Coaches help members improve health

Weight loss, lower BMI among the outcomes

Health care costs for participants in a health and wellness coaching program were $19 to $22 per member per month less than for a control group in a study by an independent researcher conducted for Medica, a health insurance company with headquarters in Minneapolis.

In a study of 1,051 participants, members averaged a 6% reduction in weight and a 7% improvement in body mass index. Participants with diabetes reduced their hemoglobin A1c levels by 35%. In addition, 96% of members participating reported overall satisfaction with the program and 90% said that as a result of the program they were more confident in managing their own health, says Chelsea Anderson, manager health and wellness for Medica.

The health and wellness coaching program was developed by Medica and launched in the fall of 2008. Nearly 37% of Medica's membership who are invited to the program choose to participate.

"We are making a shift in our approach from managing disease to managing the whole person and focusing on overall health and giving people the skills they need to change their behavior and lead healthier lives," Anderson says.

Members eligible for the program are identified through claims, based on their responses to a health risk assessment, and referrals from providers, case managers, the Nurse Line, customer service, or self-referrals.

Once members are identified as eligible for the program, the health plan sends them a mailing followed by two phone calls from a health coach who explains the program and invites them to participate. If members don't respond, the health coach follows up again in six months.

Medica's heath coaches have a variety of backgrounds and include nurses, social workers, psychologists, exercise physiologists, and health educators. They all go through Medica's 200-hour in-house training program developed in partnership with the University of Minnesota's Center for Spirituality and Healing.

Typically, members choose to talk with the health coach frequently in the beginning, tapering off to once a month. In the beginning, phone calls typically last 40 minutes to an hour and gradually drop to 20 to 30 minutes.

Members work with the same health coach for the duration of the program. When members begin the program, they take the Patient Activation Measure, which assesses their knowledge, skills, and confidence in managing their own health. The coaches use the information to personalize the program as they work with the members to set goals and support them in meeting their goals.

"Some members have very specific goals. Others may need guidance on how to set a goal. The health coaches work with members to set realistic and achievable goals," says Michelle Murdock, senior director, clinical operations.

For instance, if members want to lose weight, the health coach helps them zero in on what success looks like and what intrinsically motivates the member.

"The coaches take the role of guiding the individuals so they can divide their main goal into smaller, realistic goals, rather than tackling a huge goal and becoming discouraged," Murdock says. For instance, if weight management is a goal, instead of focusing on activity and improving their diet at the same time and becoming overwhelmed by the challenge, the member might start with becoming more active. And instead of the goal being to run in a 5K race, a sedentary member might start out just walking around the block, then gradually increasing the distance and the pace.

"A lot of times, we have found that the members' perception of themselves is a factor," Anderson says. For instance, a member may have been an athlete in his teens and 20s but hadn't worked out regularly for 10 years. Starting out to work out at his former level of intensity is not a realistic goal so the coach guides the person to come up with a smaller goal and gradually increase the level of activity.

"The issues they work on are based on the individual. On the surface, the problem may seem to be related to activity, but there may be some underlying factor such as finances or other stressors," Anderson says. In some cases, the coach may identify depression as a problem and will get the member to the right support either through Medica Behavioral Health or the member's primary care physician.

The coaches recommend best practices for condition management and provide the members with supplemental tools and information such as websites and organizations that offer information on managing diseases.

If members have complex conditions that need additional management, the coaches refer them to the health plan's case management program for intensive support.