HERO ON HEALTH: Industry Voices

Diagnostic and Evaluation Tools: Understanding the Health and Well-Being of Populations
by Victoria George and David Schweppe

Employers are increasingly concerned with the health and productivity of their workforce. They ask for answers to tough questions—how can I help my employees be healthier and more productive? What should our workforce health program focus on, and how do I know what interventions will work? Fortunately, there are tools employers can use to get information to answer these questions. The first step, however, is to use these diagnostic tools to identify the state of health and productivity within an organization at the community, environmental and individual levels.

Community Health

Assessing the health of a community gives insights into the types of activities that support the health of employees living in that community. One such tool that employers can use is the Gallup-Healthways Well-Being Index®, which surveys at least 500 U.S. adults on a daily basis on many health and well-being measures, including emotional health, physical health, healthy behaviors and work environment. Another useful tool is the County Health Rankings and Roadmaps produced by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. The rankings, which exist for nearly every county in the United States, focus on factors that affect health, such as education, income, access to health insurance and healthy food and smoking and obesity rates.

Kaiser Permanente and its community partners use the Community Health Needs Assessment (CHNA), a web-based resource that allows employers a glimpse into understanding the community’s health based on publically available population health data. CHNA measures include: demographics, poverty levels, education, morbidity, mortality, health behaviors, number of children who receive free lunch at school and the overall community environment. Employer groups use assessments at the community level to inform and tailor the types of activities they might include in a workforce health program.

Workplace Health

Tools for assessing the health of a specific workplace focus on evaluating not just work environments, but organizational factors that can be critical to the success of the organization’s employee health management program. Among these tools are worksite audits such as the Lifegain Health Culture Audit, workplace culture surveys like the WELCOA Well Workplace Checklist and employee interest surveys. These tools aim to identify specific areas in which employers can target investments in time and resources to have the greatest impact on the health of their workforce. In addition, employers often conduct comprehensive surveys that cover a broad array of health practices, such as the Centers for Disease Control (CDC) Worksite Health Scorecard and the Health Enhancement Research Organization (HERO) Employee Health Management Best Practice Scorecard. The CDC scorecard focuses on health promotion interventions targeted at specific conditions as part of a comprehensive workplace health promotion program. The HERO scorecard is used to determine employer best practices by analyzing strategic planning, leadership engagement, engagement methods, program availability and measurement and evaluations. These types of comprehensive survey tools help employers identify and implement programs and policies such as a no-smoking policy, open stairwell campaigns, or initiatives to offer healthy food in vending machines and cafeterias to promote healthy behaviors at the work site.

Individual Health

Once an employer has taken a broader look at the community and work environment, the next step is to review the health of the employee population. Understanding the health conditions and risk factors within an employee population helps guide program offerings and track progress over time. The most common tools that enable employers to assess individual employees’ health statuses are health risk assessments such as HealthMedia Succeed®, StayWell® Health Assessment, and Wellsource® Personal Wellness Profile. These self-report tools provide the employee with a snapshot of his or her health and generate recommendations for improvement. In the process, they also give the employer an aggregate view of health risks and existing health conditions for their employees.

The use of clinical data can also be helpful for identifying areas where employers can focus on improving the health of an individual or an employee population. Often, this sort of data takes the form of claims reporting. However, at Kaiser Permanente, we are able to draw on an electronic medical record system to provide a variety of aggregate clinical reports that inform employers about lifestyle risks and preventive care (like BMI, cholesterol, blood pressure, smoking and preventive screenings) that could support their workforce health programs.

Kaiser Permanente is leading the way with measures to include reporting for employers on the percent of their employees who have had a flu shot or who meet exercise guidelines. At every primary care visit, patients are asked if they exercise and, if so, how many minutes per week. Their answers are then recorded in the medical record as a vital sign. Exercise as a vital sign will soon be available as an important factor for better understanding the health behaviors of an organization’s employee population, and is just one way that the variety of tools that support the evaluation of health and well-being of populations will continue to evolve and expand.