The document provides guidance on developing an effective Health Risk Assessment (HRA) for a health plan, noting that one should form a committee to determine the appropriate questions, target the right audience, include required elements, consider various completion methods, and ensure follow up with customized results and health resources for members. The HRA should gather personal health and social information to identify risks and needs while meeting regulatory and accreditation standards through an accessible process. Developing an HRA requires thorough planning but can help health plans and case managers improve members' health.

1. Developingan
HRATCSHealthcareTechnologies
Prepared by: India Carson, RN, MSN

2. About:
Youworkforahealthplanandyourorganizationwantstodevelopa
HealthRiskAssessment(HRA). Wheredoyoustart? What
questionsdoyouwanttoask? Whatquestionsshouldyouask?
WhatdoyouintendtoaccomplishbycompletingtheHRAwithyour
members? Doyousimplywanttofulfillarequirement,ordoyouwish
toidentifymemberswhohaveachronicconditionormaybenefit
fromcasemanagementorabehavioralhealthprogram?

3. Don'tGoit
Alone!
Youmaywanttoformacommitteeto
assistwiththequestiondevelopment. The
committeemembersmayincludeCase
Managers,DiseaseManagers,Prior
Authorizationstaffandanyoneelsethat
hasmembercontact. Thiswillprovideyou
withinformationaboutwhichquestions
mayelicittherightinformationandwhich
questionswillbeappropriateforyour
members.

4. YourTarget
Audience
Whoisthetargetaudienceforthehealth
plan? DoesthehealthplanserveaMedicare
orMedicaidpopulation,ordoesitinclude
Commerciallinesofbusiness? Doesitserve
bothplans? Thedesireistoaskquestions
gearedtowardthemembersyouserve. You
mayhavequestionsthatarehidden
dependingonthemember’sageorsex. For
example,youmayhidethequestions
regardingmemoryformemberswhoareless
than65yearsofageandhidethequestions
formammogramsformalemembers.

5. Accreditation?
AreyouseekingNCQAorURACaccreditation? Ifso,youmaywishtoinclude
questionsgearedtowardsatisfyingthoserequirements. Doesyourcompany
haveacontractwithCMSoraCMSentity? Ifso,youmaywanttolookatthe
CMSrequirementsforahealthriskassessment. AccordingtoCMS,the
questionsthatoneshouldaskduringanannualwellnessvisitinclude,ata
minimum: demographicdata,self-assessmentofhealthstatus,psychosocial
riskfactors,behavioralriskfactors,activitiesofdailyliving,suchasdressing,
bathing,walking,andinstrumentalactivitiesofdailyliving,suchasshopping,
housekeeping,managingone’sownmedications,andhandlingfinances.1
Inanyevent,youshouldconsiderquestionsthathelpyoumeettherequirements
fortheaccreditationwhichyouareseeking. Youalsowanttokeepinmindthat
requirementschangeovertime,thereforeyouwillwanttostaycurrentwiththe
accreditingagency’srequirements..

6. QuestionstoInclude:PersonalHealthHistory:Includingimmunizations,surgeries,pasthospitalizations,
andchronicillnesses.
PersonalHealthHabits:Anyscreeningsandannuallabtestsandimmunizations.
Medication:Acurrentlistofmedicationsshouldalsobegathered,includingover-
the-counter,vitamins,anysupplements,andthemember’sadherenceto
prescriptiondirections. Also,ifthememberisnotcomplyingwiththeprescription
directions,youwillwanttoexplorewhythememberisn’tadheringtothemedication
regimenasprescribed. Isthemedicationtooexpensiveoristhemember
experiencingunpleasantsideeffectsfromthemedication? Youshouldalsoexplore
anymedicationinteractions.
Normal:Member’sheightandweight,andself-reportedbloodpressureshouldalso
becollected. Oneshouldconductadepressionscreeningandeitheraskaboutor
conductacognitiveimpairmentexam,andaskpersonalsafetyquestions.
Social: Oneshouldalsoexplorethemember’ssocialdeterminantsofhealth. Asking
questionsabouttheirabilitytomeetdailyneeds,accesstohealthcareservices,
transportationoptions,publicsafety,socialsupport,andcultureorsocialnormswill
provideyouwithimportantinformationaboutthemember.

7. LiteracyRequirement
MetricstoMeasure:
AnHRAforanannualwellnessvisit,
accordingtoCMSrequirements,mustbe
writtenatasixth-gradeliteracyleveland
membersshouldbeabletocompleteitin
20minutesorless.4
Educationalmaterialsshouldalsobe
composedatasixth-gradelevelandbe
availableinthelanguageofpreferenceof
themember.
AlthoughscoringtheHRAishelpfulto
indicatethenumberofriskfactors,CMS
doesnotrequirescoringtheHRA.4
Youwillwanttocheckwithyour
complianceofficertovalidateeducational
requirementsforyourspecificpopulation
andyourcontractualobligations.

8. DeliveryMethodYearsago,paperandpenwerethedeliverymethodsofanHRA. Today,electronic
deliveryoftheHRAispreferred,butitisnottheonlymethodthatshouldbeavailable.
AnHRAshouldbeavailableforthemembertocompleteviaaMemberPortal. Itshould
alsobeavailablefortheCaseManagertocompletewithamemberwhileonthephone
orinperson. ACaseManagermayalsoconductahomevisittocompletetheHRAand
shouldbegiventheoptiontocompleteitviapenandpaper. Membersmayalsobe
uncomfortablewithanelectronicversionofanHRAandshouldbegiventheoptionto
completeapenandpaperversion.
TheCDCalsorecommendsthataccommodationsbemadefortheindividualswith
physical,sensory,andcognitivelimitations. Formemberswithlowvision,printed
materialinlargefontorversionsavailableinBraille,audio,orquestionsreadtothe
individualbyaCaseManagermayberequired. AccesstoHRAmaterialsanddocuments
shouldbeincompliancewiththeOfficeforCivilRights;TitleVIoftheCivilRightsActof
1964;PolicyGuidanceontheProhibitionAgainstNationalOriginDiscrimination
AffectingLimitedEnglishProficientPersons.5

9. FollowUp
Activities
AcustomizedsummaryoftheHRAshould
beprovidedtothepatientindicatingwhat
areasoftheirhealththeyarehaving
difficultywith,theirhabitsandbehaviors,
howtheycanimproveontheirown
healthcare,areviewofthepreventive
strategiestheyhavecompleted,andalist
ofonestheyhavenotdone. Itmayalso
includealistofarticlestheymayreadto
improvetheirknowledgeofahealthcare
topic.4

10. Summary
DevelopinganHRAisnoeasytask,butitcan
bedone!Withtheproperplanningand
assistancefromothersonyourteam,youcan
createaterrificHRAthatwillbeusefulto
yourmembershipandtotheCaseManagers
withinyourorganization.

11. ForMore
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