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Lifestyle program helps with smoking, stress
Coaches help members identify negative triggers
In addition to providing case management and disease management programs to help members manage their chronic conditions, CIGNA Health Care has developed a Lifestyle Management Program that helps people at risk for a chronic disease avoid developing the condition.
"We truly believe that staying healthy is necessary to reduce medical cost trends. Anytime we can improve the health of someone who is at risk for a chronic disease before they become a high-cost claimant, it's a win-win situation for the individual as well as the employer plan," says Laurie Gondek, vice president of health advocacy products, who oversees the lifestyle coaching and disease management components of the Bloomfield, CT-based health plan.
CIGNA offers three primary lifestyle coaching programs — CIGNA's Quit Today tobacco cessation program, Strength and Resilience stress management program, and Healthy Steps to Weight Loss.
"When we analyzed our health risk assessments, we found that these areas are the top drivers that when unmanaged can move individuals into acute or chronic situations," she says.
For instance, the health plan has determined that if it can persuade a member to quit smoking, it will result in an annual savings on health expenditures of $1,623.
"When people are overweight, they are subject to diabetes and cardiac issues, which are very expensive to treat. Stress can create a profound impact on any illness. That's why our programs have a strong behavioral component to address the whole person and the stress behind his or her situation," Gondek says.
All of the programs have both a telephonic and an online component.
"We recognize that a great number of people at risk prefer to engage online and we offer the telephonic program for those who prefer a more personal approach," she says.
The health plan's health education coordinators work closely with employers to come up with wellness and health improvement plans based on the risk of their employees. Some employers put incentives in place to promote individuals to take a health risk assessment or to take actions that reduce their health risks.
"We identify the people who are eligible for the program from the health risk assessment and claims and laboratory data. Many people self-refer themselves to the program when they decide they would like to quit smoking, lose weight, or learn to manage their stress," Gondek says.
When members sign up for the program, the coaches access claims utilization and use that as well as the health risk assessment responses to come up with a plan.
"They work with them on the changes they most want to make and help them develop a way to manage their health. Our goal is to help people who are at risk stay healthy and prevent future health care costs," she says.
The coaching program typically takes about 12 weeks.
"Some individuals want to talk to the health coach frequently in the beginning and then have weekly conversations. Based on how they are following their plan and their personal preference, the health coach can ramp the services up or down," she says.
Health coaches are available by telephone 24 hours a day, seven days a week, even if the member has a question or concern outside the regularly scheduled coaching call.
"The health coaches frequently get calls from people in the Quit Today tobacco cessation program on weekends or late in the evenings when they are experiencing a temptation to smoke. Members have regularly scheduled calls but can call in at any time," she says.
The health coaches are cross trained to work with people who want help in all three areas.
"Sometimes there are individuals who tried to quit smoking and experienced stress and weight gain. Many individuals need some of the elements of all three programs," she says.
Members typically work with the same health coach throughout the program, except for the after-hours calls.
The program is tied closely to CIGNA's behavioral, disease management, and case management programs, which work with individuals who are at higher risk. If the Lifestyle Management coaches determine that participants need more intense care coordination, they can refer them to another program.
Like other participants in coaching and disease management programs, people participating in the Lifestyle Management Program are screened for depression.
"If they screen high for depression, we can seamlessly integrate them into the new behavioral employee assistance plan [EAP] disease management programs, which address the needs of individuals who are more acute. The stress program has a strong referral rate into the depression disease management program where members can receive more intensive coaching to help them handle their problems," she says.
A portion of members who enroll in the tobacco cessation program have a substance abuse problem as well. The health coach can refer them into a program that will get them help for their addiction.
Members in the weight loss program must be cleared by their physician in order to participate and need to lose a moderate amount of weight.
People who need to lose a larger amount of weight are enrolled in the health plan's case management program. If they are morbidly obese and are looking at the possibility of bariatric surgery, they are referred to the high-risk case management program.
"Our program teaches the coaches to meet individuals where they are. They learn to interview the individual and to make sure we understand any behavioral issues so we can effectively help them change their lifestyles," Gondek says.
For example, a 65-year-old man who had been smoking for many years was not feeling well and wanted to get well enough to be able to travel to see his new granddaughter. The coach worked with him on how he could reduce his smoking and finally eliminate it over a three-week period.
The coaches work with the overweight members to set a weight loss goal and work with them on strategies to meet the goal.
The coaches talk about the behavior of eating as well as the volume that people eat. Participants receive a workbook that helps them identify situations that trigger their eating. They also receive a portion plate, a tape measure, and a pedometer.
The portion plate has designs that demonstrate the size or portions. For instance, a serving of meat is equal to a deck of cards; a medium potato is the size of a computer mouse.
"Many people don't know what the size of a serving is. The plate indicates that half should be fruits and vegetables, a quarter grains, and a quarter meat or protein," she adds.
"It helps people succeed when they have someone they are accountable to. The health coaches help motivate them to keep dieting and exercising. They're not here to scold them; they're there to help the individuals determine what circumstances might have prevented them from following their plan," she says.
When someone enrolls in the stress management portion of the program, the health coach asks them to list the things that are driving stress.
"The coaches help the participants identify triggers for stress and develop strategies to deal with them. Many times, stressed individuals also have problems sleeping, which compounds the stress," she says.
Participants in the stress management program report positive outcomes in other aspects of their lives as well, Gondek says.
"Stress has a strong productivity piece to it. About half of the people who have taken the stress program report an overall health improvement status. They also say they're more productive at work and even in their personal lives," she says.