Archive for the ‘Health Coaching’ Category

Infographic: How to Make Fitness Resolutions that Stick in the New Year

December 30th, 2016 by Melanie Matthews

The failure rate for New Year's resolutions is truly shocking. Every year some 64 percent of people will resolve to change for the better. Eating healthy food, losing excess pounds or getting fit are the most common goals, according to a new infographic by Fitness Review.

The infographic examines the key factors which can increase the success rate of these goals.

Infographic: How to Make Fitness Resolutions that Stick in the New Year

Increasing demand for quality-based, pay-for-value healthcare has elevated the health coach's contribution to chronic care management and population health. From supporting 'rising risk' populations telephonically to conducting home visits for recently discharged high-risk, high-cost individuals, health coaching offers an essential care management touch point.

2016 Healthcare Benchmarks: Health Coaching is the fifth comprehensive analysis of the health coaching arena by the Healthcare Intelligence Network, capturing key metrics such as populations, health conditions and health risk levels targeted by health coaching programs; risk stratification criteria; prevalence of embedded coaching within care sites; coaching tools and incentives as well as program outcomes and ROI from more than 100 healthcare organizations.

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Use Annual Wellness Visit to Screen for Social Determinants of Health in High-Risk Medicare Population

December 13th, 2016 by Patricia Donovan

The social determinant of social isolation carries the same health risk as smoking, and double that of obesity.

With about a third of health outcomes determined by human behavior choices, according to a Robert Wood Johnson Foundation study, improving population health should be as straightforward as fostering healthy behaviors in patients and health plan members.

But what's unstated in that data point is that the remaining 70 percent of health outcomes are determined by social determinants of health—areas that involve an individual's social and environmental condition as well as experiences that directly impact health and health status.

By addressing social determinants, healthcare organizations can dramatically impact patient outcomes as well as their own financial success under value-based care, advised Dr. Randall Williams, chief executive officer, Pharos Innovations, during Social Determinants and Population Health: Moving Beyond Clinical Data in a Value-Based Healthcare System, a December 2016 webinar now available for replay.

"The challenge is that few healthcare systems are currently equipped to identify individuals within their populations who have social determinant challenges," said Dr. Williams, "And few are still are structured to coordinate both medical and nonmedical support needs."

The Medicare annual wellness visit is an ideal opportunity to screen beneficiaries for social determinants—particularly rising and high-risk patients, who frequently face a higher percentage of social determinant challenges.

Primary social determinants include the individual's access to healthcare, their socio- and economic conditions, and factors related to their living environment such as air or water quality, availability of food, and transportation.

Dr. Williams presented several patient scenarios illustrating key social determinants, including social isolation, in which individuals, particularly the elderly, are lonely, lack companionship and frequently suffer from depression. "Social isolation carries the same health risk as smoking and double that of obesity," he said.

While technology is useful in reducing social isolation, studies by the Pew Research Center determined that segments of the population with the highest percentage of chronic illness tend to be least connected to the Internet or even to mobile technologies.

"Accountable care organizations (ACOs) and other organizations managing populations must continue to push technology-enhanced care models," said Dr. Williams, "But they also have to understand and assess technology barriers and inequalities in their populations, especially among those with chronic conditions."

In another patient scenario, loss of transportation severely hampered an eighty-year-old woman's ability to complete physical rehabilitation following a knee replacement.

Dr. Williams then described multiple approaches for healthcare organizations to begin to address social determinants in population health, including patients' cultural biases, which may make them more or less open to specific care options. This fundamental care redesign should include an environmental assessment to catalog available social and community resources, he said, providing several examples.

"This is not the kind of information you're going to find in a traditional electronic health record or even care management platforms," he concluded.

HINfographic: Health Coaching: A Win-Win Game Plan for Behavior Change

November 28th, 2016 by Melanie Matthews

From supporting 'rising risk' populations telephonically to visiting recently discharged high-risk, high-cost individuals at home, health coaches aim to score all-important health behavior change. Seventy percent of respondents to the 2016 Health Coaching survey by the Healthcare Intelligence Network have launched health coaching ventures.

A new infographic by HIN examines the primary duties of health coaches, the trend toward co-location of health coaches and incentives for health coach participation.

2016 Healthcare Benchmarks: Health Coaching2016 Healthcare Benchmarks: Health Coaching is the fifth comprehensive analysis of the health coaching arena by the Healthcare Intelligence Network, capturing key metrics such as populations, health conditions and health risk levels targeted by health coaching programs; risk stratification criteria; prevalence of embedded coaching within care sites; coaching tools and incentives as well as program outcomes and ROI from more than 100 healthcare organizations.

2016 Healthcare Benchmarks: Health Coaching drills down to explore health coaching case loads, experience, certification, performance measurement (individual and program) and more key metrics and is supported with more than 50 graphs and tables. Click here for more information.

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Infographic: Achieving Wellness Goals

September 2nd, 2016 by Melanie Matthews

Choosing the right tools and components for employer-sponsored wellness programs can make the difference in terms of generating healthy behavior change in employees, according to a new infographic by CompPsych.

The infographic examines what motivates employees to achieve wellness goals and compares results from health trackers versus coaches.

Increasing demand for quality-based, pay-for-value healthcare has elevated the health coach's contribution to chronic care management and population health. From supporting 'rising risk' populations telephonically to conducting home visits for recently discharged high-risk, high-cost individuals, health coaching offers an essential care management touch point.

2016 Healthcare Benchmarks: Health Coaching is the fifth comprehensive analysis of the health coaching arena by the Healthcare Intelligence Network, capturing key metrics such as populations, health conditions and health risk levels targeted by health coaching programs; risk stratification criteria; prevalence of embedded coaching within care sites; coaching tools and incentives as well as program outcomes and ROI from more than 100 healthcare organizations.

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Have an infographic you'd like featured on our site? Click here for submission guidelines.

Health Coaching Success Metrics and 8 More Behavior Change Benchmarks

July 7th, 2016 by Patricia Donovan

Satisfied clients and participants on track for goal attainment are two hallmarks of a can't-lose coaching initiative.

Satisfied clients and participants on track for goal attainment are two hallmarks of a can't-lose coaching initiative.

What are the hallmarks of a winning health coaching strategy? The answer depends on what's being measured: the effectiveness of the individual coach, the participant's progress, or overall program success.

That's the feedback from 111 healthcare organizations responding to the 2016 Health Coaching Survey by the Healthcare Intelligence Network.

If you're looking to measure the health coach's success, then client satisfaction is the best indicator, say 27 percent of these respondents.

On the other hand, for a gauge of an individual's progress, look to the participant's goal attainment, report 78 percent.

This same metric—goal achievement—is also the best indicator of program success as a whole, agree 64 percent.

The May 2016 survey documented a number of other health coaching benchmarks, including the following:

  • Motivational interviewing is a coach's top tactic to effect behavior change, say 83 percent.
  • All-important ‘face time’ with coaches is plentiful: 47 percent embed or co-locate health coaches at points of care, with most onsite coaching occurring in primary care offices (50 percent) or at employer work sites (50 percent).
  • Nine percent even embed health coaches in hospital emergency rooms.
  • While a majority focuses on coaching high-risk individuals with multiple chronic illnesses, 51 percent now extend eligibility for health coaching to individuals stratified as ‘rising risk.’
  • Nearly half of respondents—48 percent—offer health coaching to patients and health plan members with behavioral health diagnoses.
  • Reflecting the surge in telehealth, 12 percent of respondents offer video health coaching sessions to clients.

Download an executive summary of the 2016 Health Coaching survey.

Yale New Haven’s High-Risk Care Management Commences with Its Employees

January 14th, 2016 by Patricia Donovan

A care management pilot by YNHHS for employees and their dependents with diabetes was a template for future embedded care management efforts.

Disenchanted with vendors it engaged to provide care management for its workforce, Yale New Haven Health System (YNHHS) launched an initial care management pilot for its high-risk employee populations. The pilot went on to become a very robust program and served as a training ground for two more embedded on-site care management initiatives. Here, Amanda Skinner, YNHHS's executive director for clinical integration and population health, provides details from on-site face-to-face care management for YNHHS employees and their dependents.

We have an RN care coordinator based on each of the four main hospital campuses of our health system: one in Greenwich, one in Bridgeport and two in New Haven. All of the RN care coordinators in this program are trained in motivational interviewing. The intent is for them to work with our high-risk, high-cost employees who have chronic diseases, and with their adult dependents that also fall into that population.

The care coordinators work with these employees across the entire system to help them access the care they need, identify their goals of care, get under the surface a little to determine barriers to their being as healthy as they can be, and manage them over time. We did create some incentives for employee participation in this program, including waived co-pays on a number of medications (for example, any oral anti-diabetics).

When we initially launched the program, we limited it to employees and dependents that had diabetes, because that was the population for which we had very robust data. We also knew that diabetes was generally a condition that lent itself well to the benefit of care coordination; that there were a lot of gaps in care. When we looked at our data, we saw that ED utilization was very high for this population; that their past trend was rising, that utilization of their primary care provider was actually below what you would expect. This meant that they were under-utilizing primary care, over-utilizing hospital services, and were not particularly compliant with care.

With that population, we saw a lot of opportunity that a care management program could help address. In general, diabetes is a condition that lends itself to accepting a helping hand, to help people understand their condition and address the medical and social issues so they can manage that condition more effectively.

The program has been tremendously successful. We expanded it this year to include wellness coaches based at all of our delivery networks’ main campuses as well. These coaches work with a lower risk population and are available to any health system employee that wants to work with a coach to set care goals and then meet with the coach monthly or quarterly to track improvements against those goals. This expansion is because we’ve seen such positive results from this program.

Source: 3 Embedded Care Coordination Models to Manage Diverse High-Risk, High-Cost Patients across the Continuum examines YNHHS's three models of embedded care coordination that deliver value while managing care across time, across people, and across the entire continuum of care. In this 30-page resource, Amanda Skinner, executive director for clinical integration and population health at Yale New Haven Health System, and Dr. Vivian Argento, executive director for geriatric and palliative care services at Bridgeport Hospital, present a trio of on-site care models crafted by YNHHS to manage three distinct populations.

New Population Health Management Strategy for ‘Emergent-Risk:’ Arrest Trajectory of Compounding Conditions, Cost

June 11th, 2015 by Adam Kaufman, PhD, President & CEO, Canary Health

Adam Kaufman, PhD, president and CEO, Canary Health


For many years, healthcare organizations have invested in two approaches to population health management: First, wellness management for healthy populations who want to prevent illness, and second, disease/case management for the very sick who must adhere to physicians’ prescribed medical care.

Now, organizations are filling the gap between the healthy and very sick by investing in the 'emergent-risk' population—adults with one or more pre-chronic or early-stage chronic conditions. Population goal: arrest the trajectory of compounding chronic conditions that compound declines in quality of life and compound increases in cost of care.

Consumer Engagement with Digital Health Self-Management

For many years, the natural worsening of chronic illness has been the focus of academic institutions, a few digital health innovators, and pioneering health plans. As a result of these efforts, a new class of digital health programs is now proven to arrest the trajectory of chronic illness. It started when Stanford’s Patient Education Research Center discovered that self-efficacy (a person’s belief in his or her own ability to achieve goals) had the strongest correlation to improved health outcomes. With this discovery, the concept of health self-management was born. Thus began the drive to engage and impact consumers.

Over the years, healthcare organizations across the United States began offering Stanford’s in-person workshops with notable improvements in health and with measurable reductions in cost of care. According to Stanford research, participants reduced pain, fatigue, depression, and A1C—and reduced ER visits and days in the hospital for up to one year.1 While results were impressive, the programs had one drawback for managers of population health: due to the cost and complexity of in-person delivery, the programs were hard to scale.

As web-based technologies advanced, the research community began to search for ways to harness digital innovation to scale evidence-based programs. In 2006, researchers at the University of Pittsburgh tested the first digital self-management program aimed at diabetes prevention. This digital translation2 of the NIH’s Diabetes Prevention Program3 (DPP) delivered outcomes that mirrored those achieved with the DPP’s in-person, self-management intervention—but at a fraction of the cost.

Data-Driven Insight: The Compounding Effect

As health plans began to adopt digital health self-management, data revealed deeper insights into individuals with prechronic and early-stage chronic conditions. Data from years of Canary Health research with a pioneering health plan shows that chronically ill patients add, on average, a new chronic condition every two to three years. These compounding conditions drive compounding increases in the cost of care—specifically in the areas of pharmacy, medical equipment, and outpatient care.

And without intervention, according to Advisory Board, each year 15 to 20 percent transition to the high-risk population of very sick individuals who require high-cost medical care. This trajectory of chronic illness translates into an additional $1,000-$3,500 in expenses per person, per year. With 80 million adults in this population, that’s an additional $80-$280 billion in costs each year to the U.S. healthcare system. If healthcare leaders don’t prevent this compounding effect, both health plans and providers will hit a financial tipping point where the cost of care puts both margins and mission at risk.

Proven Outcomes: Arresting the Trajectory of Chronic Illness

As health plans began to measure the ROI of digital interventions, a deeper look at results revealed the broader and longer-term impact4 of digital health self-management programs. For emergent-risk populations, the interventions accomplished the following:

  • Halted the progression of individuals’ preconditions to diabetes, heart disease and other conditions;
  • Slowed the progression of existing conditions, and;
  • Prevented compounding conditions and compounding costs of care.

On the heels of this research, the goal became “trajectory impact” at a population level: programs for the emergent-risk population are now designed to arrest the trajectory of compounding conditions and compounding costs of care. With digital technology’s ability to scale, entire emergent-risk populations can be targeted immediately for outreach and intervention.

And with the lower cost structure of digital technology, health self-management interventions can generate a return beginning one year after the intervention and continuing over the lifetime of each individual.

Citations:
1 Lorig K, Sobel DS, Stewart AL, Brown BW, Bandura A, Ritter P, González VM, Laurent DD, Holman HR. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care 1999; 37(1):5-14. View the abstract at http://www.ncbi.nlm.nih.gov/pubmed/10413387.

2 The digital translation of the DPP was described in the journal article from McTigue, et al. Using the Internet to Translate and Evidenced Based Lifestyle Intervention into Practice Telemedicine and e-Health Vol 15#9 November 2009. Read more at http://www.ncbi.nlm.nih.gov/pubmed/19919191.

3 The Diabetes Prevention Program (DPP), a major, multicenter clinical research study, discovered that modest weight loss through dietary changes and increased physical activity sharply delayed the onset of type 2 diabetes among pre-diabetic patients. The study showed that taking metformin also reduced risk, although less dramatically. Read more at http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram.

4 A two-year, controlled matched study by Canary Health for GEHA, a self-insured, not-for-profit association providing health and dental plans to federal employees and retirees and their families through the Federal Employees Health Benefits Plan. For a briefing on case study results, contact akaufman.canaryhealth.com

About the Author: Adam Kaufman is a health economist and the president and CEO of Canary Health. He speaks to audiences nationwide on the accelerating trend of chronic illness and the financial tipping point that threatens the margins and mission of American healthcare organizations and advises healthcare senior management teams on making strategic investments in their emergent-risk populations. Prior to serving Canary Health as President and CEO, Adam served as general manager of dLife’s Healthcare Solutions division. Kaufman has served as adjunct assistant professor in the economics department at the University of Southern California, and he is the author of a data analytics patent that predicts consumer engagement.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Health Coaching Trends: Infographic

May 29th, 2015 by Melanie Matthews

A growing number of work sites offer face-to-face and/or telephonic health coaching as part of their wellness programs to help employees improve their health status and reduce healthcare costs.

A new infographic by WellSteps examines the effectiveness of health coaching programs, who should be targeted by health coaching efforts and the recommended number of health coaching interactions.

Evidence-Based Health Coaching: Motivational Interviewing in Action Validated in over 300 clinical studies, motivational interviewing (MI) remains the most patient-centered and effective approach for supporting better patient engagement and activation, disease self-care, treatment adherence and lifestyle management.

Evidence-Based Health Coaching: Motivational Interviewing in Action is the first MI video training series especially designed for clinicians who serve individuals at risk of, or affected by, chronic diseases. Whether you are serving in a wellness, disease management, or care management program, or a primary or specialty care setting, hospital or community program, this series will help you build the practical MI knowledge and skills you need to support your patient health and address the behavioral factors that are responsible for over 85% of avoidable healthcare costs.

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4 Behaviors of the Highly Activated Patient

May 7th, 2015 by Patricia Donovan

The success of a population health intervention depends upon participants' level of self-engagement. The Patient Activation Measure™ (PAM) designed to assess an individual’s knowledge, skill and confidence in managing their health, consists of a 13-item scale that asks people about their beliefs, knowledge and confidence for engaging in a wide range of health behaviors. Here, PAM developer Dr. Judith Hibbard, MPH, Dr.PH, describes some of the traits associated with a highly activated, engaged patient.

It is important to understand exactly what is happening with individuals at different levels and what is going to help them. We did several studies to find out if activation predicts behaviors, and to determine which behaviors it predicts. We did a national probability study and then replicated that study in the United Kingdom. They found almost exactly the same results as we had in the United States. Since then, there have been many more studies.

We found that people who scored higher on this measure were more likely to:

  • Engage in preventive behaviors like screenings or immunizations.
  • Engage in healthy behaviors, such as regular exercise and having a healthy diet.
  • Engage in more disease-specific self-management behaviors, such as monitoring or adherence.
  • Engage in more health information-seeking behaviors.

Once we saw these results, we began to look at the data a bit differently. We realized from the data that some behaviors don’t start until people move further along that dimension of activation.

Source: Three Pillars of Health Coaching: Patient Activation, Motivational Interviewing and Positive Psychology
health coaching
Judith Hibbard, MPH, Dr.PH, is a professor of health policy at the University of Oregon. For more than 30 years, she has focused her research on consumer choices and behavior in healthcare. Dr. Hibbard is the lead author of the Patient Activation Measure™ (PAM) and advises many healthcare organizations, foundations and initiatives.

CHRISTUS Remote Patient Monitoring Challenge: Balancing Mission and Margin in Fee-Based World

March 5th, 2015 by Patricia Donovan

CHRISTUS Health recently expanded its remote patient monitoring program from 24 to 170 participants.


In its initial months of coaching 23 patients to wellness at home via remote monitoring, CHRISTUS Health nearly halved participants' average cost of care, experienced no 30-day readmissions, and realized a 100 percent patient satisfaction rating.

Now, having expanded its remote patient monitoring (RPM) enrollment to 170 high-risk, high-cost patients, the challenge for the multi-state and international integrated delivery network is scaling up RPM technology while balancing its mission of keeping patients healthy and in their homes with the financial fallout of keeping reimbursed patients out of the hospital in a largely fee-for-service environment.

"As a faith-based system, we are very passionate about keeping patients healthy and keeping them at the less restrictive, least risk environment. However, we also have to make sure our revenue stream is sufficient so that we keep our doors open," noted Dr. Luke Webster, chief medical information officer for CHRISTUS Health during Remote Patient Monitoring for Chronic Condition Management, a February 24, 2015 webinar now available for replay.

Dr. Webster was joined by Shannon Clifton, director of connected care for CHRISTUS Health, who described the daily RPM program's eligibility criteria and clinical workflow process as well as its clinical, financial and quality benefits.

Constructed around a Bluetooth®-enabled monitored kit sent home at hospital discharge, the RPM initiative is now supported by a team of six care transition nurses, up from a single nurse at the program's outset, Ms. Clifton explained.

Other program elements include in-hospital kit delivery and patient education, as well as nurse coach monitoring following the patient's return home.

Participants, who are identified via CHRISTUS's care transition program, self-monitor key biometrics. A nurse coach responds to any alerts, coaching the patient back within wellness parameters and alerting the primary care physician if necessary to further engage the patient.

Patients remain in the program for up to 60 days. There are now 100 RPM kits in circulation, up from the initial ten in the program's first phase.

While patient satisfaction remains high—98 percent currently in the expanded phase—CHRISTUS must also contend with the uncertainty of mobile health and a degree of provider skepticism and resistance. Another RPM-related hurdle is the additional workload it creates for care transition nurses.

With the support of its CFO, CHRISTUS Health is exploring options to optimize its RPM investment, including advocacy for expanded telehealth reimbursement; RPM subscription options for 'the worried well' who would pay for the monitoring; and development of a centralized e-hub, among other ideas.

Listen to Shannon Clifton describe the critical stage of the 60-day program that strives to keep high-risk patients within wellness parameters.