The Evolution of Health Risk Assessments in the U.S.

National Recruiters

The Health Risk Assessment (HRA) has become an integral part of the practice of preventive medicine. While the ACA (Affordable Care Act) brought HRAs to national attention in 2012, HRAs have had a long and fascinating history, which started in the 1940s. It would be the work of many, spanning several decades, that would result in the modern day HRA as we know it. So, who were the pioneers behind the contemporary HRA and how did it become such a vital part of preventive care?

An Evolution of HRAs: From 1940 to the Present

Dr. Lewis Robbins: The Father of the HRA

The idea of an HRA grew out of the work of Dr. Lewis Robbins in the 1940s. Dr. Robbins “pioneered the philosophy of ‘prospective medicine’ linking behavioral risks to a patient’s survival prospects.” While working on cervical cancer and heart disease prevention, he conceived of the idea that a “physician might record a patient’s health hazards as a guide to preventive efforts.” He then developed the health hazard chart to accomplish this goal. Robbins thought this chart could “give the medical examination a more prospective orientation.”

1950: Robbins Creates the HRA

As the chief of the cancer control program at the public health service, Robbins, in 1950, “directed the preparation of tables of 10-year mortality” used in determining medical risk. These tables helped establish several small demonstration projects with HRAs.

1970s: “How to Practice Prospective Medicine” Is Published and The Society for Prospective Medicine Is Born

In 1970, Dr. Robbins published “How to Practice Prospective Medicine.” This publication “outlined an HRA package including a questionnaire, risk computations, and feedback strategy.”

Then, in 1974, a professional association called The Society for Prospective Medicine was formed. It promoted “a set of practice standards for the use of HRA techniques and served as a clearinghouse for sharing experiences and information on the use of HRAs in health promotion programs.”

The CDC, in 1977, became directly involved in HRAs when the Department of Health and Human Services began planning a health education program for federal employees. The CDC would consult with “the Ministry of Health and Welfare in Canada who had developed an early form of a risk assessment tool, called EVALU*LIFE.

In 1979, the U.S. Surgeon General would publish a report titled “Healthy People.” The report provided information on the personal impact of specific health risk factors.

1980s and 1990s: CDC Award and Dr. Edwin Hutchins

The CDC, in 1980, would award a contract for The Risk Factor Update Project to a team of researchers from UCLA, General Health Inc., and the American College of Preventive Medicine. This project was to “review and further develop the methodology by which HRA calculations of personal risk were determined from questionnaire data.”

The work of Dr. Edwin Hutchins would also drive the concept of HRAs in the 1980s. He worked on an HRA software program which debuted on September 17, 1987. The software was presented at a conference in Atlanta entitled “Healthier People” that was hosted by President Jimmy Carter. The software went out to 26 state health departments and three universities.

Dr. Hutchins would later establish the Healthier People Network in 1992 to “maintain the continuing scientific development of the HRA and have it available in the public domain.”

1990s and Beyond: The Growth of HRAs in Corporate Wellness Programs

After the work of Hutchins and the CDC project, studies and research continued regarding the benefits of HRAs. While the healthcare community was further evaluating HRAs, their use started to grow in popularity among corporations. These private entities began using HRAs in their corporate wellness programs.

2012 to the Present: ACA HRA Medicare Mandate 

In 2012, with the passing of the ACA (Affordable Care Act) HRAs were once again thrust into the spotlight. An integral component of the ACA tasked the CMS (the Centers for Medicare and Medicaid Services) with requiring an HRA is conducted as part of the Medicare AWV (Annual Well Visit). The reason behind the use of the HRA was to “help systemize the identification of health behaviors and risk factors such as tobacco use and nutrition.” The HRA, in this situation, was meant to be used “by physicians in developing a personalized prevention plan for the patient.”

Being Part of a Legacy: Working With HRAs

The HRA has a long history which has involved many pioneers. Now and in the future, HRAs are becoming essential tools in preventive care.  If you are a medical professional and want to become a part of the HRA legacy, contact the experts at National Recruiters. At National Recruiters, we recruit medical professionals who want to take the next step in their careers, especially in the area of HRAs. Contact our top healthcare recruiters today to learn more!

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