The HRA: Your Wellness Program’s 2014 MVP?





OK, hear me out… This isn’t 2004, I know, but some new research has shown us again not to pan the humble HRA. The Journal of Occupational and Environmental Medicine for December just came out with a great new study that shows that the HRA ALONE drove significant reductions in seven of eight key health risks and led to CUTTING THE AVERAGE HEALTH CARE COST IN HALF AFTER THREE YEARS (You can get the abstract of the article here).


This is interesting timing because in meetings with wellness program managers in the Midwest just a couple weeks ago, I was hearing about how passé HRAs are. One seasoned wellness leader said, “My employees often say that their HRA results are the same every year–so why should they fill one out?” Another said, “[HRAs] are boring and hard to get people to complete.”


I have to think that these well-meaning wellness professionals must be somewhat representative of many of you out there. Have you had a challenge getting folks to complete HRAs? Tell us in the comments your challenges and your ideas for getting more out of your HRA…


So as an ode to the humble HRA, I want to do a couple posts on them in the New Year. First, we’ll look at how to make the HRA more of a memorable and powerful intervention, second, how to drive much greater participation, and third, we’ll give you some edgy ideas on how to push your vendors (or reasons to fire vendors that can’t cut it).


But first …..take a few minutes over the holidays to consider your HRA. This thing should feel like one of your children or at least a beloved pet! It is such an important part of delivering results-driven wellness. How can you plan program interventions without it? How can you risk stratify your population without it? How can you measure your program’s effectiveness without it?

For something so important, of course you would have to fight for every percentage-point of participation, and doggedly look for ways to improve the user experience.


Join us in January to learn about breathing new life into the humble HRA!


May these last two weeks of the year be a time of enjoying family, friends and the joys of the holidays!


  1. It’s great to hear a pro-HRA argument! It has been the functional unit of a population health program for the reasons you state – a way to assess individual health and provide an intervention referral, a way to guage population health issues and plan programs, and a progress measuring stick. However, in this day and age, it has to be quicker to complete (while remaining meaningful), and able to be done off of any device. Also, with today’s common practice of “complete this or pay more in monthly contributions”, I am concerned about how honestly people are answering. It has to not only be convenient, but personally compelling. People need to feel that they are doing something that can help them – not just checking a box.
    This is a really important debate for our industry and a challenge for all of us to figure out.

  2. According to the JOEM article, the HRA was administered “as part of a health and wellness program (HWP) and included disease management and behavior change components.”

    My question is how the study authors were able to attribute the results solely to the HRA and not the other program components. I’ve contacted the lead author but haven’t received a response.

    Wouldn’t it be great if all we had to do was administer a HRA annually and get these wonderful results?

  3. I believe HRA’s can be helpful to answer questions about behaviors (sleep, stress, depression, diet, activity levels, etc.). I do not think HRA’s should overlap with what is collected from biometric screenings or physician forms. This creates double work to sync up the results and to make sure they are completed honestly and accurately. We are working on some really exciting new delivery methods for HRA’s and we believe it will transform their experience and completion rate. To the first comment, I agree that they must be convenient and short. To the second & third comment, yes it does seem a little ridiculous that the HRA is responsible for the program savings.

  4. I agree with you, Larry, that there’s still a place for HRA’s. The study by Seth Serxner and friends from JOEM in 2003 first showed the benefit of the dose response of HRA’s. It made complete sense to me, that we pay more attention to our health risks if we’re constantly reminded of them. I think it’s true even if we’re reminded only once a year, but especially if healthy choices are promoted throughout the year. As Earl Nightingale said, “The mind moves in the direction of our currently dominant thoughts.”

  5. Thanks for all of your comments on my original post! You all raise good issues that need additional attention and thought. My purpose in highlighting the recent JOEM article was to identify an article that points to some of the potential value of the HRA that I don’t believe we are generally attaining. It’s my opinion that we have bolted up an HRA (Any HRA- for that matter!) and forgotten about doing the challenging research and developmental work on how to make it a truly meaningful experience to the user. If you will bear with me….I would be interested in what each of you think would make the activity of taking an HRA a meaningful experience for your own wellness?

  6. Personally, the incentive and learning are both important. Many would like to know basic recommendations and why. For example, the recommendation for sleep is 8 hours. Research suggests one will be better able to maintain weight and have improved productivity; important functions for most! Professionally, the more a client knows about what they ‘should’ be doing, the better they are at assessing their health vision and what shorter goals they may want to work towards. This makes establishing baby steps toward those goals easier.

    • Excellent point Joan! Your comment highlights for me the interconnectedness of various elements of personal health knowledge (Like sleep patterns and weight loss) and underscores the need for helping the individual understand these inter-relationships. How do you help the people you coach appreciate these kind of connections?

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