Four Essentials of an Effective Disease Management and Wellness Program for Self Funded Plans

Michael J. Reidelbach, MBA, and Diane Bellard, RN, MS

Nov 13, 2009

We know that a vast majority of chronic diseases can be prevented through healthy lifestyle choices, but many individuals aren’t aware of their health status. A 2009 study of health care consumer attitudes by Deloitte Center for Health Solutions¹ revealed that seven of eight Americans believe they are in good health. But in all actuality, nearly half of all American live with at least one chronic condition.²

While individuals endure the physical and psychological burden of chronic illnesses, employers most often bear the brunt of associated costs. The need to empower, educate, and inform employees of ways to effectively manage their health is becoming increasingly evident. But not all Disease Management (DM) programs are created equal. There are arguably four key components to an effective program.

1. Helping Employees Know their “Numbers”

The first step toward better health is awareness of areas in which the participant has the opportunity to improve. The National Cholesterol Education Program (NCEP) recommends that adults age 20 and older have their cholesterol checked every five years. However, nearly 22 percent of individuals in this age category have never checked theirs.³ Additionally, the Centers for Disease Control and Prevention (CDC) estimate that 6.2 million people in the United States have undiagnosed diabetes, while 54 million have prediabetes, a condition where the blood glucose levels are higher than normal but not high enough to be classified as diabetes.⁴

The interest in worksite wellness initiatives continues to rise, and it is no wonder; a study by the American Journal of Preventive Medicine showed that employers who invest in worksite health promotion programs can see a return of $3-$6 for every dollar invested over a 2-5 year period.⁵ These savings manifest in the form of reduced direct medical costs, as well as indirect costs such as absenteeism, worker’s compensation claims, short-term disability, and presenteeism.

Knowing biometric values, such as cholesterol levels, blood pressure, Body Mass Index (BMI), and HbA1c levels, is critical to the success of preventing, identifying, and effectively managing chronic conditions.

Bottom line: Informed employees are more empowered to take charge of their health.

2. Providing Self-Monitoring Tools and Equipment

While knowing your numbers may be the first step to improving health, monitoring key indicators is the second. The Deloitte study found that 64% of respondents would be interested in using an in-home medical device that could help them improve their health or treat a condition, and more than one-third reported interest in using online tools to help them assess, monitor, and manage their health.¹

Some of the benefits of providing disease-specific equipment to participants who are being coached include:

• Promoting optimal self-management of a condition and compliance with the physician’s plan of care
• Supplying Nurse Health Coaches with critical information to monitor participants’ progress and facilitate coaching
• Providing information for participants to share with other members of their health care team
• Facilitating prompt identification of potential problems

Several studies have documented success with using home-monitoring equipment. One study among congestive heart failure patients utilizing a remote system found that hospitalizations had been reduced by 82 percent within a three-year period. Prior to utilizing the remote system, most of the enrollees had been hospitalized two or more times in the previous 12 months.⁶

Another study compared the outcomes of individuals with hypertension who were provided a home blood pressure monitoring system versus individuals who were assessed in a health clinic.⁷ The results showed that more individuals with home monitoring devices achieved their targeted blood pressure than those without them. Although the blood pressure control between the two groups was not substantially different, it would likely contribute to an important reduction in vascular complications among the hypertensive population.

Bottom Line: Individuals who track their health and lifestyle habits are more likely to achieve positive outcomes. Arming employees with blood pressure cuffs, glucose meters, and other disease-specific equipment is imperative to supporting self management of chronic conditions.

3. Offering Personalized Health Coaching

The Deloitte Center for Health Solutions study found that one in three consumers indicated they would be interested in working with a personal health coach who could help them create and stick to a personal health plan.1 While health coaching remains at the center of most DM programs, coaching content and delivery methods may vary.

Historically, the emphasis of coaching has been placed on health care professionals telling individuals what to do to improve their health. Yet recent shifts in industry practices and findings point to Motivational Interviewing (MI) as a more effective tool in eliciting positive behavioral changes among DM participants.

The focus of MI is not "counseling," but rather activating motivation for change and adherence to treatment by exploring an individual’s own desires, goals, reasons, abilities, and needs related to change.⁸ Coaches who employ MI participate in active listening to understand participants’ values and priorities. For example, individuals who indicate they are motivated to improve their health for a specific goal, such as the ability to do activities with their grandchildren, are more likely to embrace the changes necessary to achieve their goals.

Clinical trials have demonstrated that patients exposed to MI are more likely to:

• Participate in follow-up visits
• Improve medication adherence
• Monitor their glucose
• Improve glycemic control
• Increase exercise
• Increase fruit and vegetable intake
• Reduce stress and sodium intake
• Keep food diaries
• Have fewer hospitalizations9

One study of women with type 2 diabetes showed that MI, when added to behavioral obesity treatment, helps improve weight loss and glycemic control.¹⁰ Prodigy Health Group, an integrated health management and benefits provider for self-funded employers, managed care companies, and insurers, has also found success by employing MI.

“My Nurse Coach has truly been wonderful in helping me develop a plan for improving my health,” notes one Prodigy DM participant. “After I get off the phone with [my Nurse Coach] I feel better about myself.” Another participant said, “If it had not been for my Nurse Coach, I wouldn’t be using my peak flow meter or have returned to my pulmonary doctor.”

Bottom Line: Encouraging participants to articulate and resolve ambivalence about their health is fundamental to effective DM coaching.

4. Promoting Healthy Behaviors through Incentives and Communication

According to a 2008 survey by Watson Wyatt and the National Business Group on Health, companies continue to find success by offering workers financial incentives for participating in wellness and health management programs.¹¹ The survey estimated that nearly 75 percent of employers offer incentives that range from reductions in premiums to cash incentives. Prodigy Health Group has implemented a $250 cash incentive for employees who participate in its DM program for one year. As a result, the company has actively engaged 80 percent of targeted individuals.

It has been demonstrated that even moderate incentives can help engage employees in healthy behavior. Financial incentives between $51 and $100 have been shown to boost participation in smoking cessation and weight management programs and encourage workers to get biometric screenings.¹¹ But even the best incentive programs can fail if they are not regularly communicated.

A study of Acme Manufacturing, a metal finishing company that developed a health and wellness program for approximately 40,000 individuals, found that integrated marketing communications played a key role in the success of its wellness program.¹² In an effort to increase completion of the corporation’s Health Risk Assessment (HRA), Acme launched a campaign that included e-mail notifications and reminders, intranet ads, postcards, posters, and table tent cards. In addition, Nurse Coaches, 24/7 health line nurses, and EAP partners actively reminded employees and their family members to take the HRA. In only one quarter, the integrated communications approach helped produce a 117% increase in HRA completion over the entire previous year.

Bottom Line: Incentives and Employee Communications = Increased Participation

Conclusion

So what does all of this mean to employers? The evidence is clear: most DM programs offer education and coaching to members, but one size does not fit all. Providing awareness of key health indicators, individualized attention, one-to-one motivational coaching, and self-management tools are essential to engaging individuals in effectively managing their health.

Sources
¹Deloitte Center for Health Solutions. 2009 Survey of Health Care Consumers: Key Findings, Strategic Implications. 2009.
²National Center for Chronic Disease Prevention & Health Promotion. Behavioral Risk Factor Surveillance System Prevalence and Trends Data. 2007.
³Centers for Disease Control and Prevention. Chronic Disease Overview. 2009. http://www.cdc.gov/NCCdphp/ overview.htm.
⁴Centers for Disease Control and Prevention. National Diabetes Fact Sheet. 2005. http://www.cdc.gov/ diabetes/pubs/pdf/ndfs_2005.pdf.
⁵American Journal of Preventive Medicine. December 2005.
⁶Hoggle, J. Device Helps Patients Live Longer; Payers Save Money. Advance for Health Information Executives. August 2003.http://www.bhttp://health-care-it.advanceweb.commj.com/cgi/content/full/329/7458/145.
⁷Forbes, L. et al. Blood Pressure Control by Home Monitoring: Meta-analysis of Randomized Trials. BMJ. June 2004. http://www.bmj.com/cgi/content/full/329/7458/145
⁸Huffman, Melinda H. Health Coaching: A Fresh, New Approach to Improve Quality Outcomes and Compliance for Patients with Chronic Conditions. Home Healthcare Nurse. September 2009, Vol. 27, 8.
⁹Rollnick, S., et al. Motivational interviewing in health care: Helping patients change behavior. 2008.
¹⁰Barclay, Laurie MD. Motivational Interviewing Improves Weight Loss in Women with Type 2 Diabetes. May 18, 2007. http://cme.medscape.com/viewarticle/556715;meddomainjsession=fW0VKTHJvplGhvbpCpnRsKRG3LyK
gqbW5sYZ3CYSyDs90QkggJxt!-386879937.
¹¹Watson Wyatt. Companies Continue To Add Wellness Programs, Watson Wyatt/National Business Group On Health Survey Finds. April 15, 2009.[Press release]. http://www.watsonwyatt.com/news/press.asp?ID=20961.
¹²Chapman, L. et al. The Changing Role of Incentives in Health Promotion and Wellness. The American Journal of Health Promotion. September/October 2008, Vol 23, 1.
¹³Business Insurance. Largest Disease Management Service Providers. 2008. http://www.businessinsurance.com/ article/99999999/PAGES/1014

 

Michael J. Reidelbach, MBA, is the President and CEO of American Health Holding, Inc. After accumulating more than 20 years of diverse business experience in sales, marketing, and product development, Michael launched American Health in 1993. With a focus of providing service excellence, he built the full-service medical management organization that today is the seventh largest Disease Management provider in the country.13

 

Diane Bellard, RN, MS, is the Director of Disease Management and Wellness at American Health Holding, Inc. Diane has more than 30 years of health care experience in acute care settings and managed care. Her passion for health and wellness has been a driving force in developing American Health’s advanced nurse coaching model and practices.

American Health Holding is a multi-URAC accredited medical management firm that provides services spanning the health care continuum, including Case Management, Utilization Management, Disease Management, Lifestyle/Wellness, Maternity Management, Medical Review, and Hospital Bill Auditing. American Health Holding’s superior technology, which includes a comprehensive suite of internet products, provides a level of flexibility that supports integrated solutions for creating healthy outcomes.

For more information about American Health, visit the Web site http://www.AmericanHealthHolding.com/SFM/, e-mail marketing@AHHinc.com, or call
(866) 614-4244.