A promising new method to managing health care costs has emerged
from the consumer-driven health movement with proven resu...
A sound investment
High health care costs have dogged
human resource and employee benefit
professionals for years, but the...
In addition to reaching more of the
high risk population, the enhanced care
model encourages a deeper one-on-one
Such reports are usually delivered on
a monthly and quarterly basis, with the
latter offering an in-depth analysis of
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Coaching employees-to-better-health


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Coaching employees-to-better-health

  1. 1. A promising new method to managing health care costs has emerged from the consumer-driven health movement with proven results for employers and health care consultants. The key is reaching just beyond standard practices to enhance member engagement in wellness and care management programs. This leads to additional opportunities to improve member health outcomes, increase satisfaction and sustain healthy behaviors. Population health programs typically focus on high volume and high cost chronic conditions such as coronary heart disease, heart failure, diabetes, asthma, chronic obstructive pulmonary disease, and related co-morbidities such as chronic pain, obesity, depression, renal failure and hypertension. But evidence is emerging that shows results can be optimized when this approach is: • Broadened to include preference-sensitive conditions that drive high utilization and medical costs involving lifestyle factors. • Built around frequent and intensive personalized member outreach. • Designed to engage members through comprehensive health coaching to provide the most effective interventions for diverse populations. Avivia Health From Kaiser Permanente delivers this ground breaking program, which was developed by Health Dialog Services Corporation, to employer groups nationwide. The efficacy of this program is supported by a year long, randomized trial conducted by Health Dialog of nearly 175,000 individuals that was published in September 2010 in The New England Journal of Medicine.1 The study, entitled “A Randomized Trial of a Telephone Care-Management Strategy,” was authored by David E. Wennberg, M.D., M.P.H., along with Amy Marr, Ph.D., Lance Lang, M.D., Stephen O’Malley, M.Sc., and George Bennett, Ph.D. It was the largest research of its kind ever conducted to assess the effectiveness of enhanced telephone-based care management on medical costs and resource utilization. Coaching Employees to Better Health Broader, Deeper Population Outreach Generates 4:1 ROI A Supplement to Employee Benefit News • Produced by SourceMedia’s Custom Media Group Sponsored by:
  2. 2. A sound investment High health care costs have dogged human resource and employee benefit professionals for years, but they are just as worrisome to C-suite executives who face mounting pressure to rein in spending wherever possible—especially in a sluggish economy or competitive business climate. Consequently, they are looking for compelling opportunities to accomplish this increasingly important corporate objective. The conclusion of this study is that the average medical and pharmacy cost per member per month (PMPM) was determined to be $7.96 lower for health plan members who received enhanced support, including a 10.1% reduction in annual hospital admissions and a greater than 4:1 return on investment (ROI). A deeper review of these findings illustrates how organizations that are willing to commit the necessary time and resources to improving the health of their workforce can substantially grow their investment in human capital. “This study shows that an analytically driven, targeted, population-based program can decrease hospitalizations and surgical procedures and thereby reduce total medical costs for the population as a whole,” according to the researchers. “The reductions in resource utilization were within the categories one would expect, given the intervention: high-variation medical admissions and preference-sensitive surgical admissions. Although not a panacea, a scalable intervention that substantially reduces expenditures by supporting patient involvement in the decision-making process could be an effective component of health care reform.”2 Historical disease management trends have cast doubt about the extent to which traditional outreach mechanisms or standard industry measures can make a substantive difference in an organization’s bottom line. In using rigorous randomized comparisons, the researchers sought to address dissatisfaction with current engagement and measurement approaches and examine the impacts of enhanced telephonic member engagement. Enhanced care model The enhanced intervention involving the populations served by two regional health plans exceeded traditional program support in that a larger number of subjects were targeted for outreach. Individuals in both the enhanced care and usual care groups were identified through predictive models that calculated the estimated total cost of services, identified gaps in effective care, and forecasted the likelihood of surgical intervention for a preference-sensitive condition. However, for the group receiving enhanced care, the thresholds for predicted health care costs or resource utilization among persons with chronic or preference-sensitive conditions were lowered to encompass a wider range of individuals. Finally, these analytics identified subjects for enhanced care who were not diagnosed with certain specified conditions but who according to the models were at high financial risk.1 Proprietary predictive models were used to determine the most effective level of support for members based on their condition or risk levels. These models were deployed to broaden outreach, with claims-form codes used to identify health plan members in a health maintenance organization, preferred- provider organization and point-of-service plan with the highest financial risk3 . The individuals who participated in this study had group health insurance coverage through one of seven employers (which received Health Dialog’s services at least one to four years prior to the study). That list included a state university system, state employee group, natural-resource extraction company, public educational service agency, nonprofit association of independent colleges and two manufacturers. Roughly 10% of the enhanced support group received telephone-based coaching; these individuals were contacted through a combination of outbound health coach and interactive voice recognition (IVR) calls. The number of outreach attempts made to those in the enhanced support group was greater than the traditional support group. The study’s health coach team, which included registered nurses, licensed vocational nurses, dietitians, respiratory therapists and pharmacists, used proprietary software to support treatment decisions, guide discussions, provide education, and make referrals to relevant Web site links, medical encyclopedias or other resources, plus videos, DVDs and printed materials. Total population health approach Health care analytics are used in conjunction with a total population health approach to assess the risk of high utilization and costs, as well as the prospect of surgery and adverse clinical outcomes across the entire member population. Risk scores also incorporate potential variation in care drivers, such as the per capita availability of general and specialty surgeons and acute care facilities.4 This approach incorporates a larger pool of health care information in addition to information about individual risks and treatment levels. A Supplement to Employee Benefit News • Produced by SourceMedia’s Custom Media Group Differences in Average Monthly Medical Costs between Enhanced and Usual Support, According to Service Category Source: Wennberg DE et al. N Engl J Med 2010;363:1245-1255 -6.04 -0.05 -1.61 -0.78 0.52 1.00 – 0.00 – -1.00 – -2.00 – -3.00 – -4.00 – -5.00 – -6.00 – -7.00 – Inpatient hospital Emergency room Outpatient hospital Outpatient office Pharmacy Service Category DifferenceinAverageMonthlyCostsbetween UsualSupportandEnhancedSupport($)
  3. 3. In addition to reaching more of the high risk population, the enhanced care model encourages a deeper one-on-one relationship between each member and their personal health coach over time. Receptivity scores help guide resources to the members most open to health coaching and decision support. Health coaching relationships empower members to be more active in their health and well being. This bond can create a greater receptivity to coaching, which is invaluable considering that there is a set of conditions driving inpatient and outpatient utilization that present a high degree of sensitivity to health coaching activities. Under an enhanced care approach, health coaching and support services are broadened to encompass 65 wellness and condition management topics. The program model also takes into account health-risk assessments (HRAs), biometric screenings and prior-authorization data. Another component is the incorporation of a robust provider communication, education and engagement strategy. Broader range of conditions A major component of the enhanced care program includes targeting a broader range of health care conditions and concerns beyond traditional core chronic conditions. For example, additional high-risk conditions that are identified include anxiety, migraines, spinal stenosis, chronic fatigue, tobacco use, joint pain, back pain, peptic ulcer, chronic kidney disease, and cancer. Outreach is also provided to members who have frequent emergency room and/or hospital admissions. The telephone is a particularly effective conduit for health care coaching on a mass scale, serving as the hub on a wheel of program engagement—with Web-based tools, e-mail, multimedia presentations, and direct mail serving as the spokes. Calls can be tailored to pinpoint the needs of members with high or moderate health risks along the health continuum based on a complete set of their information at each health coach’s fingertips. Results show that participation in enhanced support programs was almost three times the engagement rate in a typical arrangement.1 The power of personalization also is reflected in corporate branding. IVR technology enables caller ID to display the name of an employer-sponsored program—allowing members to press certain prompts to learn more information or speak with a health coach. This consultation is built around a variety of different tools and techniques to identify opportunities where members can not only eat better and exercise more but also adhere to a prescription drug regimen to manage a chronic illness or avoid dangerous drug interactions. While HRAs can serve as an effective tool in determining each member’s health status and assessing the person’s needs, the nature of self-reporting is such that it could skew a program’s recommendations. The enhanced care model, mindful of this pitfall, instead relies on an evidence-based approach that uses medical and pharmacy claims data to identify and stratify more members in need of health care coaching, as well as questionable health conditions, relative to risk scoring. Patient claims data can be leveraged for examining hospital admissions, trips to the ER, specialist visits, co-morbidity or pharmacy measures for predicting adverse clinical outcomes if one’s condition is not properly managed. Various risk scores are applied to members, who are stratified into high, moderate and low risk groups to help manage obesity, stress or even tobacco cessation. Assessing key measures A final piece of the puzzle for taming health care costs in the workplace involves how activity measures for key population segments are documented. Reporting under the enhanced care approach includes operation metrics for health coaching call centers that rate how quickly a call is answered, hold time, call volume and other critical information. A Supplement to Employee Benefit News • Produced by SourceMedia’s Custom Media Group Health Coach Activity and Outreach According to Cohort and Study Group Cohort and Study Group1 No. of Subjects Subjects Targeted for Coach Contact2 % Coach Contacts3 no./1000 persons/yr Subjects Contacted by Coach % Videos Sent Coach Mailings all subjects Usual support 87,243 7.8 79.3 3.7 3.8 35.3 Enhanced support 86,877 25.8 233.0 10.4 12.2 125.3 Subjects with selected chronic conditions Usual support 8,515 34.4 331.1 15.9 16.8 194.2 Enhanced support 8,465 76.1 978.7 39.8 41.4 605.5 subjects with preference-sensitive conditions that put them a risk for surgical intervention Usual support 9,161 18.2 113.1 6.3 11.4 55.4 Enhanced support 9,190 59.5 398.5 22.2 41.1 240.2 subjects with other high-risk conditions Usual support 19,446 5.5 53.1 2.8 2.2 20.8 Enhanced support 19,364 30.9 183.5 10.8 12.7 105.1 all other subjects Usual support 50,121 2.3 27.6 1.5 0.7 8.3 Enhanced support 49,858 9.1 57.5 3.1 1.6 23.9 1 Data are shown for cohorts at baseline: during the study year, subjects could move among the outreach cohorts (the largest number of moves was out of the “all other subjects” cohort into the “preference-sensitive conditions” or “other high-risk conditions” cohort) but not between the two study groups. 2 Targeted subjects were directly telephoned by coaches or were called by an interactive voice-response system and given the option to transfer to a coach. 3 Contacted subjects included only those who spoke with a coach. All differences between the usual-support and the enhanced-support groups were significant (P0.001). no./1000 persons/yr Source: Wennberg DE et al. N Engl J Med 2010;363:1245-1255 continued on back
  4. 4. Such reports are usually delivered on a monthly and quarterly basis, with the latter offering an in-depth analysis of program effectiveness. They can be used to compare intervention and control group outcomes with regard to an array of PMPM medical and pharmacy cost measures, an analysis of utilization rates involving hospital admissions and ER visits, as well as primary and specialty care physician visits, clinical quality indicators based on HEDIS measures and member satisfaction. Service providers need to offer a flexible model that provides solutions to the various challenges that employers and health care consultants are facing. Enhanced care offers a more in-depth approach for employers seeking to improve member health while simultaneously controlling health care costs. Conclusion An enhanced care program provides the answer to employers who are interested in lowering health care costs, but are skeptical about traditional approaches to measur- ing financial outcomes of care manage- ment programs. There is no easy answer to achieving this major business objective, but employers and health care consultants can take heart in this emerging approach to enhanced care management that is reduc- ing medical and pharmacy costs, as well as resource utilization, by broadening the scope of traditional programs and delivering proven results based on large randomized trials. n References 1. New England Journal of Medicine, Volume 363(13):1245-1255, September 23, 2010 2. Catlin A, Cowan C, Hartman M, Heffler S. National health spending in 2006: A year of change for prescription drugs. Health Aff (Millwood) 2008; 27:14-29. [Erratum, Health Aff (Millwood) 2008; 27:593] 3. International Classification of Diseases, 9th Revision 4. Foundation for Informed Medical Decision Making home page For more information on Avivia Health, visit www.aviviahealth.com or call 1-877-4AVIVIA. Avivia Health is a complete wellness and condition management service provider, powered by Kaiser Permanente’s 65+ years of population care management expertise. We offer a comprehensive suite of health, wellness, and productivity optimization capabilities that help companies better control their health care costs and give employees the resources they need to move toward a healthier lifestyle. We build our programs on a whole-person philosophy, focused on preventing disease, maintaining a healthy lifestyle, deploying evidence-based practices, and treating each member as an individual instead of a collection of symptoms. Our customizable services are available in all 50 states. Health Dialog Services Corporation is a leading provider of healthcare analytics and decision support. The firm is a private, wholly-owned subsidiary of Bupa, a global provider of healthcare services. Health Dialog helps healthcare payors improve healthcare quality while reducing overall costs. Company offerings include health coaching for medical decisions, chronic conditions, and wellness; population analytic solutions; and consulting services. Health Dialog helps individuals participate in their own healthcare decisions, develop more effective relationships with their physicians, and live healthier, happier lives. A Supplement to Employee Benefit News • Produced by SourceMedia’s Custom Media Group About AVIVIA