HomeMy WebLinkAboutHealth Risk Assessment Memo
TO: BOARD OF COMMISSIONERS
FROM: DAVE INBODY & RONDA CONNOR
SUBJECT: HEALTH RISK ASSESSMENTS
DATE: 1/18/2013
CC: TOM ANDERSON, ERIK KROPP
Background
In January 2011, Deschutes County offered health risk assessments to anyone on the health benefits plan
over the age of 18 at no cost. The health risk assessment included the following:
Online Questionnaire – Each participant completed a series of questions regarding a variety of
health-related topics such as nutrition, exercise, tobacco use, safety, hygiene, stress, etc…
Biometrics – Height, weight and blood pressure was measured for each participant
Fasting Blood Work – Blood was drawn from each participant and the cholesterol, triglycerides
and glucose levels were tested
In January 2012, in an effort to increase participation, employees were given a one -month health insurance
premium holiday ($65 value) for taking a health risk assessment. This had a significant impact on
participation among employee. Spouse and dependent participation was about the same as 2011.
Chart 1: Participation by Year and Participant Type
Employees Spouses Dependents
(18-26)
Total
2011 Participants 320 48 9 377
Eligible 1,018 716 176 1,910
% Participating 31% 7% 5% 20%
2012 Participants 525 50 7 582
Eligible 1,002 697 245 1,944
% Participating 52% 7% 3% 30%
2013 Health Risk Assessment
In both 2011 and 2012, the health risk assessments were primarily offered through events held at six work
locations. Deschutes County paid Healthstat, the operator of the Deschutes Onsite Clinic (DOC), $40 per
participant to conduct these events. In 2013, the DOC, operated by Medcor, will take a different approach.
During the period from January 1-March 31, eligible members of the health benefits plan will schedule an
appointment at the DOC for their health risk assessment at a cost of $25 per participant. In early March, an
assessment will be made regarding participation and, if necessary, events will be planned for the end of
March.
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2013 Incentive Options
In order for an incentive to be received, the participant will be required to complete the online
questionnaire, the blood draw, biometric readings and a follow-up visit at the DOC to review the results.
The addition of an incentive in 2012 significantly improved participation among employees. For 2013, the
recommendation is that an incentive be offered not only for the employee, but also for participation from
the spouse. Currently, there are 1,035 employees and 727 spouses covered by the health benefits plan.
There are several options for providing an incentive. Here are three such options.
Option #1: Health Benefits Premium Holiday – Similar to last year’s method, all employees
who complete all the requirements for the health risk assessment would rec eive a health benefits
premium holiday for the month of July 2013. If a spouse completes the health risk assessment, a
premium holiday will be provided in August 2013. This option would be pre -tax. Last year
indicated that such an incentive is effective, however, due to the extended period for employees to
participate and providing three months for them to schedule a follow-up appointment, the
incentive is not timely.
Option #2: Direct Payout – Once a participant completes all the requirements for the health risk
assessment, a $50 check will be generated for that participant. This option is timelier than option
#1, however it could not be provided pre-tax; therefore, employees would be taxed on it.
Option #3: Premium Adjustment – If an employee and spouse complete all the requirements for
the health risk assessment, their monthly health benefits insurance premium will be discounted $5.
This option is not timely, but it is pre-tax. It would require both employee and spouse to
participate, which could impact participation. As an incentive, it would extend throughout the
year.
Chart 2: Comparing Incentive Costs
Option #1 Option #2 Option #3
Cost per Employee $65 $50 $60
Cost per Spouse $65 $50 $0
Total Cost $57,265 $44,050 $31,050
These calculations assume a monthly premium of $65 and 50% participation
Why do Health Risk Assessments Matter?
The purpose for providing health risk assessments for health benefits participants is to encourage a pro -
active, preventive approach to health care. The participant is provided a snapshot of their health condition
and risk factors can be minimized before the onset of a chronic condition. For Deschutes County, a
healthier population results in lower health benefits costs.
1. Most Expenses with Few Participants - In the last 12 months, 31% of health benefits expenses were
as a result of 37 participants out of a total population of 2,92 0.
Chart 3: 2012 Health Benefits Cost Distribution
# Participants % Participants Expense % Total Expense
$0 101 4% $0 0%
$1 - $1,000 987 34% $486,092 4%
$1,001 - $2,000 622 21% $920,591 7%
$2,001 - $5,000 761 26% $2,371,034 18%
$5,001 - $10,000 237 8% $1,621,859 12%
$10,001 - $25,000 130 4% $2,065,977 16%
$25,001 - $50,000 45 2% $1,615,566 12%
$50,001+ 37 1% $4,044,939 31%
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2. HRA Participation Leads to Cost Savings - Many high-value claims are for behavioral-driven
conditions. For example, among the 50 most expensive participants, 15 are diagnosed with heart
disease and 10 are diagnosed with diabetes. The risk for both of these conditio ns can be tracked
through the testing provided as part of the health risk assessment, such as blood pressure, cholesterol,
triglycerides and glucose. In comparing the HRA results among those who participated in both 2011
and 2012, the following were identified:
24% reduced their number of risk factors
83% identified with high blood pressure reduced it to normal range
56% identified with high glucose level reduced it to normal
76% identified with high triglycerides reduced it to normal
40% of tobacco users quit
Each of these changes results in cost savings. Those who took the health risk assessment in 2011
averaged $3,832 in claims over the next 12 months compared to those who did not take the health risk
assessment who averaged $4,972. This was also reflected in health service claims for specific services. The
following chart illustrates the difference:
Chart 4: Comparison of Claims for Specific Services by HRA Participation
Change from 2010 to 2011 Visits
HRA
Cost
HRA
Visits
Non-HRA
Cost –
Non-HRA
ER Visits -15% +$1,293 -25% -$2,378
Office Visits +6% -$44,295 +15% +$89,481
Inpatient Hospital -40% -$65,499 +29% +820
Outpatient Hospital and
Ambulatory Surgical Care -20% +$81,192 -3% +$81,812
Other Places of Service -27% -$9,660 -5% -$4,252
TOTAL -10% -$36,969 +4% $165,483