Archive for the ‘Health Coaching’ Category

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.

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

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

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

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

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.

11 Statistics about Stratifying High-Risk Patients

November 20th, 2014 by Cheryl Miller

Healthcare organizations use a range of tools and practices to identify and stratify high-risk, high-cost patients and determine appropriate interventions. Most critical to the stratification process is clinical patient data, say an overwhelming 87 percent of respondents to the Healthcare Intelligence Network’s (HIN) inaugural survey on Stratifying High-Risk Patients. However, obtaining and verifying patient data remain major challenges for many respondents. Following are 10 more statistics from our survey.

  • „„Hospital readmissions is the metric most favorably impacted by risk stratification tools, according to a majority of respondents.
  • „„In addition to high utilization, clinical diagnosis is considered a key factor in stratifying high-risk patients, according to 16 percent of respondents.
  • „„Case management as a post-stratification intervention is offered by 83 percent of respondents; health coaching by 56 percent.
  • Reducing heart failure (HF), pneumonia (PN), and atrial myocardial infarction (AMI) are among the greatest successes of risk stratification programs.
  • Diabetes is considered the prominent health condition among high-risk populations, according to 37 percent of respondents; other prominent conditions include hypertension (20 percent) and mental health/psychological issues (15 percent).
  • Physician referrals are cited by 76 percent of respondents as an important input for stratification, followed by case/care manager referrals (71 percent).
  • „„Home health and/or home visits are available to risk-stratified populations of 56 percent of respondents.
  • „„LACE (Length of stay, Acute admission, Charleston Comorbidity score, ED visits) is considered the primary indice and screen to assess health risk, according to 33 percent of respondents.
  • Nearly half of respondents (45 percent) cite high utilization of the emergency department (ED) or hospital as the most critical attribute of high-risk patients.
  • „„While more than half of respondents have a program in place to identify and risk-stratify complex cases, the majority admit it is too early to tell the ROI achieved.

Source: 2014 Healthcare Benchmarks: Stratifying High-Risk Patients

2014 Healthcare Benchmarks: Stratifying High-Risk Patients captures the tools and practices employed by dozens of organizations in this prerequisite for care management and jumping-off point for population health improvement — data analytics that will ultimately enhance quality ratings and improve reimbursement in the industry’s value-focused climate.

Infographic: Motivational Interviewing

November 19th, 2014 by Melanie Matthews

Motivational interviewing (MI) is a standardized, evidence-based approach for facilitating behavior change, according to a new infographic by Health Sciences Institute.

The infographic explores the four key phases of MI and evidence to support MI’s impact.

Evidence-Based Health Coaching: Patient-Centered Competencies for Population HealthTo succeed in a value-driven system, healthcare organizations will need to shift primary responsibility for health management to the individuals it serves. Evidence-based health coaching supports these population health goals by aligning best practice care with patients’ needs and values.

Evidence-Based Health Coaching: Patient-Centered Competencies for Population Health presents a template for evidence-based coaching that emphasizes clinical competencies, along with real-life applications from a health system already utilizing clinical health coaches within its value-based healthcare network.

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J&J and Canyon Ranch Partner on Corporate Wellness Program

July 10th, 2014 by Cheryl Miller

An organization is only as healthy as its leadership.

And that’s one of the key reasons behind a recent corporate wellness venture between Johnson & Johnson’s Human Performance Institute (HPI) and Canyon Ranch. The Human Performance Institute has collaborated with Canyon Ranch by combining the principles of their flagship course, Corporate Athlete® with Canyon Ranch’s integrative wellness offerings. The hybrid course, called The EXCELerate Program — The Power of Energy for Purpose & Performance, offers clients a five-day health and wellness experience that incorporates the full resources and amenities of Canyon Ranch’s flagship property in Tucson, Arizona and HPI’s premier energy management performance training program.

We spoke to Bill Donovan, the General Manager of the Human Performance Institute, Wellness & Prevention, Inc., about this program.

HIN: Can you tell us a little about the program?

(Bill Donovan) The purpose of this program is to expand our reach and impact more lives by working together to create the ultimate wellness experience. The Human Performance Institute’s Corporate Athlete training is based on 30 years of proprietary research and depth of knowledge in training elite performers. We started with professional athletes in the world of sports. We learned very quickly that the strategy of increased performance in sports was easily transferable to any environment. So we moved into other areas, surgery, medical, Special Forces, military; now Fortune 500 executives are the main focus for us. The program combines the sciences of performance psychology, nutrition, and exercise physiology. And the premise is to help train people to expand their energy so they can increase their performance in work and in life.

When you look at Canyon Ranch, they’ve also been around for over 30 years. They have an award-winning integrative approach to wellness. Their world-class facilities create the perfect environment for this wellness experience to come to life. Together we educate, empower, inspire, and help create lasting change in people through the blended experience. Canyon Ranch is very much hands-on, one on one. HPI is more group training. Together, we create customized experiences that cover critical dimensions of health and can truly have impact.

Who is Canyon Ranch and Human Performance Institute targeting for enrollment in their new EXCELerate program?

The program is designed to benefit anyone, but the key targets are senior level executives and leaders that are looking to improve health, performance, and be able to thrive in the face of constant demand and pressures. One thing we see in the world today is that the demands and pressures being put upon us and our leaders in particular continue to increase. How do we rise up in the face of that and not only survive but thrive?

Secondarily, we’re focusing on past graduates of our respective programs; graduates of HPI and Canyon Ranch loyals who want a more in-depth and immersive experience.

What will this program’s impact be on absenteeism, productivity and performance for employees in general?

It’s designed with senior leaders in mind, and built on the premise that the culture of an organization is often a reflection of its leadership. So if you believe that great success and change starts with leadership, then that’s what this program is about. It’s an immersive five day training program designed to help individuals make healthy, sustainable life changes, resulting in optimized well being, improved health, and enhanced performance.

When a senior leader, who is often the busiest person in the organization, can role model the behaviors that people aspire to, whether it is an optimistic outlook, focus, better work/life balance, better fitness, or eating habits, or maybe even overall health across all dimensions: mental, emotional and physical, they give hope and inspire those they lead. That is the critical first ingredient towards creating cultural change within an organization.

How will this program differ from standard wellness or disease management programs?

The immersive experience is a big part of it. I don’t know of any program that brings together the best of both group training around performance with holistic, hands-on, unique, individual experiences to really focus on helping to improve health. Bringing together the best of Canyon Ranch and HPI and our Corporate Athlete Program create something unlike anything in the market, and I think this really sets us apart.

To learn more on the program, with dates scheduled for July 13-18, and October 19-24 in 2014, click here.

Infographic: Clinical Health Coaching Skills

June 4th, 2014 by Jackie Lyons

Healthcare professionals trained with clinical health coaching skills can increase patient engagement and activation, improve health behavior and prompt better self-care, according to a new infographic from Clinical Health Coach.

This infographic also helps healthcare professionals identify and apply clinical health coaching skills in patient-centered care, including what clinical health coaches know, what their duties are and why they matter.

Want to know more about clinical health coaching? Evidence-Based Health Coaching: Patient-Centered Competencies for Population Health presents a template for evidence-based coaching that emphasizes clinical competencies, along with real-life applications from a health system already utilizing clinical health coaches within its value-based healthcare network.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

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Clinical Health Coaching Transforms Care Conversation

May 27th, 2014 by Patricia Donovan

Evidence-based health coaching drives the population health management processes required to succeed in a value-based system—the industry’s quantum shift to ‘Healthcare 3.0,’ advises William Applegate, executive director of the Iowa Chronic Care Consortium.

How do we change to this Healthcare 3.0? One way is to create real patients that are in patient-centered medical homes. NCQA level three medical home recognition is great, but there are still a number of those medical homes that need to add ‘meat and potatoes’ to what they have achieved.

Next, we need to build a true population health capacity. We need to develop differentiated health teams. You can’t really create a robust health coach as a professional in an organization and then not change the position description of others. The trained clinical health coach can actually improve the ability of a physician to operate at the highest level of their license. That’s part of how a health coach fits into a healthcare team. It’s not just an addition. It’s a kind of reformation of how we’re approaching healthcare with patients.

You need to use trained performance health coaches to make this shift. And you need to activate patients towards self-care. And as I say over and over, we really need to inspire their own accountability.

There are two big features in transforming care. One is transforming the conversation, and the other one is transforming the care process. In transforming the conversation, we need to employ a performance-oriented health coaching. That’s more than motivational interviewing.

We need to rely on the science of behavior change. An awful lot of healthcare professionals deep down don’t believe that we can move individual behaviors. I don’t think we can change people’s lives dramatically. But we certainly can change some of their health outcomes, because we know that our chronic diseases are essentially learned; they’re exacerbated by things that we do to ourselves.

Excerpted from: Evidence-Based Health Coaching: Patient-Centered Competencies for Population Health

6 Key Elements of Population Health Management

May 20th, 2014 by Patricia Donovan

A carefully curated population health management program begins with risk stratification and fosters collaborations with stakeholders that can raise the bar on health outcomes while educating participants about appropriate utilization of services such as the hospital emergency room.

Beyond that framework, for the great majority of respondents to a 2012 survey on population health management by the Healthcare Intelligence Network, this strategy should also encompass health coaching.

With healthcare’s value-based purchasing increasingly favoring a population-centric approach to health management, the top PHM program components cited by respondents are the following:

  • Health coaching: 78.7 percent
  • Provider feedback on care gaps: 46.8 percent
  • Support group: 29.8 percent
  • Telemonitoring: 25.5 percent
  • Other: 23.4 percent
  • Group visits: 19.1 percent

Excerpted from: 57 Population Health Management Metrics: Assessing Risk to Maximize Reimbursement