Program helps employees learn to stay healthy

Face-to-face encounters, telehealth keys to success

An overweight nurse with diabetes who works for Little Rock, AR-based Baptist Health System summed up the key to the success of the 2020 Health Solutions disease management program: "Knowing that you are going to be looking at my blood sugar levels helps me be consistent in taking my medication and checking my blood sugar," she told her disease management nurse, Paula Evans, MSN, RN, CCM, CS.

"She knew what to do, but having me check on her made her accountable to someone. She's lost weight and her blood sugar is under control," says Evans, clinical practice specialist with Baptist Health 2020 Health Solutions.

When the nurse joined the program, she already was going to a fitness facility and was a member of Weight Watchers, but she kept forgetting to take her medication, was not monitoring her blood sugar, and hadn't been to her primary care physician in more than a year. That's all changed now.

"Not everybody has such fabulous success but the people who participate in the program are more aware of what they have to do to stay healthy," Evans says.

Baptist Health Home Health Network created 2020 Health Solutions after the successful implementation of a disease management program for home health patients.

The home health agency shared the results of their home health patients' outcomes with the health care system administration and suggested using the same process with employees since the model can be applied to anyone with a chronic disease, says Paula Suter, RN, MA, CNS, CCP, director of chronic care management for Baptist Home Health and 2020 Health Solutions.

Many of the first employees in the program were diabetics who didn't understand the importance of testing their blood sugar or who were not taking insulin, either because they couldn't afford it or they didn't understand the importance of keeping their blood sugar under control.

"Our clinicians work with our clients in a way that they feel comfortable, divulging any ambivalence they may have with treatment as a first step toward facilitating behavior change. As a result of our work using motivational interviewing principles, we rectified a lot of those problems within the first months and, based on that, anticipate very good future results," Suter says.

The agency plans to enroll 100 to 150 individuals in the first phase of the program and use the cost savings to expand the program to include people with chronic diseases who have not been hospitalized or those at risk for developing a chronic disease.

"We know that early intervention can prevent hospitalizations and save money in the long run," Suter says.

Employees of Baptist Health, their family members who are covered by the health plan, and retirees have the option of joining the program if they have been hospitalized for chronic diseases.

The program is completely voluntary. To encourage participation, employees may choose from four benefit options if they participate in the program. Those include paying the generic-level copay for any medication related to a chronic disease; free membership in a fitness club; waiver of the two-year employment requirement to participate in the health system's weight management program; and an additional paid day off from work every quarter, Evans says.

When employees agree to participate in the program, a 2020 Health Solutions nurse visits them at work for a minimum of an hour and a half to complete a comprehensive three-part health and behavioral assessment and gather other information that will help in developing a plan of care.

"Whenever possible, we go to the worksite to make it convenient for the employees. If they are retired and home bound, we will make a home visit," Evans says.

Evans sees the employees in person at least twice, and follows up with them by telephone or e-mail, depending on the employee's preference.

"By meeting with them face to face, we begin to establish a rapport with the employees so they will feel comfortable working with us," Evans says.

The nurses ask the employees to bring in a list of all the medications they are taking and request their lab values and other information from the physicians.

Through an arrangement with a cell phone service provider, the agency has purchased Blackberry phones with Blue Tooth technology that are programmed to collect data from blood glucose meters and scales and send the data to the database monitored by the 2020 telehealth nurses.

Evans sets up the employees with the Blackberry device and teaches them how to use it on her second face-to-face visit. The device reminds the clients to check their blood glucose consistently and is a communication tool between the nurse and client for coaching.

Employees with heart failure or those who are at home use a different device that interfaces with a telephone landline.

The heart failure patients enter their weight and answer questions every day.

"Having the device helps make people aware of what they need to do to stay healthy. For instance, a heart failure patient may not remember what her weight was last week but the computer will make her aware," she says.

The 2020 nurses work with the employees to develop goals and a plan for meeting the goals.

"We talk to them about their disease and how it impacts their lives and what they would like to change. We ask them to rate the things they want to work with on a scale of one to 10, depending on the importance," she says.

Sometimes the employee's initial goal may be as small as to walk for 10 minutes a day or cut out one soft drink a day.

"What's important is for them to experience success. We're there to be their cheerleader as they work on getting healthier. We follow up with them to help them continue working on their goals and progressing to new goals. As a clinician, it is so rewarding to engage the client in a meaningful way. It reminds me of why I went into nursing in the first place," Evans says.