Featured Articles                                                   March 2011, Vol. III, No. 11
Worksite Wellness Programs Slowed Healthcare Cost Growth by 15 Percent

Healthcare costs rose at a 15 percent slower rate among wellness participants than a comparison group when employers consistently offered a wellness program to their employees, according to a study by Highmark Inc. The four-year study of select Highmark employer group wellness programs showed that the savings per participant was $332, indicating that substantial savings may result for group customers once a worksite wellness program is established.

The study evaluated the impact of worksite wellness programs on healthcare costs and utilization over time by matching approximately 10,000 wellness program participants at 47 Highmark employer groups with a risk-matched comparison group. At a minimum, the employer groups offered Web-based wellness programs from Highmark to their employees consistently for three or more years, which also indicates that even small interventions, like online programs, can have an impact on healthcare costs for those that participate.

The study also found that wellness program participants developed a greater tendency to pursue preventive services such as physicals, mammograms and cancer screenings, than their comparison group counterparts, possibly as a result of self-care knowledge obtained from their worksite wellness programs. Preventive care measures often cost employers more in the short term, but can help to save longer-term healthcare costs.

Get more information here.

Quotable: What to Consider When Hiring a Health Coach

"We are often asked about the pros and cons of various certifications, educational backgrounds and experiences of effective coaches. Over the last five years, we have catalogued more than 70 certification programs in coaching, particularly in areas we consider to be health and wellness. While some are better than others, if someone comes with training from other certification programs, that is great, but we do not typically require it. However, when it comes to backgrounds of individuals — RNs, counselors, health educators, exercise physiologists and dieticians — we have found on scale that we tend to gravitate toward counselors to be the health coaches. They tend to come with the richest education and work experience of managing people’s behavior change, establishing human relationships and getting to the core of the issue. On average, RNs, dieticians and exercise physiologists tend to come with more of a prescriptive background in their schooling and training. They tend to do more doling out of a plan or a program and have less background in behavior modification and management. Therefore, we will gravitate toward counselors and health educators and be more selective with RNs, exercise physiologists and dieticians. If you are choosing from 10 nurses, five will be a good fit. With counselors, we find that eight or nine out of 10 are a good fit for coaching. Therefore, we tend to look for behavior management backgrounds when we are trying to choose coaches."

                                        — Sean Slovenski, Hummingbird Coaching Services.

Learn more about hiring effective coaches.

Physicians Must Address Patients' Weight Issues, Key to Inducing Behavior Change

Clinicians can be important influencers when trying to get overweight and obese patients to control their weight and related health issues, according to a study from the Medical University of South Carolina (MUSC). By counseling patients to prevent further weight gain, clinicians can help them to have a more realistic perception of their weight. Changing these perceptions is key to inducing beneficial behavioral changes.

The increasing prevalence of overweight and obesity is a worldwide problem associated with higher risk of death, the development of certain cardiovascular diseases, type 2 diabetes and some cancers. Recent evidence suggests that lifestyle interventions, including nutrition and physical activity components, are needed to maintain or lose weight, according to the study authors. They suggest the primary care setting as suitable for such interventions, at least in the short term.

Researchers analyzed data from the 2005-2008 National Health and Nutrition Examination Survey (NHANES) on adults ages 20 to 64 years with a BMI of at least 25. The researchers were evaluating patient perceptions of overweight and obesity, and they also examined reports of physician acknowledgement of patients' weight status and whether that was associated with a difference in perceptions and behaviors, such as desire or attempts to lose weight.

"In participants with BMIs of 25 or greater, 45.2 percent reported that they had been told by their physician that they were overweight. In participants with BMIs of 30 or greater, 66.4 percent reported that they had been told by their physician that they were overweight," the authors said. "Telling an overweight patient that they are overweight was associated with a greater than eight-fold increase in the odds that the patient will classify themselves as overweight compared with a patient who has not been told they are overweight. For those who are obese, there was more than a six-fold increase." In addition, having been told that they were overweight or obese resulted in the participants having a greater desire to lose weight and, for some, attempting to lose weight.

The study authors concluded that patient reports of being told by a physician that one is overweight were associated with major increases in the odds that overweight and obese participants had realistic perceptions of their own weight, had a desire to lose weight and had made recent attempts to lose weight. "However, fewer than one-half of overweight and fewer than two-thirds of obese participants had been told by their physicians that they are overweight. This is an important intervention point that is being missed by many physicians. Physicians need to tell more overweight and obese patients that they are overweight because this may help encourage them to change their behavior to lose weight and lower their risk for many diseases," the authors concluded.

Read the full article here.

New Ideas for Incenting Behavior Change Throughout the Healthcare Continuum
Getting people to think about dying is not the first health behavior that comes to mind when employing incentives. However, incentives can be used anywhere in the healthcare continuum — including end of life — to influence behaviors, notes Neal Sofian, MSPH, director of member engagement at Premera Blue Cross. Sofian describes the barriers individuals face at this time in their lives and how the use of incentives can result in exactly the kind of care these patients want and need.

Listen to the podcast here.

New Chart: Top 5 HRA Data Outputs

Aggregate data from health risk assessments (HRAs) provides a roadmap for healthcare organizations to deliver health promotion and disease management interventions to targeted individuals — with the goal of improving clinical and financial outcomes. We wanted to see the top applications for aggregate HRA data.

Click here to view the chart.

The Office Visit: Enough Time to Effect Behavior Change?

Question: Does the brief duration of the typical physician-patient encounter allow enough time for a physician to effect behavior change?

Response: Powerful things can happen in seconds. Think about practicing motivation enhancement, relationship building and patient-centered care, and embedding that in everything that you do, even if it’s taking vital signs. Make sure that you’re listening and positively reinforcing anything that a patient is doing, paying attention to how you talk to an individual and help elicit change talk. It’s important that physicians are practicing this patient-centered relationship-building. Research shows that not only is this a positive outcome in terms of patient satisfaction with the physician relationship, but that it also drives important outcomes, such as patient health status and adherence to medical recommendations, if the patient rates the relationship as positive and collaborative.

Physicians are aware that this goes beyond the extra of having your patients like you. These relationship skills are important and can be embedded within every second that they’re talking to the patient. There is compelling evidence about the feasibility of building in everything at the point of care that is physician-delivered. We need to have models of care, and this is happening across chronic conditions, diabetes, asthma and depression. There is emphasis in getting care teams that involve roles such as care managers — who have also been called health coaches — to extend beyond the patient-physician encounter. That is the work of collaborative goal- setting — identifying the next step and then having the critical follow-up to see how it goes. Setting a goal is one thing, but learning from that experience and figuring about where to go from there is perhaps the more important step. There’s a recognition that our systems are not set up to do that within a patient-physician encounter. There are even reimbursement changes from third-party payors to start to help support these shifts in care. It all goes back to lifestyle. What happens outside of the physician’s office drives so much of gaining and maintaining health.

(Kristin S. Vickers Douglas, Ph.D., L.P., clinical health psychologist and medical director of Mayo Clinic’s EmbodyHealth program.)

Learn more about physicians and behavior change.

HCH Readers Save 10% on Coaching Resource

Healthcare organizations are positioning case managers all along the healthcare continuum to coordinate care for the complex patient, manage transitions between care sites and reduce avoidable consumption of health resources. January 2011 market research conducted by the Healthcare Intelligence Network indicates that 91 percent of survey respondents rely on case managers in daily operations, while another third will add case managers to their staff mix in the coming year. Best Practices in Contemporary Case Management, a 40-page special report, examines three separate case management initiatives as well as the impact of these programs on health outcomes, care delivery and resource utilization. It provides the details on case management programs being utilized at Sutter Health Sacramento Sierra Region, CareOregon and Lutheran Medical Center.

HealthCoach Huddle subscribers should use ordering code HCH to purchase this product at a special price!

Get more information on our Best Practices in Contemporary Case Management.

2010 Benchmarks in Health & Wellness Incentives Use

The use of economic incentives to drive engagement and results from wellness and prevention programs continues to proliferate. This executive summary captures responses of 139 healthcare organizations to HIN's second annual Health and Wellness Incentives Use e-survey on the focus, utilization and impact of health and wellness incentives, from types of incentives offered to methods for identifying individuals for incentive programs and reasons for providing incentives.

Download complimentary white paper here.



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