Medical claims costs predicted using health risk appraisal data
Association between wellness score from a health risk appraisal and prospective medical claims costs. Yen L, McDonald T, Hirschland D, Edington DW. J Occup Environ Med. 2003. 45: 1049-1057.
Aim
To test whether a wellness score, derived from the University of Michigan's health risk appraisal (HRA), can be used to predict future short-term medical claims costs.
Looked at
19,861 employees of General Motors Corporation and members of an international union (United Automobile, Aerospace and Agricultural Implement Workers of America), who were enrolled in medical insurance plans from 1996 to 1998 and who had completed an HRA in 1996.
How?
- A wellness score for each individual was generated from the HRA results and comprised three components: behavioral health risks, mortality risks, and preventative services usage.
- Behavioral health risk was calculated on the basis of the following 10 variables known to be associated with medical claims costs: smoking status, physical activity, alcohol consumption, seat belt usage, blood pressure, total cholesterol levels, high-density cholesterol levels, body weight, illness days, and self-assessment of health.
Results
- A clear relationship existed between short-term medical claims costs and wellness scores, with median costs ranging from US$867 to $1,599, depending on the score.
- Age, sex and presence of disease were significantly associated with cost.
- When controlling for disease status, age, and sex, each additional point on the wellness score (i.e. improvement in health) resulted in a $52 reduction in health services, a $5 reduction in drug/medication, and a $56 reduction in total annual medical claims costs.
- The contribution of these factors could predict 61% of the variance in future medical claims costs.
What does this mean?
HRA data can be used to predict future short-term medical claims costs for individuals, providing a more accurate estimation of costs than traditional methods using just sex, age, and smoking status. This information may be used to better target wellness and disease prevention initiatives.