Re-Envisioning the 
Health Risk Assessment

New Ocean Health Solutions partnered with Mad*Pow to re-envision the health risk assessment process with the goal of closing the gaps between population health risk profiling and individually tailored guidance and motivational support. 

  • More than 25,200 Independence Blue Cross members have completed this new PHA
  • This new PHA has received certification from the National Committee for Quality Assurance (NCQA)

  • Of those surveyed, 96% provided a positive view of the value and overall experience of the new health risk assessment

RE-INVISIONING THE HEALTH RISK ASSESSMENT

Over past several decades, a wave of ‘lifestyle diseases’ has emerged to disrupt the health and wellbeing of the western world. Physical inactivity, poor diet, alcohol, drug and tobacco abuse all contribute to increased mortality and reduced quality of life through long-term conditions such as type 2 diabetes, chronic obstructive pulmonary disease, heart disease, and obesity. The onset of these chronic conditions often occurs during typical ‘working years’ resulting in increased financial and productivity burdens to organizations due to illness-related loss of productivity due to absence from work (absenteeism) or reduced performance while at work (presenteeism).

Illustration of stressed out people
Fig 1: 77% of people regularly experience physical symptoms caused by stress

To counter these effects, employers are implementing health promotion and disease prevention programs aimed at nurturing better health through changes in employee behavior. These ‘workplace wellness’ programs can aim to prevent the onset of long-term conditions (primary prevention) or improve condition management and reduce complications (secondary and tertiary prevention). Interventions may range from targeting a single-behavior (e.g., increase physical activity) to multiple behaviors and be designed to focus on a specific condition or cross-cut multiple conditions with relevant behaviors.

Health assessment content flow and question set
Fig 2: health assessment content flow and question set

The Role of the Health Assessment
Often the starting point of wellness programs begins with a comprehensive assessment to identify health risks of employees before ideally connecting them with beneficial programs and services. Traditional health assessments include taking stock of health behaviors, biometric measurements, history of disease, and demographic data to build a risk-profile and provide feedback to individuals on how they might lower their risk score.

However, there exist many challenges within traditional risk assessment designs. Too often the question sets are long and arduous, requiring detailed medical information that may not be immediately available. Feedback provided may not be actionable due to recommendations being either too generic or vague to be relevant, too complex to be understood or too ‘in-your-face’ to be motivating. Additionally, HA feedback is not always rooted in the latest evidence regarding how to communicate health risks and the options people might choose to improve their health in a manner that directs and energizes behavior rather than frightens, frustrates, or otherwise demotivates the receiver. It is here in these challenges, where the opportunity for innovation exists despite the long-history and firm grip HA’s have on the population management industry.

The NOHS PHA Opportunity
With those opportunities in mind, Mad*Pow partnered with New Ocean Health Solutions to close the gaps between population health risk profiling and individually tailored guidance and motivational support. Together, we envisioned a solution that:

  1. Leverages a scientifically-governed set of questions that focuses not only on biomarkers of physical health and health-linked lifestyle behaviors but also explores mental health, positive functioning, social support, and financial health – items not typically present in Health Risk Assessments.
     
  2. Provides prioritized actionable feedback and recommendations that are individually tailored to individuals’ health profiles and motivation to change (readiness/importance and perceived confidence).
     
  3. Minimizes the burden and “hassle-factor” of assessment-taking by setting clear expectations up-front; using plain language throughout, providing choice and flexibility on the order of completion, and ensuring the experience is dynamic and engaging by sparking curiosity through leading teaser questions, and providing nuggets of surprising health facts, tips, and myth-busters throughout.

Delivering the Vision
It was determined early that our final scope would have two solutions; one long-form and thorough assessment – the now NCQA-validated Private Health Assessment and one boundary-pushing but valid short-form assessment – New Ocean’s Minute Health Assessment. Small overlapping teams of behavior change designers, content strategists, and copy writers were assembled to deliver the vision. One team to work on no-holds barred concept exploration and thematic development using the (now defunct) Michigan University a recognized university HRA as fodder for creative destruction and another team to work with behavior change experts Pro-Change Behavior Systems on using their HRI+ (Health Risk Assessment and Intervention) as the bedrock for the long-form assessment.

Concept sketches from design collaborations
Fig 3: concept sketches from design collaborations

Minute Health Assessment®
Our outside the box team worked to ruthlessly reduce the traditional long form HRA down to the smallest set of questions we could get away with and still provide a valid assessment. At the same time, we worked on imagining novel modes of delivering questions and providing feedback. We explored a number of different themes and interaction patterns from highly visual and playful interactions to garden, racetrack, mirror, and crystal ball metaphors. Ultimately, two separate themes came together to form the minute health assessment. The first pattern was the use of “Did you know?” teaser questions and facts (e.g., “Did you know?... When it comes to health waist size matters…) to pique curiosity and provide useful information before answering assessment topic questions and the second is the use of framing feedback outputs as health personality profiles (or archetypes) that guide assessment completers towards relevant digital lifestyle and chronic condition programs matched to their health status, overarching health goals and preferences (personality). The less than two-minute, 15-question assessment calculates an individual’s archetype from their level of belief that lifestyle behaviors can positively affect health, their overarching health goals, and lifestyle and medical risk factors.

Assessment & Intervention Ontology
Fig 4: assessment and intervention ontology

Private Health Assessment
For our work on the NCQA certified (Aug. 2018) Private Health Assessment, we aimed to establish a more rigorous and comprehensive instrument. We needed to ensure the ability to stratify employees into risk profiles, assess employee motivation for change, and offer tailored feedback and matched interventions based on resulting health and motivational profiles. In collaboration with Pro-Change Behavior Systems, we were able to design an evidence-based instrument to assess individuals’ risk of negative health outcomes, readiness to change health related behaviors, and their confidence to do so. Motivational profiles are built from constructs underpinning Self-Determination Theory (Deci E, Ryan R, 1997) and Pro-Change’s Transtheoretical Model (Prochaska JO, Velicer WF, 1997) and used to provide tailored feedback based on individual risk level, quality of motivation and stages of change. For example, individuals in earlier stages receive feedback to improve quality of motivation through by tapping into larger life and aspirational goals, individual values and interests, whereas individuals in later stages receive concrete action plans and evidence-based interventions for changing priority lifestyle behaviors.

health assessment mobile screens
Fig 5: health assessment mobile screens

The PHA question structure is similar to the MHA, with its up to 70-questions (depending on skip logic) grouped into manageable sections that can be completed in any order. Each section begins with teaser questions and novel insights and ends with personalized feedback. Upon completing the entire assessment (15-20 minutes) individuals receive detailed information and recommendations based on stratified risks and readiness to change.

Results
After three months of creative exploration and refinement, assessment question, answer, and logic editing, and over 300 paragraphs of custom feedback written, a re-envisioned health assessment emerged. Both the Minute Health and Private Health assessments provide mobile-optimized health risk and motivational assessments that deliver an engaging, personalized HA instrument for health plans and employers looking to better manage population health.

NHQA Headquarters
Fig 6: NCQA headquarters

At the of time of writing (Aug 2018), the PHA has undergone rigorous evaluation and received certification from the National Committee for Quality Assurance (NCQA) and has been completed by over 25,000 Independence Blue Cross members with 96% of those surveyed providing a positive view of the instruments value and overall experience.

 

"First health assessment in over 30 years in the industry that felt as if it was for me and not my employer."

Broker Consultant