Health coaching in employee wellness -  past present and  future
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Health coaching in employee wellness - past present and future

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Is telephonic coaching losing favor as an employee wellness component? Recent reports show that some large employers view telephonic coaching as expensive and having limited reach. If this is true, ...

Is telephonic coaching losing favor as an employee wellness component? Recent reports show that some large employers view telephonic coaching as expensive and having limited reach. If this is true, what are the other options? If not, what role should it continue to play? And what does the future of health coaching look like? Learn more by view these slides and watching the webinar at http://www.shapeup.com/lp/health-coaching-past-present-and-future

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Health coaching in employee wellness -  past present and  future Health coaching in employee wellness - past present and future Presentation Transcript

  • Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 1
  • Today’s Webinar Team Rajiv Kumar, M.D. Founder & Chief Executive Officer rkumar@shapeup.com Shawn LaVana Vice President of Marketing slavana@shapeup.com Elise Meyer Marketing Associate emeyer@shapeup.com Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 2
  • Join the Conversation on Twitter @shapeupdotcom #healthcoaching Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 3
  • ShapeUp’s Mission Statement Creating a healthier world by leveraging social influence to engage people in healthy activities Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 4
  • Today’s Agenda1. Why Health Coaching2. Telephonic Coaching3. Online Coaching4. Peer Coaching5. ShapeUp’s Approach6. Discussion Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 5
  • Why Health Coaching?A Response to Rising Health Costs Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 6
  • Employers = 1/3 of All Health Spending U.S. Healthcare Expenditures, 1960-2020 $0.1T $0.1T $0.3T $0.7T $1.4T $2.5T $4.5T 100% Out-of- Pocket Out-of- Pocket Other Private 80 Private Health Insurance Total Private 60 Other Public 40 Medicare Total Public 20 Medcaid/ SCHIP 0 1960 1970 1980 1990 2000 2010 2020 YearNote: ―Other Public‖ includes TRICARE, VA and all public health initiatives. Source: CMS; CBO; KFF/HRET Health Employer Health Benefits Survey, 2011; US Census Bureau Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 7
  • Large Employers Are Mostly Self-Funded Percent of Covered Workers in Partially or Completely Self-Funded Plans By Firm Size, 1999-2011 CAGR (99-11) 100% 5K+ 4% 80 1K-5K 2% 60 200 to 0% 999 40 20 3 to 0% 199 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Source: Kaiser Family Foundation; US Census Bureau 2011 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 8
  • Lifestyle Conditions Are Driving Costs Cost of Healthcare, # of People Afflicted, and Nutrition Index by Condition Manageable with Lactose diet & exercise Celiac Intolerant Disease Metabolic Syndrome Osteoporosis Obesity/ Overweight Hyper- High Diabetes tension Cholesterol Inflammatory Bowel Disease Irritable Bowel Syndrome Heart Disease Cancer Heartburn $60B Alzheimers/ Healthcare Sleep Cost Dementia 0 Not manageable 0 25 50 75 100 125 150Mwith diet & exercise Number of People Afflicted Source: Center for Disease Control; National Institutes of Health; Department of Health and Human Services; Illinois Department of Public Health; National Commission on Sleep Disorders Research; American Heart Association; American Diabetes Association; Alzheimer’s Association; Epilepsy Foundation; Heart Rhythm Foundation; Celiac Sprue Association; International Osteoporosis Foundation; American College of Gastroenterology; MedicineNet; Pharmacy Times; Sleep Disorders Guide; Physician’s Postgraduate Press Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 9
  • Telephonic CoachingExamining a Traditional Model Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 10
  • Discussion #1: Telephonic Coaching• What has been your experience with telephonic coaching?• Does the level of engagement justify the cost?• Have you seen measurable health improvement?• Is this approach best suited for certain employee types?• Should employers stick with this model or ditch it?If you’d like to respond, please type the discussion number and yourorganization name into the question box on the GoToWebinar control panel. Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 11
  • Telephonic Coaching Can Really WorkA Randomized Trial of a Telephone Care-Management Strategy• Objective: To assess the effect on medical costs and resource utilization• Methods: Randomized study of 174,120 subjects. Health coaches contacted at-risk individuals about shared decision-making, self-care, and behavior change.• Results: After 12 months, the average monthly medical and pharmacy costs per person in the enhanced group were 3.6% ($7.96) lower than those in the usual support group ($213.82 vs. $221.78), driven by 10.1% reduction in hospital admissions. Intervention cost less than $2 per person / month• Conclusion: Targeted telephonic intervention reduced medical costs and hospitalizations in a large population with a positive ROI.http://www.nejm.org/doi/full/10.1056/NEJMsa0902321 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 12
  • But Telephonic Coaching Has LimitsThe effect of a telephone-based health coaching diseasemanagement program on Medicaid members with chronic conditions• Objective: To examine impact on healthcare utilization and expenditures in this population• Methods: Examined changes in hospital utilizations, emergency department visits, ambulatory care, and Medicaid expenditures among participants for 1 year before and 2 years after enrollment vs. a control group.• Results: Changes in acute hospitalizations, ambulatory care visits, and Medicaid expenditures were the same in both groups. After the 2 nd year, ED visits were lower in the coaching group (8% vs. 23%).• Conclusion: Telephonic coaching did not demonstrate significant effects on healthcare utilization and expenditures in this population.http://www.ncbi.nlm.nih.gov/pubmed/21993059 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 13
  • Is Telephonic Coaching Inconvenient?―Doing The Telephone Tango‖ ―Ella doesn’t recognize the number that shows on her caller ID. She lets the call go to voice mail. The vendor rep leaves a cheerful, but cryptic message. Ella doesn’t call back. Even though the rep used our company name, and she vaguely remembers a wellness program brochure, she’s not 100% convinced it’s legit. In addition, she’s in the middle of making dinner for her family, and the cable box is on the fritz. She’s got more important things to worry about.‖http://ebn.benefitnews.com/news/telephone-tango-2710663-1.html Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 14
  • Telephonic Coaching: Employer Opinions ―We’ve seen a savings of $869 per person per year for the 530 people who have been enrolled for two years. Telephonic coaching is difficult, although for people who are struggling with a certain issue, this type of support can lead them to the next level.‖ShapeUp Annual Employer Wellness Survey, 2012 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 15
  • Telephonic Coaching: Employer Opinions ―Overall, we’ve heard good things from our employees, but we would like to switch to virtual coaching if we found a model that works‖ShapeUp Annual Employer Wellness Survey, 2012 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 16
  • Telephonic Coaching: Employer Opinions ―We can’t tell if people are just checking the box so to speak to get incentives versus if this is something that is really useful and that they are learning from.‖ShapeUp Annual Employer Wellness Survey, 2012 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 17
  • Telephonic Coaching: Employer Opinions ―Some vendors don’t get it. A couple of calls and a letter won’t have an impact on engagement.‖ShapeUp Annual Employer Wellness Survey, 2012 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 18
  • Telephonic Coaching: Employer Opinions ―I ask myself, how effective is telephonic coaching itself? Given the small number of participants, we pay a lot for it -- almost $500,000 for 3,000 people.‖ShapeUp Annual Employer Wellness Survey, 2012 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 19
  • Telephonic Coaching: Employer Opinions ―It’s unclear what the effect is. Utilization is low – in the single digits.‖ShapeUp Annual Employer Wellness Survey, 2012 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 20
  • Telephonic Coaching: Employer Opinions ―We pulled the plug on telephonic health coaching—only a small percent respond. It’s not a very motivating model.‖ShapeUp Annual Employer Wellness Survey, 2012 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 21
  • Key Points About Telephonic Coaching Studies have shown that telephonic coaching can produce health improvement and a positive ROI Other studies have shown little impact Some employers report positive outcomes and employee feedback Low participation and high cost are cited often Employees may prefer other methods of contact Some employers are looking for alternatives Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 22
  • Discussion #1: Telephonic Coaching• What has been your experience with telephonic coaching?• Does the level of engagement justify the cost?• Have you seen measurable health improvement?• Is this approach suited for particular employee types?• Should employers stick with this model or ditch it?If you’d like to respond, please type the discussion number and yourorganization name into the question box on the GoToWebinar control panel. Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 23
  • Online CoachingUnderstanding Its Efficacy Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 24
  • Discussion #2: Online Coaching• Have you used any form of online coaching in your workplace?• Did employees prefer this method of communication vs. telephonic/in-person?• How did the cost compare to telephonic/in-person?• Do you prefer human coaching or virtual coaching?• Have you seen measurable health improvement?If you’d like to respond, please type the discussion number and yourorganization name into the question box on the GoToWebinar control panel. Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 25
  • Automated Coaching via the Web Web-based Weight Management Programs in an Integrated Health Care Setting: A Randomized, Controlled Trial • Objective: Assess the efficacy of automated coaching for weight loss • Methods: 2,862 overweight and obese members of Kaiser Permanente randomized into a tailored automated coaching system or information-only web-based weight management materials. Weight assessed via self-report at 3 and 6 months. • Results: Automated coaching participants lost 3% of baseline weight, information-only participants lost 1.2%. Automated coaching participants said it was more personally relevant, helpful, and easy to understand. • Conclusion: Automated coaching can produce weight loss outcomes.Rothert, Kendra et al. Obesity. Vol. 14 No. 2 February 2006 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 26
  • Human Coaching via the Web Effects of Internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial • Objective: Compare effects of an internet weight loss program alone vs. with additional of e-mail coaching for one year • Methods: 92 overweight adults, randomized to basic internet program or behavioral e-counseling and feedback from a counselor • Results: Coaching group lost more weight at 1 year (-4.4kg) than control group (-2kg). • Conclusion: E-mail coaching significantly improved weight loss outcomesTate et al, JAMA 2003. Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 27
  • Human vs. Automated Coaching A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program • Objective: Compare human and automated coaching • Methods: 192 obese adults randomized to 3 groups: no coaching, automated coaching, human e-mail coaching • Results: At 6 months: no coaching group (-2.6 kg), automated group (-4.9 kg), human email coaching group (-7.3 kg) • Conclusion: At 3 months automated and human email coaching were as effective but at 6 months human coaching was more effective.Tate et al, Arch Intern Med Aug 2006. Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 28
  • Key Points About Online Coaching Online coaching is more scalable and can be more cost effective than telephonic coaching Both human and automated online coaching appear to produce clinically significant results Human coaching may produce better outcomes than automated coaching but at an increased cost Online coaching offers the convenience of asynchronous messaging (e.g. email, SMS) Some employers say that online coaching is inaccessible to their offline employees Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 29
  • Discussion #2: Online Coaching• Have you used any form of online coaching in your workplace?• Did employees prefer this method of communication vs. telephonic/in-person?• How did the cost compare to telephonic/in-person?• Do you prefer human coaching or virtual coaching?• Have you seen measurable health improvement?If you’d like to respond, please type the discussion number and yourorganization name into the question box on the GoToWebinar control panel. Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 30
  • Peer CoachingExploring a Promising Approach Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 31
  • Discussion #3: Peer Coaching• Have you tried using peer coaching at your company?• How did your employees respond to this approach?• Did this produce higher or lower engagement than other types of coaching?• What was the health impact?• Should more employers adopt this approach?If you’d like to respond, please type the discussion number and yourorganization name into the question box on the GoToWebinar control panel. Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 32
  • Peer Coaching & EngagementAn Online Recovery Plan Program: Can PeerCoaching Increase Participation?• Objective: Evaluate whether addition of online coaching from a peer specialist increased participation in a bipolar disorder program• Methods: 118 participants recruited, randomly assigned to online peer coaching vs. control group• Results: Peer coaching participants were more likely to return to the website after registration (71% vs. 44%) and continue using the program after three weeks (38% vs. 9%)• Conclusion: Peer coaching led to greater program engagement and retentionSimon et al, Psychiatric Services, Vol 62 No. 6 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 33
  • Peer vs. Nurse Coaching for DiabetesDiabetes Control with Reciprocal PeerSupport Versus Nurse Care Management• Objective: Compare peer-support with nurse care management• Methods: 244 men with A1c > 7.5%, randomized. Half matched with peer coach for weekly sessions, other half matched to nurse care manager.• Results: A1c decreased (8.02 to 7.73%) in peer group, but increased (7.93 to 8.22%) in nurse group.• Conclusion: Peer coaching holds promise as a method for diabetes care management.Heisler et al, Annals of Internal Medicine, 2010. Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 34
  • Peer Coaching via Recruitment & SupportBenefits of Recruiting Participants With Friends andIncreasing Social Support for Weight Loss andMaintenance• Objective: Determine the benefits of social support for weight loss and maintenance• Methods: Recruited participants (N = 166) either alone or with 3 friends or family members and then randomly assigned them to a standard behavioral treatment with and without social support strategies.• Results: Participants recruited with friends and given social support had greater weight losses at 4-months (20 lbs) and 10-months (19 lbs) than those recruited alone (15 lbs and 12 lbs). In those recruited alone, 76% completed and 24% maintained weight loss in full through month 10. When recruited with friends and social support, 95% completed and 66% maintained weight loss in full.• Conclusion: Recruitment with friends and social support led to greater weight losses and longer-term sustainability.Rena R. Wing and Robert W. Jeffery, 27 July 1998. Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 35
  • Peer Coaching via Team ChallengesA Statewide Intervention Reduces BMI inAdults: Shape Up Rhode Island Results• Objective: Evaluate weight loss outcomes• Methods: Measure weight loss achieved among 3,311 participants in Shape Up RI, a 16-week workplace-based exercise and weight loss team competition.• Results: 7 lbs, 30% achieved clinically significant weight loss of 5%, shifted the BMI distribution from mean of 29.4 to 28.2 and reduced the obese population from 39 to 31%. Weight loss maintenance at 10 months was 73%.• Conclusion: Team-based, weight loss competitions can produce weight losses in large numbers of participants and may be sustainable long-term.Rena R. Wing, et al , Obesity (2009) 17 5, 991–995. Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 36
  • The Social Influence of Peer CoachingTeammates and Social Influence Affect WeightLoss Outcomes in a Team-Based Weight LossCompetition• Objective: Investigated the effects of teammates and social influence on individual weight loss and exercise outcomes• Method: 12-week, team-based wellness competition• Results: Overweight/obese completers lost 4.2% of initial body weight. Weight loss was similar among teammates. Having a greater percentage of teammates in the weight loss division and reporting higher social influence for weight loss were both associated with greater weight loss. Clinically significant (5%) weight loss tended to cluster within teams.• Conclusion: Weight loss and the behaviors that lead to it are likely contagious, and harnessing and maximizing social influence for weight loss enhances outcomes.Tricia Leahey et al, Obesity, Feb 2012. Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 37
  • Key Points About Peer Coaching• Peer coaching can lead to higher participation and retention• Peer coaching can produce significant health outcomes• Peer coaching is the most cost effective approach• Peer coaching is most effective when the coach shares similar health issues and goals• Outcomes via peer coaching have been shown to be contagious, spreading from person to person• Peer coaching can have limitations related to the lack of formal training of the coaches Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 38
  • Discussion #3: Peer Coaching• Have you tried using peer coaching at your company?• How did your employees respond to this approach?• Did this produce higher or lower engagement than other types of coaching?• What was the health impact?• Should more employers adopt this approach?If you’d like to respond, please type the discussion number and yourorganization name into the question box on the GoToWebinar control panel. Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 39
  • ShapeUp’s Approach to Coaching Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 40
  • Empowered Peer Coaches for Everyone• Turning colleagues into peer coaches through the role of Team Captain• Peer coaches empowered to recruit, motivate, and hold peers accountable• Allowing every member to serve as a peer coach through support mechanisms and user-generated challenges• Leveraging your potent employee network at a low cost Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 41
  • Online Fitness Coaches for the Motivated• Provide additional expert support, guidance, and education for motivated individuals and teams (opt-in model)• Focus on physical activity, nutrition, and weight management• Asynchronous messaging, integrated into our social engagement platform• Coaches drive utilization of the platform, social interactions, team cohesion, and healthy outcomes Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 42
  • Key Takeaways from Today’s Webinar Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 43
  • Key Takeaways from Today’s Webinar Coaching is a dominant approach for employee wellness Various studies have showed that each method of coaching can be clinically effective Many employers are looking for alternatives to telephonic coaching Online coaching models offer greater reach, scalability, convenience, and cost-effectiveness Peer coaching holds promise as a low-cost, highly effective model for harnessing the power of social networks Further research is needed to understand the long-term impact and sustainability of health coaching on behavior change Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 44
  • Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary. 45