The Ultimate Guide to Health Risk Assessments

What is a Health Risk Assessment?

A health risk assessment (HRA), sometimes known as a health risk appraisal or health assessment, is a questionnaire that evaluates lifestyle factors and health risks of an individual. 
There are many types of HRAs, and they can be used for different purposes. For example, many population health and wellness professionals use comprehensive HRAs that cover all dimensions of a person’s total well-being, including nutrition, fitness, stress, sleep, mental health, and biometric information such as blood pressure and cholesterol. Healthcare marketing professionals use targeted, condition-specific HRAs as part of their larger marketing and patient engagement strategies. 
In both use cases, a typical HRA includes:  
  • Question section 
  • Risk score 
  • Report with individualized feedback on areas of improvement

Health Assessments For Patient Engagement and Acquisition

Health assessments can include condition-specific questionnaires, symptom checkers, and eligibility checkers that help prospective patients self-identify their need for care. These assessments are shorter than a comprehensive HRA used in population health and wellness programs, and typically focus on one condition or health concern. 

Healthcare marketers and patient navigators use health assessments to identify prospective patients, engage with them to seek medical care, and ultimately schedule patient encounters.  

Jump ahead to learn more about condition-specific health assessments that drive service-line revenue.

Background of a Health Risk Assessment

What is the history of health risk assessments?

The origin of the HRA can be traced all the way back to the late 1940s when Dr. Lewis C. Robbins (link opens as PDF)  began to document patients’ health hazards in an effort to not only treat disease but also prevent it. For the next 20 years, the idea of a health hazard chart for physicians’ use progressed to a complete HRA including a patient questionnaire, health risk computation, and feedback strategies.

In 1979 Wellsource’s very own Dr. Don Hall created the first U.S.-based computerized health risk appraisal.

The following year the Centers for Disease Control and Prevention (link opens as a PDF) released publicly available HRA software that included a self-administered survey to calculate adult health risk. This led to the widespread use of health assessments in the workplace.

What is the difference between a health risk assessment and health appraisal?

Essentially, the terms Health Risk Assessment and Health Appraisal are synonymous, as they both collect and measure lifestyle factors and health risks. Most wellness and population health managers use the terms health risk assessment and health risk appraisal interchangeably. Learn more on the Wellsource Blog.

Who takes a health risk assessment?

Typically, in population health and wellness programs, HRAs are distributed among workforce and health plan populations. Some populations may be required to take an HRA based on their care, such as Medicare and Medicaid recipients.  

  • Medicare recipients are required to complete an HRA by the Centers for Medicare & Medicaid Services (CMS), as part of the Medicare Annual Wellness Visit (AWV). The AWV informs care plans with the intention of reducing costs of care.  

Who takes a condition-specific health assessment?

Healthcare marketers use health assessments to engage with patients and drive service-line growth. Jump ahead to read more about HRAs for patient engagement and acquisition.

The value of self-reported data for improved population health outcomes

HRAs use self-reported data to provide potentially life-saving information about an individual’s current and future health risks.

This data is a critical component of understanding population health and provides health and wellness professionals the insights they need to make targeted and informed population health decisions. By gathering data right at the source—from the individual—wellness and population health professionals shape impactful programs based on information that’s often harder to gather than biometric data.

Think of self-reported data from an HRA as one dataset in your arsenal, giving additional insights into the claims and medical data you’re seeing, or corroborating the story told there. It adds layers of understanding and nuance.

This self-reported data complements biometric or clinical data a healthcare provider may gather. While the empirical data that physicians obtain—such as blood pressure or lab results—are good indicators of a person’s current health, only the individual can provide details on other aspects of their wellbeing that indicate their future risks, such as their mental health status or lifestyle habits that play a significant role in their future health.

Guide: The Value of Self-Reported Population Health Data

Self-reported data is a critical component of understanding population health and provides health and wellness professionals the insights they need to make targeted and informed population health decisions. 

Download this guide and get tips for gathering reliable, actionable insights.

The Role of a Health Risk Assessment

The role of HRAs in population health

Population health as practiced today encompasses community and healthcare entities and individuals working together to improve the health outcomes of the populations they serve. It has evolved from being primarily focused on the measurement of outcomes to now include an emphasis on comprehensive efforts, targeted outcomes, and collective responsibility. It includes the personal, social, economic, and environmental factors that influence the distribution of health outcomes, and the policies and interventions that affect those factors.

HRAs allow population health managers to collect important data to influence the success of their intervention efforts. This data can help identify and segment individuals who are at greater risk for chronic disease.

HRA data can also be viewed in aggregate, helping population health managers identify trends and predict risks before they arise. For example, noticing that individuals are maintaining unhealthy nutrition habits suggests that future health conditions may surface. Population health managers can act by enrolling individuals into coaching programs or lifestyle mediation before it becomes a problem.

The role of HRAs in Workplace Wellness

HRAs serve multiple purposes for workplace wellness. Simply taking the assessment increases the individual’s awareness of their habits and behaviors. This self-awareness can often lead to healthier habits. Some HRAs provide health education feedback and recommendations, helping motivate employees to make positive lifestyle changes. This ultimately increases productivity and decreases absenteeism, because people who eat healthy food and exercise regularly have higher job performance and are less absent from work than their peers who do not.

Health risk assessments are also an important piece of a company’s wellness program for attracting new talent, as most job seekers today expect companies to have a robust, comprehensive wellness program. According to the 2018 Global Talent Trends survey, one in two employees wants to see a bigger focus on well-being at their company. This includes not only physical wellness but mental and financial wellness as well.

The role of hras for Medicaid and Medicare Populations

Treating people with chronic physical and mental health conditions accounts for 90% of the $3.3 trillion the U.S. spends on health care. Many of these conditions are linked to unhealthy lifestyle choices such as poor nutrition, tobacco use, and alcohol and drug use, which are among the leading risk factors for disability and mortality in the United States. It’s estimated that one out of every four dollars that employers pay for health care is tied to unhealthy lifestyle choices. This means that a considerable percentage of employer healthcare expenses is preventable.

When individuals complete an HRA it paves the way for them to make healthier lifestyle choices, because it gets them thinking about the risks they face and what they can do to change their lifestyle. Over time this shift in thinking translates to a shift in behavior, which reduces the amount of money that health insurance companies must pay in claims.

Case Study: Moda Health Increases Engagement & Program Efficiency

In 2019, Moda Health replaced their manual HRA process with an online tool. The switch paid off.

Benefits of Health Risk Assessments

Why is a health risk assessment important to Health and wellness programs?

Most (90%) of the $3.8 trillion that the U.S. spends on health care annually is spent on chronic health conditions. The CMS Office of the Actuary predicts this staggering figure will grow, on average, 5.5% each year, reaching $5.7 trillion in 2026. Employers and health plans cover a significant portion of their populations’ medical expenses in a highly regulated market.

But healthcare services and prescriptions aren’t the only costs of poor health. Productivity losses linked to absenteeism cost employers $575 billion each year. Stress in the workplace costs U.S. businesses $300 billion a year, due to things like presenteeism (working while sick) and employee turnover. It’s no wonder that organizations are seeking solutions to this crippling health problem.

The solution? The Community Preventive Services Task Force (CPSTF) recommends using health assessments in combination with health education programs, based on strong evidence of effectiveness in improving health behaviors in populations of workers. The CPSTF states that using HRAs with feedback can improve a wide range of health and safety concerns, such as alcohol and tobacco use, high blood pressure, and high cholesterol. Ultimately, HRAs can reduce the number of days lost from work due to illness or disability.

How can an HRA improve population health?

People often get caught up in their daily lives of work and taking care of their families, and don’t always prioritize their health. An HRA offers an opportunity for individuals to stop and assess their current health status. They can reflect on the unhealthy behaviors that may be a part of their lifestyle. Some HRAs provide a report that gives feedback on how to live a healthier lifestyle moving forward. Not only that, but they are also told of their risk of chronic conditions. This self-awareness acts as a great motivator to make positive lifestyle changes, which ultimately enhances population health on a larger scale.

How can an HRA contribute to a culture of health?

Health risk assessments are one of the fundamental pieces of wellness programs in both the workplace and within health plans, because they’re the first step in individuals assessing the status of their health. When an HRA is incorporated into a wellness program it means that a whole group of people will be taking the assessment and participating in other health related activities together, which creates a culture of health. Organizations also have the opportunity to enhance this culture of health by offering incentives for completion of the HRA.

When HRAs make participants aware of their unhealthy behaviors and result in a shift in behavior, this can have a snowball effect within a population. When, for example, employees see their coworkers bringing healthy lunches to work or going for walks, this can act as a great motivator for them, especially when they witness positive results in others.

Do HRAs increase engagement in population health and wellness programs?

Successful wellness interventions are not, and should not be, an out-of-the box solution. Each population is unique and has its own specific needs. But an HRA is a key element to engagement.

When wellness and population health managers understand their participants, they are better able to design personalized wellness solutions and interventions that will resonate with their participants. Some of the areas an HRA exposes to help population health managers understand their populations include:

  • Health and lifestyle habits
  • Risks for chronic disease
  • Mental, social, and emotional health
  • Readiness to change their habits

Do Health risk assessments save organizations money?

In population health and wellness programs, HRAs are an effective tool to get a full picture of an individual’s health and well-being, including current and future health risks. The data collected by an HRA can be invaluable to program development—and it’s estimated that 75% of large companies offer an HRA as part of their health and wellness strategy. 

The return on investment (ROI) of population health and wellness tools is typically measured in overall healthcare cost savings—future dollars saved, rather than spent.

The Wellsource Health and Research team conducted a systematic review of published studies that evaluated the cost-effectiveness of HRAs. The healthcare cost savings used in the calculation of the return on investment are based on a study of a health assessment program that included administering a health questionnaire, tailored feedback and messaging, online resources, and quarterly wellness campaigns—mirroring the way Wellsource clients commonly use the Wellcomplete HRA.

What was the result? Contact the Wellsource team to learn more about this study and our estimated ROI for health risk assessments. 


Healthcare marketers use health assessments to increase patient visits and deliver clear ROI for service-line growth. Jump ahead to read more about HRAs for patient engagement and acquisition.

Case Study: $85,000 in Direct ROI from Wellsource HRA

A large state employer with 37,000+ employees partnered with Welltok to build a health and wellness program that centered on administering a Wellsource HRA. The results speak for themselves.

Choosing a Health Risk Assessment

The essentials of a high-quality health risk assessment

Health risk assessments used in population health and wellness programs alert participants to the chronic diseases and health conditions for which they are at risk. But they don’t stop there. The reporting offers insightful feedback on which areas of their health need improvement and gives tangible actions an individual can take to reduce the risk of future health problems. High-quality HRAs will include the following:

Evidence-based, scientifically valid

It’s critical that any HRA you use is evidence-based. This means that each question is crafted based on the current best evidence provided by medical research. After all, the validity of the questions is the core value of the entire assessment. Even if the assessment provides superb administrative reporting, if the questions provide little value or are inaccurate, the results will be worthless.

Attention to user experience — and health literacy

Writing questions in a clear, concise, and straightforward manner makes it easier for participants to understand questions. The better they understand the questions, the more accurate answers they can provide. Not only that, but if users understand recommendations they’re more likely to incorporate them into their lives.

For Medicare and Medicaid populations questions should be written at a basic reading level. This means explaining complicated medical terms and avoiding the use of more difficult language so that participants can understand the assessment. For Medicaid populations specifically, there are state-by-state requirements regarding the necessary reading levels of all healthcare information.

Readiness to change

Readiness to change questions help guide population health and wellness managers when determining which wellness initiatives will be the most impactful. It is much easier to take proactive steps to prevent these life-altering diseases than to treat them after they’ve become serious health concerns. It’s much cheaper too. Population health managers may enjoy millions of dollars in ROI if they invest in areas relating to health habits that their members are ready to change.

Rich dating collection and reporting capabilities

Trending and reporting capabilities of an HRA show progress from one year to the next. Many participants will remain a member of a workforce or health plan population for several years. The ability to monitor changes in lifestyle habits over time can make for real changes in population health. Reporting capabilities can include the ability to isolate members of populations that were present from one year to the next, or compare two nonconsecutive years of data.

This information is critical, as claims and biometric data do not tell the whole story. For instance, stopping chronic conditions before they begin doesn’t show up in claims data. Neither do the preventive measures within your health and wellness program.

Choosing the right health risk assessment is a big decision. There are a lot of variables. So identify your essentials and compare vendors. This checklist includes a comprehensive overview of features and requirements to consider.

What questions should an hra ask?

An HRA used in population health and wellness programs should ask questions relevant to the population that will be taking the HRA. Questions should be comprehensive enough to give a good picture of current and future health risks yet short enough to be completed in 10 minutes or less to achieve an optimal user experience and high completion rates. Learn more about survey duration and our ongoing research here. 

Questions should include:

  • Personal health history for key chronic conditions, such as cancer or heart disease
  • Lifestyle behaviors that contribute to healthy living, such as physical activity minutes or sleep habits
  • Biometrics
  • Preventive services
  • Symptoms of psychological distress
  • Readiness to change indicators

Outsourcing vs. building and maintaining your own HRA

Designing and maintaining an evidence-based, effective HRA takes a lot of time, money, and resources. An organization can hire highly paid research, development, engineering, design, quality assurance, and compliance staff to do it in-house. Or they can use a respected, proven, already certified HRA and focus their resources where they can make the greatest impact: developing and implementing health and wellness programs.

What should YOU look for in an HRA vendor?

Certain features of an HRA are must-have requirements. Others are more negotiable. For an HRA vendor to be considered, the solution should:

There are many other features to consider involving content and design, security, integration, customization and reporting, performance, and reliability and trust.

Security requirements for health risk assessments

Any HRA vendor should have rigorous controls for security, compliance, and privacy, and be compliant with Health Insurance Portability & Accountability (HIPAA) regulations and with common security standards, such as Service Organization Control (SOC) 2 requirements.

A vendor with a SOC 2 Type II report can demonstrate an effective approach to security, availability, and confidentiality controls.

What quality and compliance standards does a health risk assessment need to meet?

An HRA should be built using solid science, with health standards and evidence-based algorithms derived from guidelines and research published in peer-reviewed medical journals and from leading health organizations and thought leaders.

Scientific and health standards should undergo routine review at least annually by doctorate-level health professionals, with additional periodic reviews throughout the year. Its quality should be confirmed by an independent agency, such as the National Committee for Quality Assurance (NCQA). HRAs designed for targeted populations, such as Medicare or Medicaid, should comply with government recommendations and laws pertaining to health risk assessments.

What are considerations when designing an HRA for Medicare & Medicaid populations?

HRAs designed for Medicare and Medicaid populations are required to meet certain quality standards. An HRA vendor that has been certified with NCQA, for example, may help organizations undergoing the health care accreditation process through NCQA or URAC meet a number of requirements.

Medicare HRAs must meet Activities of Daily Living (ADLs), like dressing, feeding, and bathing, and Instrumental Activities of Daily Living (IADLs), like shopping, housekeeping, and laundry.

Medicaid HRAs must meet the literacy standards set by each state. In many states, this means that the assessment must be written at a fourth or sixth grade reading level. HRAs for Medicaid populations must also assess social determinants of health, such as what kind of environment you live in and what kind of resources you can access.

Checklist: Choosing the Right HRA

Complete our checklist to determine whether the vendors you’re considering meet must-have HRA requirements.

Integration and Delivery

What integration options are available for HRAs?

Integration capabilities are a key factor to consider when evaluating HRA vendors for your population health and wellness programs. The health data collected by an HRA is critical to building data-driven health and wellness programs, marketing campaigns, and driving key insights that help improve health.

The integration needs for HRAs will vary depending on an organization’s goals. Learn more here.

HRA Integration for population health and wellness programs

There are many ways to integrate HRA data for population health and wellness programs, but no matter the level of integration chosen, it’s critical to ensure the data is protected with end-to-end encryption, so administrators can be assured their participant data is private and secure.

  • API data integration: This capability gives program administrators advanced integration capabilities, including the ability to automatically import and export HRA data. RESTful API integrations are secure and should always use multiple redundant layers of security and compliance.
  • Loose integration: A health risk assessment can be integrated loosely, such as using SSO to direct individuals from an organization’s intranet or patient portal to the online portal that delivers the HRA. A specific API eliminates the requirement for a participant login, since the individual is already vetted through their organization’s own login method. Once the individual moves to the HRA provider’s portal, the user experience (UX) is determined by the HRA provider’s design. The HRA portal often includes an administrative portal for participant management. In this scenario, the wellness or population health manager would access HRA data, either in aggregate or personally identifiable detail, through the HRA provider’s system.
  • Tight integration: Organizations can also choose to integrate the health risk assessment into their own portal. In this case, the user experience is largely determined by the organization. The only outsourced user experience is the HRA itself. The tighter the integration, the more control an organization has over the process. For example, a wellness or population health manager who chooses the tightest integration will manage all aspects of participant communication, reporting, and data analysis. The type of API available for use is based on the kind of integration selected at the time the health risk assessment is deployed. Any HRA integration should include a comprehensive, fully documented web service integration guide for customers who choose these options.

Delivering your HRA

What is the best way to deliver an HRA? It will depend on the specific preferences and needs of your population. HRAs can be delivered online, distributed as a paper assessment, or telephonically. 

Administering your HRA online is the most convenient and flexible option for most organizations and participants. Completed on a computer, tablet, or smartphone, HRAs that are delivered digitally give wellness and population health managers immediate access to HRA data.

For individuals, digital HRAs are also more convenient. They can take the HRA anywhere, at any time. An online health risk assessment should be optimized for use on any screen—smartphone, tablet, laptop, or desktop—and have a built-in timeout to protect privacy.

Does integrating an hra deliver better completion rates?

Integration reduces roadblocks to HRA completion. An HRA that fits seamlessly within an organization’s intranet or wellness portal provides an undisrupted user experience. Make someone login twice, for example, and you’ve decreased your chances the individual will start the HRA, no matter how well designed the HRA might be.

Additionally, it is important to know your population, and the level of integration that will give them the greatest confidence that their personal information is confidential and secure. All HRAs are bound by privacy and security regulations. However, integration is especially helpful when dealing with individuals who might have reservations taking an HRA that appears to be from a third party they don’t know and trust. Some members could have greater confidence answering personal or sensitive questions when an HRA fits seamlessly with a health plan’s website or portal, for example. On the other hand, an employee could be more inclined to take an HRA that is obviously offered by a third party.

HRA Data Integration for Healthcare Marketing

Health assessments for service-line growth collect critical health data that fuels marketing initiatives—so data integration options are built for speed. Jump ahead to read more about data integration for healthcare marketers using health assessments.

Wellcomplete™ For Population Health and Wellness Programs

Experience the power of hRA data

For over 40 years, health plans, wellness organizations, and companies committed to improving health outcomes have relied on Wellsource for innovative, evidence-based, NCQA-certified health risk assessment solutions to drive informed decisions with actionable data.
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Health Assessments for Patient Engagement & Acquisition

Healthcare marketers and patient navigators use short, condition-specific health assessments to identify prospective patients, engage with them to seek medical care, and ultimately schedule patient encounters.  

Health Assessments for Patient Engagement & Acquisition

Healthcare marketers and patient navigators use short, condition-specific health assessments to identify prospective patients, engage with them to seek medical care, and ultimately schedule patient encounters.  

Who takes a Condition-Specific Health Assessment?

Condition-specific health assessments help health professionals drive patient engagement and are a lead-generation tool that can boost patient acquisition. Prospective patients are online and actively searching for solutions to their health conditions. These short assessments help patients self-identify their health concerns, and give health care teams the information they need to identify and connect with patients for appropriate care and follow-up.  

By connecting providers to patients with an engaging experience, healthcare marketers are able to direct patients to the next step in their health journey, effectively turning website visits into scheduled  appointments.  

The role of a Health Assessment in Healthcare Marketing

Healthcare marketing is undergoing a rapid transformation. As modern consumers become more used to targeted, personalized communications in their everyday lives, they also expect the same user experience in their healthcare journey. 

A health assessment tool offers patients a way to self-select their need for care, get more information about treatment options, and become more familiar with a healthcare organization’s brand—all before ever stepping into the healthcare setting. Healthcare marketers use condition-specific health assessments: 

  • As a lead capture tool for patient acquisition, keeping a record of initial engagements to inform future care.  
  • As part of an integrated digital front door strategy to target the right person, for the right care, at the right time.  
  • Rich data collection for healthcare marketers to segment future communications and deliver more personalized marketing campaigns at scale. 
There is a hierarchy of needs that allows a person to pursue optimal health. Undiagnosed, major health hurdles—such as joint pain, cancer, obesity, etc.—make it more difficult to pursue total, whole-person well-being. Condition-specific health assessments guide patients to the right type of care to address their specific health concerns—and ultimately help them advance in their journey to wellness.

Driving Patient Acquisition & Service-Line Growth

Virginia Hospital Center (VHC) was looking to increase patient visits and service-line revenue for their bariatric program. In just 3 months, the Wellactivate assessment for bariatric surgery helped generate 158 contacts who were eligible for surgery and 25 new patient visits.

Data Integration for Healthcare Marketing Programs

Health assessments for service-line growth collect health data that fuels more personalized, targeted marketing initiatives. Because of this, data integration options are built for speed, so that new assessments can be deployed quickly to meet your marketing program needs. Some examples of how this is accomplished: 

  • Raw data is made available to administrators for deeper analysis.  
  • PushData functionality allows integration with a client’s API, secured via SSL encryption from end to end. 
  • Access to underlying web service APIs is via HTTPS, so POST body content (data) is secured via SSL encryption from end-to-end. 

Do Health Assessments increase patient engagement and patient acquisition?

Condition-specific health assessments provide a guided learning experience that helps patients self-identify their risk, educates them as to the lifestyle factors that may contribute to their risk, and encourages them to take the next step in their health journey. As an educational tool to motivate patients, health assessments provide clear guidance and next steps, before a patient ever enters the hospital doors. 

In fact, a recent study found that breast cancer risk assessments increased use of mammography services among medically underserved groups from 37% to 51%. 

Health assessments for patient acquisition: 

  • Engage interested patients who are already searching for care options.  
  • Educate, motivate, and convert web visitors into patients.  
  • Meet patients where they’re at in their health journey. 
  • Harness existing brand recognition and reinforce positive brand associations through a seamless digital experience.  

Learn more about user experience and health assessments.

Wellactivate™ For Patient Engagement & Acquisition

Condition-specific health assessments to drive patient acquisition & engagement

Additional Resources

HRA data & Social Determinants of Health

What can Health Risk Assessment data tell us about the social determinants of health within a population?

Checklist: Choosing the Right Hra

Complete our checklist to determine whether the vendors you’re considering meet must-have HRA requirements.