Health Coaches Tackle Both Risks and Goals

By Karen Pallarito

May. 15, 2008

Green Bay Packers coach Vince Lombardi once described winning coaches as the ones who “get inside their player and motivate.” That’s good advice for the gridiron, and it also works in the workplace, say providers of health coaching.

    The field has blossomed as employers grapple with the impact that preventable health conditions have on health care costs and productivity. Health coaching is becoming a mainstay of employer wellness initiatives, according to the companies that provide the services.

    “We become the little voice on your shoulder that’s saying, ‘Now, we know what we’re supposed to do. Let’s set some goals,’ ” says Roger Reed, executive vice president at Gordian Health Solutions Inc. in Franklin, Tennessee. “It’s almost a personal trainer approach.”

    IASIS Healthcare, an owner and operator of acute-care hospitals also headquartered in Franklin, joined the health coaching bandwagon when it hired Gordian to counsel its medical plan participants beginning in 2006.

    Russ Follis, the hospital system’s vice president of human resources, says the rationale was twofold. “If we can get less claims coming in by having healthier employees, it’ll end up saving us money in the long run in terms of our health plan benefit costs,” he says. Secondly, “we are a health care company, and promoting healthy lifestyles just seems the appropriate thing to do.”

    A growing number of employers are joining the fray. A joint National Business Group on Health/Watson Wyatt Worldwide annual survey of employer-sponsored health programs found that 60 percent of large U.S. employers offered health coaching in 2007, a 7 percent increase from 2006.

    “Employers are concentrating more on how to keep their healthy people healthy,” says Diane Murphy, senior health and productivity consultant in Watson Wyatt’s Minneapolis office.

    Health coaching has gained traction as employers tackle workers’ multiple health risks, including physical inactivity, stress, tobacco use and obesity. The concept builds on research led by Dee Eddington, director of the University of Michigan Health Management Research Center in Ann Arbor, and others linking reduction of health risks to reduced health care costs.

    “A lot of folks put their big toe in the pool of wellness” by starting a health risk assessment program, “and then they realize, ‘Oh, wait. All I’m doing is finding out how sick my employees are,’ ” says Michele Dodds, vice president of health and wellness at Chicago-based employee assistance program provider ComPsych, which offers health coaching.

    Many health care providers are adding coaching to their mix of services. New York-based WebMD added a health coaching capability when it purchased Indianapolis-based Summex in 2006. In June 2007, Humana, based in Lexington, Kentucky, launched a new wellness program, including a coaching component, through its Fort Worth, Texas-based Corphealth subsidiary. The British United Provident Association, a London-based provider of health care services, entered the coaching business with its acquisition in December 2007 of Boston-based Health Dialog.

    There is tremendous variability among health coaching programs. The better ones hire highly trained health professionals, such as physician assistants, nurse practitioners, exercise physiologists and registered dieticians, wellness experts say. A health education or coaching credential often is required, since the coach’s main role is to help employees assess their risks and set achievable goals for improvement. The frequency of health coaching typically depends on the number and severity of a person’s health risks. A higher-risk individual may need monthly sessions.

    To create a seamless experience for employees, a health coaching company must coordinate with an employer’s health plan, disease management company and other wellness providers. It’s common for these companies to physically sit around a table and craft a plan to refer employees to the appropriate service.

    Coaching often is conducted over the phone to cater to an employee’s schedule. “It’s more convenient, more accessible and it’s actually less costly to provide the service via telephone,” says Dr. Neil Gordon, chief medical and science officer for Nationwide Better Health in Columbus, Ohio.

    In contrast, Marathon Health, a health services company based in Colchester, Vermont, has its coaches counsel employees face to face at the work site. Having a physical presence boosts employee engagement, with participation rates of 70 percent to 75 percent, says Chuck Reuter, the company’s president.

    Fees vary widely, depending on an employer’s size and the mix of health coaching services offered. ComPsych says its programs cost 65 cents to $1.25 per employee per month. Nationwide Better Health says an employer can spend an average of $100 to $250 per participant per year, or roughly $8 to $21 per employee per month. Marathon Health charges about $10 to $15 per employee per month.

    Companies that expect hard data on ROI, or on how well coaching works, will have to wait. There is limited data so far on the efficacy and cost-effectiveness of health coaching, says Susan Butterworth, director of health management services of Oregon Health & Science University in Portland, based on a comprehensive review of research to date.

    At Fiserv Inc., a large financial services company, the jury is still out on health coaching. In two small pilot projects—one that lasted 12 weeks and another that lasted five months—obese employees lost an average of just seven pounds in each test. Because of the weight loss, “I’m not going to say this wasn’t successful,” says Linda Schuessler, manager of wellness promotion in Brookfield, Wisconsin, for Fiserv. For now, though, the company is focusing on increasing opportunities for physical activity, she says.

    In the meantime, IASIS saw $1.1 million in health savings from reduced claims frequency and costs in 2007 over the prior year, largely because of the company’s Healthy Steps wellness program, along with health coaching, Follis says.

    “Anything you can do for the health of your employees is a win for everyone,” he says.

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