copy format.
Most health risk appraisals are written at the 6th to 8th grade reading levels to ensure that all questions can be readily understood by diverse employee populations. On average, an employee-based health risk appraisal will take anywhere from 10 to 20 minutes to complete.
Once completed, employees will receive a customized and tailored individual report detailing their personal health status. Generally, if an employee completes the HRA electronically, they will receive this report immediately via a PDF that can be printed on a local network. If the employee completes a hard copy version of the HRA, they will receive their personal report via the mail in about two weeks time.
Cost of HRAs
Generally, a good health risk appraisal will cost approximately $5 to $15 per employee for an electronic version and $10 to $25 per employee for a hard copy version. The hard copy version is generally more expensive because it involves the physical cost of producing a paper-based HRA as well as mailing fees. It’s also customary to anticipate a set-up fee to make sure that your account and database are configured properly. To maximize your budget, it’s essential to communicate with your HRA vendor to uncover any additional fees that may apply to data transfers and report generation.
The key to making the HRA process work for both the employee and the employer is confidentiality. Employees should be assured and comfortable that the employer will have no access to any individual employee health data. In addition, employees should also be informed that the company will receive an aggregate report of the overall findings, but that this report does not and will not contain any individual health identifiers. Just to give you a heads up, if response rates are below 50 people, an aggregate report is generally not provided to further protect confidentiality.
It goes without saying that well-positioned incentives are critical in driving up participation rates in the company health risk appraisal process. While participation norms are hard to come by, it’s generally accepted that without any incentives, companies can expect about 10% of the employee population to participate. With the proper incentives, participation rates have been achieved as high as 95%+. Let’s take a closer look at the broad categories of incentives.
- Trinkets and T-Shirts. The first general category of incentives is trinkets and t-shirts. Incentives that fall within this category generally include t-shirts, water bottles, pedometers, etc. While not known to drive huge participation rates, trinkets and t-shirts can certainly be used to increase the overall participation rate for your health risk appraisal. This approach works especially well in the first year as the incentives—although inexpensive—are novel as employees are generally unfamiliar with how the process works. If utilized, this form of incentive can increase participation rates from 10% to 20%.
- Merchandise and Gift Certificates. The second general category of incentives includes merchandise and gift certificates. Because these have a higher perceived value, merchandise can drive participation rates to somewhere around 40%. Specifically, merchandise includes things like movie tickets and gift certificates—and the higher the perceived value, the greater the participation rates.
- Tax-Advantaged Cash Incentives. The third general category of incentives includes cash. As one would expect, cash speaks loudly to incent participants to take part. Many companies will offer $25 to $50 tax-advantaged cash incentives to increase participation rates. And it works. In fact, if you utilize this type of incentive you can generally expect participation rates to exceed 50%. A word of instruction is necessary here. It’s essential that cash is awarded in a special tax-advantaged format. This allows employees to receive the $25 to $50 after taxes. If you don’t utilize this format, employees are awarded odd amounts like $19.38 which generally doesn’t have all that much perceived value. But, if done right this category of incentives is powerful. Just as an aside, many struggle with understanding how this is actually done. Not to worry, check with your benefits people as they will have a solid grasp on this concept.
- Benefit Plan Redesign. The fourth and final category of incentives involves a redesign of your present benefit plan. Specifically, health risk appraisals can be made a mandatory part of the company benefit re-enrollment process. If you take this approach, you can expect participation rates of 100% for those that utilize your company’s benefit plan. While the participation rates are hard to argue with, many companies don’t like the feedback that comes along with strong-arming employees into adopting a personal health risk appraisal.
Similar to making it mandatory is the notion of raising health insurance premium levels for all employees and then offering a significant reward for those who participate in the health risk appraisal process. For example, it’s not uncommon for companies to inform all employees that contributions for health insurance will be increasing for everyone by $500 in a given year. At the same time, employees are informed that if they take a confidential HRA, that $500 fee will be waived. Although it takes some effort and communication, when companies incorporate this approach to incent employees, participation rates often exceed 85%.
Communicating The HRA Process
While there is little question that an incentive helps to drive participation, it is also essential to fold in a solid communication plan. This communication plan should be initiated four to five weeks prior to the launch of the HRA. The communication plan should include several important messages. The first message that employees should get is, “we care about you as an employee of this organization.” The second message is, “your health status is the pearl of great price and we want to help you maintain or improve your health for years to come.” The third message is, “we are offering you the opportunity to participate in a voluntary health risk appraisal process.” Finally, employees should be given a contact number so that they can gather further information or clarify concerns.
Once your communiqué includes these core elements, you’ll also need to highlight how the process will work logistically and, once completed, how they can acquire their incentives.
Like incentives, the communication plan is an essential part of the HRA process. If done well, participation rates will remain high.
Ideally the HRA process should be conducted each year. In so doing, your employees will have an ongoing account of their personal health status and you, as an organization, will have a year-by-year record of health trends in your organization. If the organization is unable to fund the HRA on an annual basis, we would recommend doing it every two years. While not ideal, it still provides a useful and important function within the organization.
Data Source #2: Company-Wide Health Culture Audit
The second primary source of data that should be collected is a company-wide health culture audit. Again, for the uninitiated, a health culture audit is an instrument that assesses the company’s overall culture as it relates to health and productivity. A good health culture audit will assess things like your company’s health norms, your employees’ individual attitudes about health, and the personal perceptions that exist concerning health and well-being as it relates to your organization.
While many people struggle with the term culture, this need not be the case. In essence, culture is how things get done in your organization. It’s the way people collectively and individually go about doing their jobs day-in and day-out. Obviously, your health culture is how people go about staying healthy while they’re employed by your organization.
From our experience, it is essential to collect information relating to the overall health of your company’s culture because your culture is a powerful influence on individual health status. This audit will provide you with important information as to how people are perceiving and embracing your company’s health and productivity initiative.
If you are on the fence about the need for offering a health culture audit, consider this. It is possible to improve employee health and, at the same time, destroy individual trust and morale. For example, we’ve encountered companies that have been zealous in their approach to improving employee health status. They’ve gone to great lengths to implement health risk appraisals and behavior management programs. Utilizing a “big stick” approach (as opposed to carrots) companies have strong-armed their employees into adopting healthier behaviors. While generally well-intended, many of these companies have also systematically destroyed their company’s culture. By offering an annual or bi-annual health culture audit, these companies could have been forewarned to the damage that was being done and changed their tactics. However, by failing to utilize the health culture audit process, strong-arming companies have won the risk factor reduction battle, but lost the war because employees became alienated, disengaged, and hostile to the overall health management process.
Although the concept of a health culture audit has been around for a long time, there are still relatively few on the market. But, because the priority of maintaining employee health and well-being has been elevated, there’s little doubt to the fact that there will be more audits available in the future. If you are interested in learning more about the health culture audit process, we encourage you to log on to www.healthyculture.com.
Data Source #3: An Individual Interest Survey
The third primary source of data is an individual interest survey. An individual interest survey will uncover both met and unmet health interests within your employee population. Like the HRA and health culture audit, an individual interest survey should be considered a non-negotiable part of the annual or bi-annual data collection process.
Indeed, an individual interest survey is more than just a nice complement to the aforementioned data sources. To be sure, this data source provides an opportunity to triangulate all of the information gathered and systematically sift through it to ensure that your employees are being offered programs and interventions that are of particular importance to them. If you choose to forgo an annual interest survey, you do so at significant risk—to both you and your employees.
In reality, there are several reasons why we feel so strongly about interest survey administration.
An interest survey can uncover hidden opportunities. By committing your organization to doing an annual interest survey, you can uncover hidden opportunities that can exponentially move your wellness program forward. For example, an interest survey allows your people to tell you what’s important to them. And, if we’re smart enough to listen, the payoff can be significant. In fact, without an annual interest survey, it’s unlikely that anyone would have uncovered the burning desire for newly emerging financial wellness programs. If you still question whether interest surveys can uncover hidden opportunities, we encourage you to contact practitioners who are offering leading-edge programs. More often than not, they’ll tell you that it’s due to staying in close touch with their employees. This closeness, many times, is due to a well-designed interest survey.
Interest surveys make employees feel a part of the process. In addition to uncovering hidden opportunities, an interest survey makes your employees feel a part of the overall programming process—and this is of great value. Indeed, the more involved your employees are in your company’s health management process, the more committed they are to making it successful. Plain and simple, employees feel good when they are given the opportunity to make their opinions known. In some instances, employees may be telling you things you’ve known for a long time. But just because you’ve known them, doesn’t necessarily mean that your employees have felt that their opinions mattered.
Interest surveys offer you the opportunity to balance needs and interests. This is a crucial aspect of interest surveys. In fact, by collecting interest survey data, practitioners can balance both needs and interests thereby creating programs that advance both individual health interests and organizational wellness priorities. For example, imagine a company that, because of the enormous healthcare costs and the toll that tobacco use takes on productivity, places a high priority on tobacco cessation programs. While the organization’s aggregate health risk appraisal report indicates that there is indeed a need to address this important topic, few employees are interested in this intervention—without providing an employee interest survey, this company is basically programming for an organizational need that has little employee interest. And, unfortunately, many organizations have found this out the hard way.
Now consider how an employee interest survey might have avoided this situation altogether. By gathering interest data, the practitioner would have identified that employees place an enormous emphasis on physical activity and weight management interventions. The astute practitioner would have seen that the organizational need was to address tobacco cessation, but employee’s interests lied in physical activity and weight management.
In this case, to balance both needs and interests, the company’s wellness practitioner chose to widely promote physical activity and weight management programs among the employee population—and once employees were actively engaged, the practitioner began to integrate the very real need of tobacco cessation into the actual content of the physical activity and weight management programs. By taking this approach, this practitioner was able to engage larger numbers of people in listening to the merits of quitting tobacco products or in supporting those who would like to quit. At the same time, they avoided the negative pushback—and lethargy—associated with programs that are of low overall interest to the organization as a whole.
Developing An Interest Survey
While it is possible to use an off-the-shelf interest survey, we would recommend that you develop your own. The best way to do this involves a two-step process.
- Conduct Focus Groups. The first step to developing your own interest survey is to conduct a series of focus groups with your employees. Focus groups should incorporate a diverse group of employees who represent the typical consumers who would take part in your programs. The focus group itself should be held in a quiet room and will generally take about 1 to 1½ hours. During this focus group discussion, it is essential that you pose broad-based, open-ended questions that engage participants in the communication process. To be sure, each question posed to focus group participants should start with how, what, why, when, and/or where. These types of questions give participants an opportunity to elaborate—which is precisely what you are looking for. If you ask questions that, for example, begin with the word “Do,” you will get “yes, no, or I don’t know,” as a response. Speaking from experience, the silence created in the group will be uncomfortable to say the least.
- Once you’ve conducted your initial focus groups, it’s time to make sure that you transcribe your notes, audio tapes, or video to uncover common themes among the group. Again, speaking from experience, you do not want to let your notes get cold.
- Developing the Interest Survey. With focus groups behind you, it’s time to start crafting the interest survey itself. Given the vast amount of information you’ll have from your focus groups, you’ll be surprised how quickly the survey will come together. Generally, it’s just a matter of structuring your questions into yes/no or Likert scale response mechanisms. Prior to launching your interest survey to the population at-large, you’ll definitely want to pilot test the survey with a small sample of colleagues and employees. While it can be a hassle to do this—not to mention that it slows the process down—you’ll sleep easier knowing that there aren’t any landmines in your survey.
The Three Primary Sources of Data
In this article, we’ve outlined the three primary sources of data that you’ll need to collect in order to develop and advance a results-oriented wellness program. From experience, we recommend gathering data utilizing health risk appraisals, health culture audits, and employee interest surveys—at a minimum! Certainly, there are other important forms of data that can be collected. If you have the opportunity to utilize other forms of data like a modifiable medical claims analysis and/or absenteeism records just to mention a few, we would encourage you to do so. However, the three primary sources of data discussed in this article should remain at the core of your initiative.