As someone who evaluates health improvement programs for a living, Ariel Linden, president of Linden Consulting Group in Hillsboro, Oregon, has seen many missteps.
One client threw in the towel after it could not prove that employee behavior had changed. But the company did not determine whether the health coaches it had retained were properly trained, and it wasn’t motivating employees to participate, Linden says. What’s more, union leaders failed to recognize the value to employees and were discouraging workers from participating.
That company’s failed effort has some valuable lessons for organizations that are considering health coaching. Before hiring a company to provide such a program for employees, wellness experts recommend thoroughly evaluating the provider and the program itself, as well as understanding its responsibilities in making the program work.
Here are some suggestions for successful health-coaching programs:
Assess the potential savings. Ask a provider how it plans to save you money. If the answer is through reduced hospital admissions, find out how many admissions your company currently has, Linden says.
Look into the exact categories of savings, the number of employees who will generate that savings and the time frame for achieving a return—all of which should be measured against health care spending before implementing a coaching program.
If a provider promises a steep or speedy return on investment, be skeptical. There aren’t enough large-scale studies to demonstrate such savings.
For example: In seeking a health coaching provider, Blue Shield of California identified six serious contenders. And of those, "only one really tried to show that they had established direct, claims-based savings," says Dr. Andrew Halpert, senior medical director of the 3.2 million-member plan. Blue Shield did not choose that vendor and instead selected WebMD, at which the primary focus was improving consumers’ health over time, which could result in future claims savings, he says.
Evaluate the coaches and methodology. Find out how health coaches are trained, credentialed and supervised. Know what techniques they will use. "Motivational interviewing" is the only scientifically validated coaching method to facilitate behavioral change, says Susan Butterworth, director of health management services at Oregon Health & Science University in Portland. According to the school’s Web site, motivational interviewing "is a client-centered, goal-oriented method of interacting with people to help them change their health behaviors. Motivational interviewing enhances a person’s own intrinsic motivation to change by exploring and resolving ambivalence." Many providers are becoming interested in integrating the approach into their interventions, but few have provided the training and follow-up necessary to bring their coaches to a truly proficient level, Butterworth says.
Communicate the program. Ohio State University’s wellness program is widely recognized and well-received among employees. The university spent "a considerable amount of time" communicating it, says Gretchen Feldmann, communications manager in OSU’s Office of Human Resources in Columbus.
Yet the health coaching component that was launched in August 2006 has garnered mixed reviews. One group of OSU employees uses, understands and enjoys the program; the other group doesn’t quite understand that it is voluntary, and some see it as invasive, she says. The remedy: a targeted communications campaign to be rolled out before open enrollment this fall. OSU will solicit employee "testimonial champions" who are willing to share personal stories of success with a health coach, Feldmann says.
Engage employees. Start by giving employees incentives to take a health risk assessment, Linden says. Once health risks are identified, the coaching provider can help determine who needs such help and how often. Incentives can boost participation in health coaching.
At OSU, employees can earn $120 a year in premium reductions for undergoing a health risk assessment, plus up $125 a year in cash for participating in preventive care services, including $25 for participating in sessions with a health coach.
Collect and analyze data. Larry Chapman, senior vice president at WebMD Health Services in Seattle, says employers should use quantitative and qualitative measures for "lifting up the hood" and "seeing exactly what’s going on in the engine" of their health coaching provider. Questions to ask include: Has there been a reduction in the number of risk factors or in the severity of risk per employee? Is there a difference over time in per capita claims costs of employees involved in coaching versus nonparticipants? How do the costs of low-, medium- and high-risk employees compare?
"That change in growth rate is really one of the primary success parameters that tells you you’re making a difference in the rate of growth of these people’s health care costs," Chapman says.