Health coaching and population health management

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30 Νοε 2013 (πριν από 3 χρόνια και 18 μέρες)

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© HealthFitness 2012



Integrated Health Coaching: The
Next Generation in Health Behavior
Change Management




Dennis Richling, Chief Medical and Wellness Officer

Kelly Merriman, Vice President, Service Delivery

©
2012 Health
Fitness
Corporation

2

What You
W
ill
L
earn
T
oday


The three levels of health coaching within the integrated health
coaching model and how individuals are assigned to each level;


How health risk factors and a predictive modeling algorithm are used
to determine a person's eligibility for coaching;


How coaches can maximize the interactions between coaching clients
and their primary care and specialist physicians;


Tools used by the health coaches to achieve engagement, behavior
change and condition management; and


Key metrics used to evaluate the health coaching model, program
effectiveness and results.

©
2012 Health
Fitness
Corporation

3


Dennis Richling, MD Kelly Merriman

Chief Medical Director and Wellness Officer Vice President, Service Delivery

©
2012 Health
Fitness
Corporation

4

Meet at
-
risk Adam…

Adam doesn’t know he’s at risk
.

Where does Adam belong?



40 years old



Married, 2 daughters



Manager, works 50 hours/week



BMI 28, blood glucose 99



C
holesterol 204, BP 122/88


No longer exercising

no time
(kids in sports, plus job demands
and normal aches and pains of
middle age)



©
2012 Health
Fitness
Corporation

5

Risks Are Costly

Chronic

Disease

Biometric

Risks


Risky
Absent

Healthy

Behaviors

Risky
Present

UnHealthy

Behaviors

Absent

Behaviors

Bad

Behaviors

$$

$$

$$$

$$$$

Reducing $$$$ = REDUCING risks

Reducing risks = Changing Behaviors

Changing Behaviors =



-
Adding Absent Behaviors



-
Reducing Bad Behaviors

©
2012 Health
Fitness
Corporation

6

Health risk factors and predictive
modeling algorithm used to determine a
person's
eligibility for coaching


©
2012 Health
Fitness
Corporation

7

Health Coaching

Traditional DM

Today

©
2012 Health
Fitness
Corporation

8

Right coach for the right person


Health coaching


Advanced practice coaching


Nurse coaching

©
2012 Health
Fitness
Corporation

9

Lifestyle Interventions





New
diagnosis/
uncontrolled
chronic disease

Controlled chronic
disease, lifestyle risks

Lifestyle risks

Nurse Coach

Advanced
Practice Coach

Lifestyle
Coach

Individuals matched to:

©
2012 Health
Fitness
Corporation

10

Meet Sally…

Sally’s Goal: Lose 20 pounds

Where does Sally belong?



52 years old



Married, two teenage boys



Works night shift



Struggles with weight



Hard to prioritize healthy


eating & exercise



Diabetes (5 years)



Regular physician visits



Compliant with meds






©
2012 Health
Fitness
Corporation

11

W
hen Henry met Sally

Sally’s Goal: Lose 20 pounds

Secondary coaching goal: reduce medications

as
a result of the weight loss


Where does Henry begin?

©
2012 Health
Fitness
Corporation

12

Meet Bob…

Bob’s Goal: Become healthier so he can go fishing
with his grandson

Where does Bob belong?


56 years old


Acute MI diagnosed in the ED


CAD diagnosis; cardiac cath
and stent placement


No beta blocker prescribed


Completed cardiac rehab,
afraid he might go off course


BMI 32, mild hypertension


No regular exercise


No dietary changes to date

©
2012 Health
Fitness
Corporation

13

W
hen Nurse Nancy met Bob

Bob’s Goal: Better heart health

Secondary coaching goal: reduce
risk of future MI
and worsening CAD


Where does Nancy begin?

©
2012 Health
Fitness
Corporation

14

Remember at
-
risk Adam?

Adam doesn’t know he’s at risk
.

Where does Adam belong?



40 years old



Married, 2 daughters



Manager, works 50 hours/week



BMI 28, blood glucose 99



C
holesterol 204, BP 122/88


No longer exercising

no time
(kids in sports, plus job demands
and normal aches and pains of
middle age)



©
2012 Health
Fitness
Corporation

15

W
hen Coach Karen met Adam

Adam’s Goal: Stay healthy, boost energy

Secondary coaching goal: reduce
risk of future
chronic disease


Where does Karen begin?

©
2012 Health
Fitness
Corporation

16

Tools
T
o
A
chieve
E
ngagement,
B
ehavior
C
hange
and
Condition
M
anagement




Motivational
Interviewing

Positive
Psychology

Appreciative
Inquiry

Stages of
Change

©
2012 Health
Fitness
Corporation

17

Smarter Coaching
T
hrough
T
echnology

Integrated View of Participant
Health Status and Goals

Participant
Priorities

Biometric
Results

HRA
Results

Coaching
Goals

Program
Data

Incentive
History

Benefit
Design

©
2012 Health
Fitness
Corporation

18

Goal: Active,
sustained
engagement

©
2012 Health
Fitness
Corporation

19

Integrated Coaching Reduces Risk by
Changing Behaviors

17%

Reduction in
High
-
Risk
Participants

10%

Reduction in # of
Risks for
Participants

Individual

Population


High
-
touch primary

coach model



Opt
-
in enrollment



Participant choice (on
-
site,
telephonic, online)



Goal progression framework
(behavior and/or clinical)



Ongoing participant assessment
to ensure accurate coach
assignment



Improve health and control costs


©
2012 Health
Fitness
Corporation

20

M
etrics to Evaluate the Health
C
oaching
M
odel


Participation

Change in
Risk

Cost
Reduction

Measures of program effectiveness and results

©
2012 Health
Fitness
Corporation

21

Multiple Risk Factor Summary

Risk Churn

Low

T1:
3,319
(
59.9%)

T6: 3,797
(
68.5%)

Moderate

T1:
1,832
(
33.0%)

T6: 1,513
(
27.3%)

High

T1:
393
(
7.1%)

T6: 234
(
4.2%)

564
Low

to Mod

216
High to Mod

98
High

to Low

983
Mod

to Low

39
Low

to High

116
Mod to High

2,716
Remained Low

733
Remained Mod

79
Remained High

Low = 0
-
4 Risks

Moderate = 5
-
6 Risks

High = 7+ Risks

All Employees:


T1/T2/T3/T4/T5/T6

(n=5,544)

©
2012 Health
Fitness
Corporation

22

All Employees


T1/T2/T3/T4/T5/T6

(n=5,544)

8.9%
Reduction

5.4%
Reduction

Risk Factor

Employees

T1

T2

T3

T4

T5

T6

Blood Pressure

28.8%

27.9%

25.8%

24.0%

22.8%

20.8%

BMI

78.2%

78.9%

79.1%

79.5%

79.4%

79.6%

Cholesterol

81.5%

83.1%

81.0%

80.8%

81.1%

80.0%

Depression

9.1%

8.0%

6.6%

6.3%

5.7%

5.7%

Fitness

64.1%

59.8%

58.6%

58.1%

57.9%

58.2%

Glucose

28.4%

31.4%

30.4%

29.7%

31.3%

30.8%

Stress

10.2%

8.8%

7.6%

7.9%

7.4%

8.0%

Tobacco Use

17.9%

16.9%

15.4%

14.2%

14.4%

14.1%

Average Number

of
Primary Risk Factors

3.18

3.15

3.04

3.01

3.00

2.97

Primary Risk Factors

6.6% Reduction

©
2012 Health
Fitness
Corporation

23

Biometrics

28.8%

78.2%

81.5%

28.4%

27.9%

78.9%

83.1%

31.4%

25.8%

79.1%

81.0%

30.4%

24.0%

79.5%

80.8%

29.7%

22.8%

79.4%

81.1%

31.3%

20.8%

79.6%

80.0%

30.8%

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Blood Pressure
BMI
Cholesterol
Glucose
% "At Risk" - Time 1
% "At Risk" - Time 2
% "At Risk" - Time 3
% "At Risk" - Time 4
% "At Risk" - Time 5
% "At Risk" - Time 6
T1/T6
changes tested using McNemar Test

Significant changes are coded with an asterisk (*)

*T1/T6: p<0.0001

*
T1/T6: p=0.0022

*
T1/T6: p<0.0001

T1/T6: p=0.1629

All Employees


T1/T2/T3/T4/T5/T6

(n=5,544)

Company’s Custom 14 Risk Factors

©
2012 Health
Fitness
Corporation

24

Behaviors

1.9%

64.1%

72.1%

10.4%

17.9%

1.8%

59.8%

68.0%

9.5%

16.9%

1.6%

58.6%

64.2%

9.5%

15.4%

1.8%

58.1%

62.0%

9.3%

14.2%

2.0%

57.9%

58.8%

8.8%

14.4%

1.9%

58.2%

57.6%

8.5%

14.1%

0%
10%
20%
30%
40%
50%
60%
70%
80%
Alcohol
Fitness
Fruits &
Vegetables
Seat Belt
Tobacco
% "At Risk" - Time 1
% "At Risk" - Time 2
% "At Risk" - Time 3
% "At Risk" - Time 4
% "At Risk" - Time 5
% "At Risk" - Time 6
T1/T6 changes
tested using McNemar Test

Significant changes are coded with an asterisk (*)

T1/T6: No Change

*
T1/T6:
p<0.0001

*
T1/T6:
p<0.0001

*
T1/T6:
p<0.0001

*
T1/T6: p<0.0001

Company’s custom 14 Risk Factors

All Employees


T1/T2/T3/T4/T5/T6

(n=5,544)

©
2012 Health
Fitness
Corporation

25

Successful Programs Offer


On
-
Ramps and Off
-
Ramps

Dennis Richling, MD


Kelly Merriman

Chief Medical Director and Wellness Officer

Vice President, Service Delivery

Dennis.Richling@hfit.com



Kelly.Merriman@hfit.com