In particular, HRA completion rates of greater than 80 percent have more than doubled in the last three years, from 8 percent to 17 percent, according to 123 organizations who completed the October 2013 HRA survey.
What’s behind this upswing in a risk stratification tool that is the backbone of population health management? A plethora of factors are likely contributing to this trend, starting with a jump in mandatory HRAs from 15 to 21 percent in the three-year period. Then there are the rewards: while the use of incentives remained level at around 55 percent, favored incentives have shifted from the trinkets, gift cards and cash rewards evident in 2010 to this year's premium-based incentives, which may be more appetizing to participants faced with consumer-driven plans and higher deductibles to meet.
Overall, the use of gift cards and cash awards dropped about 66 percent over the last three years, while reductions in insurance premiums rose from 44 to 52 percent. About one-fifth of respondents contribute to an individual's HSA in exchange for HRA completion, a new benchmark from this year's survey.
Then, respondents’ favored stick-over-carrot approach must be factored in: from 2010 to 2013, the number of organizations imposing penalties for HRA non-completion jumped from 15 to 21 percent.
Technology also may have improved HRA accessibility and facilitated completion: Web-based HRAs jumped from 69 to 79 percent, while the use of print and telephonic HRAs dropped about 20 percent. And these technologies are not limited to younger beneficiaries. Tempted to mail an HRA to a Medicare beneficiary? Not so fast: Medicare patients are readily able to adapt to an electronic form of the HRA from paper documents, noted one respondent.
Despite IT backing and more integration of HRAs into the care process, respondents stressed that when it comes to HRAs, there is no 'One size fits all' approach.
“Each population is unique demographically,” contributed one respondent, while another noted: “One size does not fit all. We have different core HRAs for use in Medicare, Medicaid and commercial populations.”