General Business Issues

Featured Health Business Daily Story Oct. 17, 2008

Health Plans Add Coaches to Target Behavior and Boost Effectiveness of Wellness Programs

Reprinted from HEALTH PLAN WEEK, the industry's leading source of business, financial and regulatory news of health plans, PPOs and POS plans.

By Mike Carbine, Editor, (mcarbine@aispub.com)

On Oct. 1, Minnesota-based Medica Health Plans launched a new health coaching program after testing it on several member groups during 2007. And a program being piloted by CIGNA Corp. combines the insurer's behavioral health experience with a unique health-coaching methodology in an effort to help enrollees lead healthier lives. CIGNA and Medica are among a growing number of health insurers that are incorporating new health coaching strategies into their wellness programs.

Using a computer-based program, Medica's new program identifies and then reaches out to members with chronic diseases and multiple health problems to offer them a personal coaching program. Medica launched the program after determining that such members used, on average, $20,000 in health care resources annually. The coaching program is replacing Medica's existing disease management program.

Greg Bury, a Medica spokesperson, tells HPW that during the coaching program's test phase, the insurer saw an average savings of $300 per member per month in terms of emergency room and inpatient hospital use.

CIGNA says its model takes the idea of personal coaching to the next level by making it a primary tool in a program designed to give members one-stop access to the insurer's vast menu of health promotion and disease prevention programs.

"We know that 70% of chronic diseases are preventable or reversible by changes in behavior, Christina Stasiuk, D.O., senior medical director for health advocacy, tells HPW. The health plan's new integrated personal health team program was tested last year on a small group of early-adopter employers. It emphasizes the whole person rather than a single-condition approach.

"Those participating in the program are assigned to one coach who becomes the individual's main personal contact throughout the entire process," Stasiuk explains. "That coach may refer you to other coaches who are trained in certain health issues, such as smoking cessation, diet and nutrition, exercise, diabetes and other conditions. But your primary coach owns the relationship," she notes. The coach remains the enrollee's sole point of contact.

Stasiuk says that CIGNA's Care Coaching approach is based on six models of behavior change. Coaches are trained to listen with a "third ear" so they can identify the factors underlying a particular health behavior or problem. "The goal is to discover whatever factors may be underlying the presenting issue." Stasiuk says. "The coaches are trained to ask a series of questions that will help….get to the root of the issue and help the individual make a change that will really impact his or her health and well-being."

CIGNA plans to roll out the program next year to a select number of large clients. The company also will offer the program to its own employees in 2009.

Insurers, Employers Have Different Goals

While data show that wellness programs can help reduce medical costs, employers more often view such programs as a tool for increasing productivity. Health plans, meanwhile, report saving money on hospital, emergency room and other medical costs through wellness programs that target their high-risk members.

But one problem with these programs, health plans and wellness experts tells HPW, is getting people to follow through on what they learn from a health risk assessment (HRA), a common starting point for many wellness programs. Only 40% of those who complete an HRA will do something based on the information. The remaining 60% fall into what Michael Samuelson, president and CEO of The Health & Wellness Institute, calls the DNA, or "Do Nothing Approach," category. Incentives may help spur people to take an HRA. But often it takes more than money to motivate people to act on what they know.

The reason many people take a do-nothing approach, Samuelson says, has to do with human psychology. "There are too many sociological, psychological, biological and other factors involved in human behavior. As a result, you can't just present people with information and expect them to act." The information, he says, will be processed on an intellectual level and sit there. "People know what they need to do, but they move into the 'someday village,' telling themselves they'll do something tomorrow or someday."

What a coach can do, Samuelson tells HPW, is help motivate people to act on the information by moving it from the intellectual to the emotional and then visceral level so it can become "cellular," or an ingrained part of the individual's everyday behavior. An avid mountain climber, Samuelson likens the coach to a Sherpa who, through a series of probing questions, helps the climber identify the summit and start the climb to the top.

The questions begin with the results of the HRA, move through the implications of a DNA approach, and conclude by exploring the benefits that will result from an action plan. Samuelson says the process uses low-pressure information to help move people from awareness to education to intervention and, eventually, new behaviors.

Blues Plan 'Smokes Out' Unhealthy Behaviors

BlueCross and BlueShield of Minnesota's Whole Health Support wellness program now includes a coaching component for members who engage in unhealthy behaviors such as smoking. Shawn Patterson, vice president, marketing, says these members are identified when data from their risk assessments indicate they would benefit from various health and wellness programs made available by the insurer. The coaches are available telephonically to help members address the dynamics of their behavior and provide them with access to other support resources.

The coaching program has helped the insurer boost its smoking-cessation rate among plan members. "Data show that 17% of adult Minnesota residents smoke. But it's only 10.9% in our book of business," Patterson says.

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