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The following article is from MANAGED HEALTHCARE EXECUTIVE.

In their corner: Health coaches support consumer efforts toalter behavior

The interest in health coaching is driven by purchasers' desire to lower medical benefit costthrough wellness and disease management, according to Steve Richter, senior vice presidentat Keenan & Associates, Keenan HealthCare division. "This means facilitating behaviorchange in consumers who know what lifestyle or other behavior changes they need to make,but have not followed through," Richter says.

Health coaching can include disease management, case management, utilization review andgenerally applying evidence-based medicine guidelines to care delivery, according toMicali.Because of the strong imperative to provide behavior modification interventions, healthcoaching recently has gained great popularity because of the ability to address multiplebehaviors, health risks and self-management of illness in a cost-effective manner,Butterworth says."If we can encourage people to make healthier lifestyle choices and adhere to theirtreatment plans by facilitating self-care competencies, the outcomes include reduced healthrisks and better self-management of chronic conditions," she says.

OHSU HMS offers health coaching through a multidisciplinary group, including nurses,dietitians and other health promotion specialists, who spend time with individuals primarilyby telephone.


"During these interactions, the health coach focuses on identifying both the physical and mental obstacles that prevent members from taking charge of their health and bettermanaging their chronic conditions," says Jay Krueger, senior vice president of businessstrategy, APS Healthcare, a specialty healthcare company based in Silver Spring, Md.,which bundles health coaching into its disease management program.The number of health coaching sessions may vary on the program being pursued, Micalisays. "Someone who wants to significantly change diet and exercise to address obesity mayrequire a high frequency of sessions and a long duration, given that eating habits can bevery slow to combat," he says.

Health coaching is fairly intensive and not necessary for every member, according toButterworth. "The most cost-effective way to administer all health promotion and disease management interventions is to identify members/employees at greatest risk and stratifythem by need for varying the intensity of services," she says.

Candidates for health coaching tend to respond positively because health coaches act as anadvocate, according to Krueger. "Health coaches provide a supportive environment to helpmembers obtain positive healthcare results that are sustainable over time," he says."Individuals who are involved in their care make better decisions and are more able toengage their physicians and other support resources in managing their care."In addition, many health coaching programs offer consumers financial incentives toparticipate, Micali says.

CIGNA has found that the majority of individuals respond positively to outreach from a health coach, according to Daniel L. Ober, DO, medical senior director, health advocacyand information at CIGNA. "Some may not be aware of their health risks or haveinformation to help them incorporate changes or follow a doctor's recommendations," Dr.Ober says. "Others find it helpful in setting goals and like the accountability of knowing their health coach will be calling them."CIGNA has formed CareAllies Health Coach program that targets those who are at higherrisk for future healthcare problems, based on their responses to a health risk assessment."We are focusing on consumers as the end-users of our clinical management and healthadvocacy services," Dr. Ober says.

When a CIGNA HealthCare medical plan is offered by a plan sponsor, CIGNA provides clinical management and health coaching programs, which include disease management programs, a 24-hour health information line and a healthcoaching program."CareAllies provides plan sponsors with these programs when an employer wants to offer aconsistent set of clinical management and health coaching programs across their entireworkforce, whether or not they have an underlying CIGNA medical plan," Dr. Oberexplains.
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The CareAllies team averages about two health coaches per 1,000 members, along with a team of health advisors, level-of-care nurses, nutritionists, lifestyle management specialists,a dedicated health coach medical director, multiple specialty physicians and a pharmacist.The number of health coaches may be adjusted to meet volumes and utilization and demand, says Dr. Ober. "Our health coach program is individualized, dependent on the member's need," Dr. Obersays. "Attempting to make dietary or physical activity changes, for many individuals,requires a series of small steps over several months."Aetna offers a Wellness Counseling service that looks at health risk assessment data and risk-stratifies members, according to Anthony Rubino, product specialist for the MemberAdvantage Programs, and subject matter expert for the Aetna Healthy Body, HealthyWeight, and Wellness Counseling. The Wellness Counseling service costs 60 cents per-member per-month (PMPM) and the Aetna Healthy Body, Healthy Weight program costs$1 PMPM. "The Wellness Counseling services lower modifiable risk factors, identifycandidates for disease and case management programs earlier, educate about Aetna consumerism tools and support positive health-related behavior change," Rubino says.Wellness Counseling nurses provide outreach to members if they are at risk for a number ofconditions. "This type of early intervention has been shown to identify at-risk membersearly and to manage a condition early before the condition becomes chronic or severe,"Rubino says.

CareFirst BlueCross BlueShield is launching a health risk assessment tool"MyHealthProfile" this month and a "Healthy Lifestyle Coaching" health coaching service for smoking cessation, exercise participation, as well as weight and stress management fromHealthways this October, according to Dr. Safeer. "Our health coaches will not be spending time telling participants that smoking is bad for you or for your lungs–which offers a lowerprobability of being effective. Instead, we will partner with the participant to take intoaccount their individual situation when approaching their unhealthy behavior," he says.

Tracey Walker is senior editor for MANAGED HEALTHCARE EXECUTIVE.
http://www.ohsu.edu/hms/pdf/ManagedHealthcareExecutive.pdf.