White Papers

Health care solutions and benefits management for employers and HR teams. Providing direction on health care consumerism and population health and wellness.

Case Study: An Employer Purchased Health Coaching Program

Investigating the impact of comprehensive health coaching techniques on employee health, behaviors and individual biometric risk indicators

By Provant Health Solutions, LLC.
 
The key to organizational success in today’s competitive marketplace is ensuring that a company’s workforce is healthy and productive.  Employee health risks can negatively impact an organization’s ability to function through lost productivity, absenteeism and poor work performance (presenteeism).
 
Additionally, it is well understood that costly, chronic health conditions and illnesses not only increase the likelihood of poor job performance and productivity but also contribute to increased medical claims. In some cases, the combination of medical expenditures and lost productivity costs employers up to 75% of their total expenditures.1 Employer health care expenses continue to outpace inflation which may be attributed  in large part, by poor health behaviors and lifestyles that lead to chronic disease and illness. 
 
To date, motivational interview-based health coaching is the only technique to have been fully described and consistently demonstrated as causally and independently associated with positive behavioral outcomes. 2 High quality health coaching provides a mechanism for building personal capacity to adopt healthier behaviors and lifestyles that lead to better outcomes, and long term maintenance of new behaviors. 
 
Connective Coaching Program Design
Provant Health Solutions, LLC offers a unique OnLine, OnSite, OnCall program and service strategy that coordinates all three service modalities to encourage program participation and improved outcomes. Our proprietary Connective CoachingSM model is a comprehensive health coaching program that can be delivered in any of our program modalities.  Connective Coaching is supported by evidence-based principles for empowering individual choice in support of total well-being and uses a combination of motivational interviewing, Prochaska’ behavior change theory and other unique assessment and stratification mechanisms to provide a focused and engaging encounter with participants. Provant Health Solution Connective Coaches use our Interventional Therapy (IT) program suite to address individual core risk factors that address the following common lifestyle and behavior categories: 
Health Coaching Qualifications                                                                            
Provant Health’s Connective Coaches include a wide variety of qualified professionals such as, Registered Dietitians, Registered Nurses, Exercise Physiologists, and those with advanced degrees in health care and preventive services who are qualified to provide condition management support. 
 
Connective Coaching Program 
Provant Health provided a two (2) year ongoing Connective Coaching program for a client with approximately 800 employees that was launched in November 2006 and concluded Dec. 31,  2008. The goal of the program was to motivate eligible employees to engage in healthy behaviors and adopt certain lifestyles that would maintain or improve their overall health as demonstrated by qualitative and quantitative aggregate outcome reporting. A risk stratification model was applied based on individual, annual Health Risk Assessment biometric screening results. Stratification and risk identification results found the following core risk categories: 
 
Individuals were stratified into low, moderate and high-risk categories and were enrolled in the Connective Coaching program. The outbound call averaged 15 minutes per encounter and the frequency of follow-up calls was determined by risk category as follows:
 
Through coaching encounters, health coaches migrated individuals to a lower or higher risk group as appropriate. Migration was determined by Health Risk Assessment data, biometric screening data, and/or subjective assessment information during a coaching encounter. 
 
Participant Enrollment
Individuals from the employer’s multi-site locations were eligible to participate in the telephonic Connective Coaching program. They were required to be at least 18 years of age, to complete a Health Risk Assessment (HRA) and Biometric screenings. They were enrolled at the time of screening or by mail.  Eligible individuals were stratified into the appropriate risk category and were assigned a Connective Coach.   
 
Incentive Design
The eligible participants were included in an employer sponsored incentive program that was associated with their monthly premium contribution for their health insurance. To meet the incentive requirements, each participant had to connect with their health coach as scheduled and determined by their risk level.  Health coaches made 3 initial outbound enrollment calls to eligible participants. If contact was not made, the health coach documented the attempts and determined the participant to be non-compliant and no longer eligible for the incentive program.
 
Provant Health was responsible for monthly tracking of number of participant contacts, health topics discussed, risk change over time, and non-compliant participants.  This information was  provided to the client’s broker through monthly aggregate reporting and participation tracking to support the administration of the health insurance premium incentive design. 
 
Program Components-Implementation
Each individual actively engaged in their personalized health improvement plan (PHiP).  The low-risk participants completed their obligation for the employer sponsored incentive program with one required contact with their Connective Coach. The moderate-risk individuals connected quarterly with their Connective Coach and high-risk participants connected monthly.  If individual health status changed over time while in the care of the health coach, (improved or increased risk), the health coach adjusted the PHiP accordingly to compensate for the risk change.
 
The Connective Coach used each encounter to revise the individual PHiP according to the individual’s health needs and/or mental health and emotional needs. Connective Coaching encounters were recorded and constant re-assessment and evaluation was provided.  
 
Program Components-Case Closure
The program concluded at the end of a two (2) year cycle. The two-year commitment was determined by the employer at the start of the program.  A project closure letter was sent to all eligible participants by their personal Connective Coach in November 2008. The letter provided remarks about aggregate program success and reminders to use the resources and techniques learned to maintain individual goals.  Our proprietary Connective Coaching program facilitates a strong bond between the health coach and the participant. The closure announcement assisted participants in planning their ongoing and long-term lifestyle and health goals with the final support of their Connective Coach
 
Key Results 
The Health Risk Assessment campaign was administered on behalf of the employer from Nov. 13, 2006 through March 13, 2008. During this period, 59% of eligible individuals participated (n=800) resulting in a final eligible coaching population of 470 participants over the two-year period. The overall average participant wellness score for year one was 66 and improved two points by the end of program year two at 68. A wellness score serves as an indicator of aggregate population health and represents a population at moderate health risk. Wellness scores below 80 generally indicate an increased likelihood that individuals will develop certain medical conditions related to certain risk factors and indicators. A year over year comparison of the population’s top four prevalent risk indicators is located in the following tables.   
 
 
Table 1. Risk Area Number Percentage 
Risk Area    2007           2007                   2008          2008                  % Risk
                   N=474        Percentage        N=470        Percentage        Change
Nutrition        275             58.0                     246             52.3                     -5.7
Exercise       184             38.8                     155             33.0                     -5.8
Weight          147             31.0                     133             28.3                     -2.7
Smoking       111             23.4                     106             22.6                     -5.0
 
Table 2. Core Biometric Risk Indicators
Blood Pressure          2007                    2008                   Risk Indicator
                                  N=474                 N=470                 Change
Normal                         118                      124                      +6
Borderline                     248                      226                      -20
High                             87                        77                        -10
 
Table 3. 
BMI                               2007                    2008                    Risk Indicator
                                     N=474                 N=470                 Change
Obese                          288                      286                       -2
Overweight                   115                      96                        -39
Ideal                              31                      30                        -1
 
Table 4. 
 Total Cholesterol      2007                    2008                    Risk Indicator
                                  N=474                 N=470                 Change
Ideal                            222                     297                     +75
Borderline                    151                     105                     -46
High                             82                       43                       -39
 
Table 5. 
HDL                            2007                    2008                    Risk Indicator
                                   N=474                 N=470                 Change
Ideal                            243                     278                     +35
Risk                             198                     154                     -44
 
Health Benefits
Unhealthy lifestyle and health behaviors have been documented as the primary contributors to the six leading causes of death in the United States (US): heart disease, cancer, stroke, respiratory disease, accidents, and diabetes.  Collectively, these health conditions and diseases account for over 70% of all deaths. 3,4,5,6 Recent research indicates a direct relationship between modifiable lifestyle risks and lower employee productivity.7,8  Relevant data suggests that the cost to employers in lost productivity due to poor employee health may be substantially more than the direct medical and disability costs.. 9,10,11   
 
Health coaches were challenged to support individual participants with lifestyle and behavior modifications that would improve individual and aggregate wellness scores.  Through our proprietary Connective Coaching approach, the population was able to improve its aggregate wellness score by 2 points over a two year coaching period.  This was achieved through individual risk migration and reduction in the core areas of weight management, nutrition and physical activity which reduce the onset of certain chronic disease such as heart disease and diabetes. 
 
The results represented in this population case study demonstrate the effectiveness of health risk migration and mitigation through a comprehensive health coaching model. Provant Health’s Connective Coaching addresses primary individual health risk and co-existing issues that impact or exacerbate the primary risk state. This population observed significant improvement in all core biometric indicators, with the most significant reduction observed in Total Cholesterol and HDL management.  This risk reduction correlates with the Connective Coaching concentration of weight management and nutrition management by the Provant Health coaches for identified moderate and high risk individuals over the two year program period. 
 
Economic Impact
Utilizing an extrapolated external study conversion methodology12, Provant Health is able to determine an estimated direct medical savings for this employer based on the four critical biometric indicators.
 
In this study, an overall improvement in weight management was observed with a total risk reduction in obesity and overweight individuals seen in roughly 41 Connective Coaching participants. Overweight and obese individuals cost employer $1500 per person per year in excess medical costs.13
 
Potential cost savings for this population based on risk migration results in $61,500.00 per year. Improvement was also observed in the management of healthy blood pressure.  Individuals with hypertension cost employers an average of $392 per person per year13 in medical costs than individuals who do not have hypertension. Potential cost saving for those individuals who effectively reduced their blood pressure to a lower risk results in a $14,112.00 per year savings.14
 
Lastly, a significant number of participants effectively reduced their risk of cardiac disease by effectively managing their diet, weight and physical activity levels to reduce Total Cholesterol readings and improve HDL readings in 160 participants. This significant improvement results in a projected cost savings of nearly $435,000.00 per year.  A combined two year medical cost savings for this employer is estimated at $1,020.024.00. 
 
Limitations
This case study has selected limitation worth noting, biometric screenings offer some limitations with respect to the following; blood samples were analyzed with LDX analyzers. Total cholesterol and glucose screenings were predominantly non-fasting although fasting state does not significantly affect the values of total cholesterol, HDL and the Ratio readings.
 
Participant’s body composition may have a +4.12% margin of error due to variables such as hydration levels, use of caffeine and whether participants had physically exerted themselves within two hours prior to screening.  Current screening methodology used by Provant Health has been determined to be a “best practice” method to predict a range of biometric values including lipids, glucose and body composition.
 
Participants may have normal blood pressure readings when measured at home but higher readings when measured in a clinical setting. This is known as “white-coat syndrome” and is due to the measurement taking place at times and in situations outside the participant’s normal routine and comfort zone.15 In addition, participants who may have used tobacco, caffeine, taking certain medications as well as those who had just eaten or exerted significant physical effort may have shown increased blood pressure values equaling as much as +10 mmHg over their normal, testing levels.16
 
Lastly, the economic impact analysis for this study was performed using an extrapolated external study methodology.  This method uses carefully reviewed literature that closely matches the employer population, characteristics, program design, interventions and time periods involved. While this method can be considered valid and reliable if the external study source closely aligns with the cohort, it does present the following disadvantages; the data is open to bias, there is difficulty in matching the external study design exactly to the cohort and the method does not correct for the number of external variables.12 
 
Conclusion
The case study demonstrates that comprehensive Connective Coaching has a positive effect on individual behaviors and subsequent risk mitigation over time. In addition, individual health improvements and reduction in biometric risks demonstrates a cost savings for those health risk indicators that improved, thus providing the employer with hard dollar justification for their Employee Health Management (EHM) program investment.
 
In this study, demonstrable biometric data supports reliable and valid outcomes which eliminates any concerns of inaccurate information from self-reported data from a health assessment alone.17 The economic model, while not scientific, is an accepted methodology for calculating return on investment for EHM programs that is easy to perform, cost-effective, and derives a net savings12. The validity of the results is strong as long as the extrapolated study closely aligns with the program and participant model.  These outcomes support the use of Provant Health’s Connective Coaching program as a powerful tool to improve individual health behaviors in an effort to manage the rising costs associated with healthcare both for the employer and the individual. 
 
Appendix-Graphs and Tables
 

 

 

References
1. D. Edington, Journal of Occupational and Environmental Medicine. V. 44, No.12; 12/02.2008 
2. Disease Management & Health Outcomes. 15(5):299-307, 2007. Butterworth, Susan W 1; Linden, Ariel                              
1 2; McClay, Wende 1 Survey of Major U.S. Employers by the ERISA Industry Committee (ERIC),
the National Association of Manufacturers (NAM) and IncentOne Inc (2008), Employee Health &
Productivity Management Programs: The Use of Incentives 
3. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States,
2000. JAMA 2004;291:1238-1245.
4. McGinnis JM, Foege WH. The immediate vs. the important. JAMA 2004;291:1263-1264.
5. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993;270:2207-2212.
6. Anderson RN, Smith BL. Deaths: leading causes for 2002. National Vital Statistics Report, Vol. 53,
No. 17. National Center for Health Statistics, March 7, 2005.
http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_17.pdf
7. Burton WN, Conti DJ, Chen C, Schultz AB, Edington DW. The role of health risk factors and
disease on worker productivity. Journal of Occupational and Environmental Medicine 1999;41:863-877.
8. Boles M, Pelletier B, Lynch W. Relationship between health risks and work productivity. Journal of
Occupational and Environmental Medicine 2004; 46:737-745.
9. Goetzel RZ, Long SR, Ozminkowski RJ, Hawkins K, Wang S, Lynch W. Health, absence, disability,
and presenteeism cost estimates of certain physical and mental health conditions affecting U.S.
employers. Journal of Occupational and Environmental Medicine 2004; 46:398-412.
10. Hemp P. Presenteeism: at work – but out of it. Harvard Business Review. October 2004.
11. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and Trends in Obesity among US
Adults, 1999-2000. JAMA 2002;288:1723-1727.
12. Chapman, L. (2001) Methods for Determining Economic Return; The Art of Health Promotion.
V4, No.6, January/February.
13. Elliot WJ, Weir DR, Black, HR. Cost effectiveness of the lower treatment goal for diabetic
hypertensive patients. Arch Intern Med 2000;160:1277-83.
14. National Heart Lung & Blood Institute, NIH, AHA 
15. Setaro JF. An update on the diagnostic evaluation of the hypertensive patient. J Clin Hypertens
2000; 2:25-32. 
16. Kaplan, NM. Treatment of hypertension: nondrug therapy. In: Kaplan NM, Lieberman E, eds.
Clinical hypertension. 7th ed. Baltimore: Williams & Wilkins, 1998:323-44. 2008 National Business
Group on Health, 2009 Plan Design Survey
17. Newell S, Girgis A, Sanson-Fisher RW, Savolainen NJ. The accuracy of self-reported health
behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a
critical review. Am J Prev Med. 1999; 17:211-229.
 
 
 
 
 


Voluntary Benefits Play Key Role in Workplace of the Future
Employees missing basic protection they expect to need in next five years

Promoting Synergy Between Value-based Insurance Design and Patient Centered Medical Home
As you well know, employers are deeply enmeshed in developing strategies to control health care costs and improve health outcomes. The current environment is not favorable to success. Medical care is fragmented, relying on obsolete paper-based management and fee-for-service payments that reward inefficiency, and employees are getting heavier and more sedentary even as more of them age into higher risk for chronic disease.

Optimizing the Efffectiveness of Health and Wellness Offerings
Arcadia Solutions, a national health care IT consulting firm, announces an important new whitepaper about the design, development and delivery of effective Health and Wellness programs for health plans.

OCI Study Shows Effectiveness of Return to Work Program


The Importance of Dental Benefits in Overall Health and as an Element of Employee Wellness Programs
2007 NADP Consumer Survey confirms dental benefits link to staff retention and improved oral health behaviors

Empowering Employees WIth Health Care Incentives
Learn what factors to consider when implementing a health care incentives plan.

Index | Sitemap |Stats & Data |  health care solutions © FieldMedia, LLC