For Clinicians

The Healthy Life HRA includes many features useful to clinicians.

From the menu on the left you are able to request a license to set up a private web account which will allow you to enroll your practice or clinic, view individual patient questionnaire answers, download data on your patient panels, and more.

Request Info on License

You have the ability to request a license to set up a private web account which will allow you to enroll your practice or clinic, view individual patient questionnaire answers, download data on your patient panels, and more. For more information, contact us at

Science and Technical Details

A frequently asked question about HRAs has to do with their predictive validity. Nothing is considered for inclusion in the HRA unless it is based on scientific studies and data that have demonstrated validity. Within the Healthy Life HRA Midlife version, there are specific risk prediction algorithms for each of 19 different causes of death (CODs), each of which carries its own specific validity. Heart attack and stroke are the best examples. For heart attack and stroke, the prediction models were derived from the Framingham Heart Study data (D'Agostino, Russell, Huse, Ellison, et al., 2000; D'Agostino, Belanger, Markson, Kelly-Hayes, & Wolf, 1995; Wolf, D'Agostino, Belanger, & Kannel, 1991.) This longitudinal study, covering more than a half century, is probably one of the best examples of predictive validity in the medical literature. In the adult HRA, heart attack and stroke combined will account for approximately 30 percent of the mortality outcomes. During its early development a number of studies also addressed the issue of the validity of the HRA (Meeker, 1988; Kirscht, 1989.)

For an additional 24 causes of death covered in the Healthy Life HRA Midlife version, the research base was not adequate to identify with reasonable validity causal risk factors for use in risk prediction. For these 24 causes of death individuals receive an estimate based age, race, sex, and population average mortality only.

For all 43 causes of death in the Health Living HRA model, we use an actuarial extension procedure with age projections tailored to specific age, race, and gender cohorts. Mortality estimates are based on the most current nationally representative mortality statistics averaged over three years. The CDC National Center for Health Statistics database we use includes data from approximately 7.8 million death certificates. For practical purposes, this represents population data.

In addition to estimating risk for 43 causes of death, the Healthy Life HRA Midlife version produces an estimate of Risk Age. Risk age compares the calculated risks based on a person’s answers with the population average and is a tool that can help individuals understand the potential benefits for adopting healthy behaviors and avoiding health hazards.

In ongoing work by Dr. Perzynski and Dr. Sudano, we are investigating the potential utility of additional clinical and administrative data for improving the risk prediction algorithms.

Your Risk Age Now

Your Risk Age Now (this is one of the numbers in your report) compares your total risk from all causes of death to the total risk of those who are your age and sex. If you have a lot of risk factors, your Risk Age will go up because your risk of dying will increase and therefore be similar to someone older than you are who will die in a shorter number of years than an average person of your age. It gives you an idea of your risks compared with the population average in terms of an age.

Your Target Risk Age

Your Targer Risk Age(also in your report) indicates what your risk age would be if you made the recommended life style changes thereby reducing your risks. Thus Your Target Risk Age will always be lower than Your Risk Age Now except for the rare individual who has no risk factors showing up on the questionnaire at all. In that case the two risk ages can be equal.

Appraised age (or risk age) is an overall measure of risk based on your current risk levels as compared with a hypothetical "average" person of your same age and sex. It is not a "biological age" nor is it a life expectancy estimate. It is merely an appealing numerical indicator intended to enable you to compare modifiable risk with peers.

An appraised age that is the same as the actual age signifies that you are at an average risk level for your age and sex group in the general U.S. population. Similarly, higher appraised ages signify above aver¬age risk and lower appraised ages indicate lower than average risk compared with a cohort with the same fixed characteristics. In general risk age is built on the concept that overall mortality risk increases geometrically with age at about 8% per year.

* Lewis C. Robbins and Jack H. Hall. 1970. How to Practice Prospective Medicine. Indianapolis: Methodist Hospital of Indiana.

Preventive Services Links

U.S. Preventive Services Task Force

The USPSTF is an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists). The USPSTF conducts scientific evidence reviews of a broad range of clinical preventive health care services (such as screening, counseling, and preventive medications) and develops recommendations for primary care clinicians and health systems. These recommendations are published in the form of "Recommendation Statements." AHRQ's Prevention and Care Management Portfolio provides ongoing administrative, research, technical, and dissemination support to the USPSTF.

About the USPSTF

The USPSTF strives to make accurate, up-to-date, and relevant recommendations about preventive services in primary care. To learn more detailed information about the USPSTF, including how it operates, current members and partners, and background information, visit

Methods and Processes

For the USPSTF to recommend a service, the benefits of the service must outweigh the harms. The USPSTF focuses on maintenance of health and quality of life as the major benefits of clinical preventive services, and not simply the identification of disease. To learn more detailed information about the USPSTF recommendation process, methods, commentary, and resources for practice, visit


USPSTF recommendations highlight the opportunities for improving delivery of effective services and have helped others provide preventive care in different populations. USPSTF recommendations have formed the basis of the clinical standards for many professional societies, health organizations, and medical quality review groups. To learn more detailed information about USPSTF recommendations, grade definitions, and topics in progress or to see a list of A and B recommendations relevant for implementing the Affordable Care Act, visit

Tools for Using Recommendations in Primary Care Practice

Based on recommendations from the USPSTF, these tools are designed to help primary care clinicians access information at the point of care.

Products Available

  • Healthy Life HRA Adult Version
  • Healthy Life HRA Older Adult 20-minute Version
  • Healthy Life HRA Older Adult Comprehensive Version
  • Healthy Life HRA Employer Version

All versions can be accessed in virtually all modern web browsers (e.g. Chrome, Firefox, Internet Explorer and Safari) as well as on multiple tablets including Windows, iPad and Android tablets.

Healthy Life HRA is offered as a Software as a Service solution.

Medicare Annual Wellness Visit HRA Plus

Section 4103 of the Affordable Care Act expands coverage for eligible beneficiaries and specifically provides for a “no co-pay” annual wellness visit (AWV) that requires an HRA Plus (an age-appropriate health risk assessment and a personalized prevention plan of service) to be administered at said visit and reimburses providers at 3.15 RVUs.

Many healthcare providers are already actively providing their Medicare patients with an HRA Plus and personalized prevention plan services1 (PPPS) at their annual wellness visits and receiving higher reimbursement rates. This section provides detailed information on who can administer and review the HRA Plus with the patient, what the HRA Plus and PPPS must include, and a simple example of the reimbursement rates in the State of Ohio.

Who can administer the HRA Plus

The following information comes directly from the text of the Affordable Care Act: a

  • physician
  • physician assistant
  • nurse practitioner
  • clinical nurse specialist
  • clinical social worker
  • health educator
  • registered dietitian
  • nutrition professional
  • certified nurse-midwife
  • certified nurse anesthetist
  • a team of any of the above under supervision of physician

1The term ‘personalized prevention plan services’ means the creation of a plan for an individual that includes a health risk assessment of the individual that is completed prior to or as part of the same visit with a health professional described [as follows]: a physician; a practitioner described in clause (i) of section 1842(b)(18)(C) [Social Security Act] [a physician assistant, nurse practitioner, or clinical nurse specialist: a certified registered nurse anesthetist; a certified nurse-midwife; a clinical social worker; a clinical psychologist]; or a medical professional (including a health educator, registered dietician, or nutrition professional) or a team of medical professionals, as determined appropriately by the Secretary [of Health and Human Services], under the supervision of a physician.

Partners, Contributors and Participating Institutions

Funded by Agency for Healthcare Research and Quality


Practice Based Research Network Shared Resource

The Center for Reducing Health Disparities

Better Health Greater Cleveland

The Cleveland Clinical and Translational Science Collaborative

The Framingham Study

The Free Clinic

The Safety Net Providers’ Strategic Alliance