Live from the Health Management Congress: High-risk Hoosiers Encouraged to Tell Own Health Story from First Coaching Call

Wednesday, July 23rd, 2008
This post was written by Melanie Matthews

The “secret sauce” in CARE GUIDE’s survey-based predictive modeling program supported with health coaching began saving the state of Indiana money after only six months by reducing healthcare encounters by the coached individuals. Jim Kenney, M.S., CARE GUIDE’s director of health coaching, and Jim Kerr, the company’s vice president of business development, shared the details of this initiative with population and DM specialists yesterday during a pre-conference workshop of the 13th Annual Health Management Congress.

Escalating healthcare costs and an unhealthy population prompted Indiana state officials to engage CARE GUIDE, who customized a health survey for the 45,000 state employees and spouses. Buoyed by strong leadership support that started with the governor, intense employee communication (486 meetings around the state to introduce the program) and powerful cash incentives, the program enticed more than 54 percent of the population to take the health assessment.

Predictably, about one-fifth of these participants were identified as high risk. But the health coaching effort that followed, which focused less on clinical compliance than on participants’ readiness to change, successfully engaged more than 90 percent of the high-risk employees in its first year. The program has maintained these levels of engagement in its second year.

“It all begins with the health survey,” said Kerr, who explained that the One Care Street survey was developed by Julie Meeke, who had been an ER nurse for 17 years in Indianapolis. “Julie saw a lot of people that didn’t need to be in the ER, and a lot of repeat visitors,” Kerr said. Meeke developed an assessment to measure gaps in perception — the difference between how an individual believes he should be feeling and how he is actually feeling. CARE GUIDE customizes the survey for each client, but the measurement of perception gaps is a constant, since it is a good predictor of when an individual will seek care. The model can be combined with claims data or biometric screening data if a client requests this.

Kenney provided a look at the health coaching component, which is done telephonically and has a basis in motivational interviewing. Coached participants leave the program better prepared to partner with care providers, manage their stress and embrace healthy habits. The keys to successful change are “a strong plan, a strong support system and seeing setbacks as an opportunity to develop a better plan,” he said. The support component can include “accountability calls” from coaches to make sure participants are still on track. All CARE GUIDE coaches come from a behavioral health background and “focus on whether and where the client should seek help” rather than the clinical data.

In the Indiana initiative, healthcare encounters by coached participants decreased by 30.5 percent, which provided the lion’s share of cost savings. Actual health trend changed from an average increase of 1.2 percent per month to a decrease of 3.3 percent per month.

Workshop participants wondered how the model could be adapted for a Medicaid population, who may not be gainfully employed or easily accessible by telephone. Kerr said a proposed pilot for Medicaid beneficiaries in Philadelphia could provide more insight.

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