Lifestyle Management

(This program will be offered to all employees with an enrollment cap of 25% of the eligible employee population.)

Numerous studies have shown that personal behavior drives roughly 50% or more of an individual’s overall health status.  Health Coach is a Health and Lifestyle Management Program that provides telephonic health coaching and counseling to individuals with common risk factors. Individuals are stratified into three categories:

•    Lifestyle Maintenance – The healthiest 60% of the population.
•    Medium Risk – The borderline 25% that need enhanced intervention.
•    High Risk – The 15% least healthy group within the population that needs significant chronic care management and support with behavior modification.

Health Coach is designed to educate participants and help them set meaningful and realistic goals and is supplemented by educational materials and regular physician care.
Health Coach is a bio-behavioral program based upon federally-approved guidelines.  Behavioral science is used to help participants make changes and maintain new behaviors.  The program is designed to reduce risks and consequently improve the health and well-being of participants. We are confident in our ability to demonstrate positive results from the Health Coach program.

Health Coach Overview
Health Coach offers a remarkable prevention-based service designed to minimize the costs associated with high risk behaviors that, left unmanaged, typically result in significant medical costs.  Healthcare experts deliver the program to individuals via telephone contact in a series of carefully planned counseling sessions.  The counselors are supported by a sophisticated information system that helps capture data, direct the sessions toward optimal results, track progress along the way and provide detailed aggregate reporting on a variety of levels.
Known as Health Coach, our program is unique in several ways:

• Health Coach provides behaviorally-based counseling to people with certain elevated risks and chronic diseases.  The process of change that we offer has been demonstrated to lower risks and to improve the management of those key diseases.
• We are able to work with people with multiple risks and multiple diagnoses. Fully 80% of the people we serve have multiple risks and/or multiple diseases.  By targeting risks and diseases, we are able to assist people on a broader scale.  For instance, we can help a person with asthma comply with medication and we can help them stop smoking.
• Our program is able to reach dispersed populations easily.  Group programs, and even clinically based programs seldom engage more than 5 to 15% of the target audience.  We will capture and communicate with up to 25% of the eligible employee population for participation in the Health Coach program. Participation is promoted from the “most in need” to the “least in need” until the 25% utilization cap is met. This assures fees expended are put to use with those that both need the service and desire to take advantage of a Health Coach for management of their lifestyle and health needs.
• Our protocols are embedded directly within our software.  The biggest problem of earlier calling services was inconsistent application of protocol and theory across counselors.  We have included behaviorally-based queries and action steps within our protocols, ensuring consistent and scientifically sound communications with participants.
• Our program easily mixes with the other types of our programming.  Health Coach, for instance, fits well within a worksite-based health and wellness program and health screening services. 

Our Health Coach nurses do not dispense medical advice, as nurses who are operating a traditional “nurse triage” line might do.  Our participants are coached based upon the groups they are stratified within.   We help individuals make behavioral changes that will lower the risks and the chances of premature morbidity and mortality.
In addition, our nurse coaches refer the participant to a physician or health care provider if there are any problems with medications, failure to follow protocol, and for face-to-face evaluation of correct usage of devices (example: glucometer, peak flow meter).  We assist the participant in preparing questions, symptom logs, concerns, and issues for the physicians.  All of the protocols that guide our sessions are available in the software that the nurses use in counseling, and clinicians review the protocols and goals each year.

The Health Coach Philosophy
We believe that each human being deserves the right to the healthiest life possible, and that Health Coach is an excellent tool to facilitate this.  We believe that behavioral change science is the best tool for helping individuals optimize their health and well being and we use this approach in our telephonic counseling.  Some of the key tenets of our philosophy and approach are:

• Assess participant knowledge.  Since there are typically knowledge deficits, we provide educational material and counselor instruction on both risk and disease.
• Ask questions.  We ask questions about health belief, learning style, self-efficacy, experience, environment, compliance with recommended treatments and medication, satisfaction with health care providers, skills in communicating with the health care team, and readiness to change.  Both specific and open-ended questions are asked in order to personalize programs to participants.
• Customize the program.  Programs are tailored to the needs and interests of participants.  We help them clarify what they want, what they need, and how they want to receive both support and information.  Our approach is completely personalized, and our process for tailoring is a systematized method of probing.
• Empathize first. Without trust and empathy, learning is compromised.  We make the personal connection first, and we continue to build that connection over time to best support our participants and their families and friends.
• Encourage involvement. We involve anyone the participant wants to include such as family members when appropriate and available.  We can communicate with physicians when requested by a participant.  We listen to participant needs in both these areas of support and communication, and respond accordingly.
• Use an empowering approach.  We know that empowerment is key to motivation and success and assist by helping the participant recognize, use, and develop the skills they need to succeed.
• Be directive.  We expect participation, progress and self-responsibility.  We help the participant set goals that are specific, measurable, action oriented, realistic and time bound.
• Always believe there is improvement in quality of life.  We assist each participant in reducing risks and managing disease.

Program Content
Health Coach intervention topics include risk management as well as disease management.  We have found that most people (more than 85%) who have active disease also have risks that can lead to other future disease and disability.  Since our program is modular, it is easy for us to assess both disease-state counseling information and risks-directed counseling and present the participant with a program specifically tailored to target needs and interests.  Currently counselors are supported with medically-appropriate and behaviorally-directed information to address:

• Hypertension
• High Cholesterol
• Weight Management
• Smoking Cessation
• Stress Management
• Diabetes Management
• Allergy Management
• Asthma Management
• Physical Activity

Professional Delivery
The critical importance of the counselor’s expertise and approach cannot be understated.  While we have a great deal of confidence in the accuracy and effectiveness of the tools provided within our software, the counselor remains an essential part of the process, and is of great significance to the success of the participants.  Each counselor manages a “caseload” of participants, retaining the relationship with their cases over the entire process.  Occasionally the counselors will work together on a multiple-risk case.  The feedback from participants with respect to the quality and effectiveness of our counselors has been overwhelmingly positive.  The program attributes based upon stratification are as follows:

Our staff is deeply trained in behavioral science.  They are hired for their content knowledge and personal communications skills, but they are continually counseled in the theory and practice of each behavioral change strategy, which have been shown to assist participants in the change process.

By using a behaviorally based counseling process, we increase the odds that participants change.  We assess each participant consistently and continually throughout the program.  We interpret those assessments and tailor the program interventions to the specific beliefs and values of the participant.  We use the following behavioral tools:

• Health belief
• Self-efficacy
• Readiness to change
• Environmental assessment
• Compliance to treatment assessment and follow-up
• Busting barriers
• Handling relapse
• Assessing for maintenance characteristics and skills
• Goal setting
• Learning style assessment

Each of these tools is used when needed, in an on-going fashion, throughout all of our intervention areas.  This is a very unique approach in health counseling and coaching.  For instance, many programs assess readiness only at the beginning of the program.  We believe this limits the power of that particular behavioral tool.  For example, a participant who is interested in lowering blood pressure may be in the action stage for complying with medication but may be in preparation for dietary adjustments.  Asking the right questions consistently allows the program to be personalized for each employee and their respective approach to behavioral change.

Quality Assurance
Each counselor’s caseload is reviewed monthly against specific quality assurance measures.  In addition, all of our counselors participate in monthly “grand rounds.”  These grand rounds focus on operational issues, advanced training, and specific case profiling.  Each session profiles one or more cases to advance the skills of all the counselors, and offers the counselor the opportunity to ask questions or solicit assistance with any particular participant case.
It is important to note that “more is not always better.”  In the case of telephonic behavior change, our goal is to achieve health status results, and to increase the sense of personal responsibility and empowerment that is necessary to maintain that change.  Frequent calling can convey a dependence on the counselor – a sense that the counselor is responsible for the change.  This can result in diminished outcomes over the long term.  While some participants require more contact than others and will be afforded that level of service where appropriate, we believe strongly that our goal is high-quality, maintained behavior change and not “logging in” a certain number of phone calls.

Workflow
Counselors use their personal skills, but are aided with a software program that guides the behaviorally based counseling process.  Our software is not just a tracking tool for participation and outcomes.  Our software includes both key information points and behavioral assessment questions and suggested action steps for every single call.  We know that the single greatest impediment to achieving outcomes is inconsistent behavioral process across counselors over time.  We bridge that gap by providing the counselor with the right queries, probes, and suggested action steps on a real-time basis to tailor the program to the very specific and personal needs of the participant.

Enrollment Issues
Participation rates are correlated to the method of enrollment, and the marketing tactics that precede enrollment.  When a participant enrolls at the time of a health risk appraisal, screening, or opportunity where they are actually given some feedback on their health status, we often are able to enroll 70% or more of our target audience. Enrollment in the Health Coach program can be done online or via inbound phone contact with the counselor.

Education & Communication
Because of our utilization of The PHD Network, our cohesive model supports and promotes a multi-point educational enrichment program. Participants benefit from the stimulation of not only dealing with phone contact, but utilizing the interactive portion of our web tools.
Each counselor follows our protocol to assure that all participants receive material from our approved sources at Duke University.  Pertinent information is always highlighted and discussed at follow up sessions. 

Tailored Programs & Materials
Participants are routinely screened for learning style and level of knowledge about their risk and/or disease.  We may find, for instance, that a referral to a self-help group, web site, or voluntary association may be to the liking of a participant.

Monitoring Progress
Our tracking system lists the goals commonly set in each area. The counselors work with the participant to establish goals, and tactics are discussed to reach those goals. During the next call, the system reminds the counselor to check the goals set in the previous session. The counselor must check on the progress of each goal set before they can continue with the call, and must mark whether each goal is met, not met, or partially met. Each of these is quantifiable.

Confidentiality
The utmost attention is given to the confidentiality of data.  No individual personal data is shared with any client or any outside individuals or organizations.  Guaranteeing confidentiality is key to program success and sustained behavior change.  Participants are told from the beginning that no individual data is ever released to the client.  Only population data is reported.  Further we do not provide program information to family members or physicians without the consent of the participants.  Detailed participant information is only available to the counselor and system administrator.  Each counselor only has information pertinent to his/her caseload.  The master database is kept in a secure location that is only accessible by the Health Coach IT staff.

Information & Reporting
Individual clients have different areas of interest for measurement and differing access and philosophy issues with respect to confidentiality and data concerning health risks and expenditures.  Depending on the unique nature of each customer relationship, we are prepared to track the following program data:

• Participant registration information and risk area (no names revealed)
• Participation data
• Health Risk Assessment data
• Medical Claims Database information, if available
• Information acquired before an intervention to access participant’s status (Health history, intervention specific pre-test)
• Information acquired after an intervention to track participant’s progress and program outcomes
• Information acquired after an intervention to access participant’s satisfaction with program
• Dates and times of calls
• Counselor making the calls
• Results of the calls (i.e. no answer, left message, had conversation)
• Self-reported biometric data
• Goals set
• Goals met, partially met or not met
• Topic area covered

Management reports use an accounting/statistical format. Reports can include:

• Total number identified as high risk.
• Total number contacted regarding high-risk program.
• Total number enrolled in high-risk program and areas of intervention.
• Reasons for declining participation in program.
• Total number of goals set, partially met, and met.
• Participants who complete program, drop out of program, and/or are terminated from program.

In addition, we are willing to work with our clients to customize management reports in advance of service delivery.  An additional fee may be charged for customized management reports.