Health Care Reform and the Role of Wellness and Prevention
Wellness & Prevention
In 1735, Benjamin Franklin published a letter in The Pennsylvania Gazette, offering his now famous axiom, “An Ounce of Prevention is worth a Pound of Cure.” He was speaking at the time to fire safety, but his message today rings as loud as a five-alarm bell regarding American health care: wellness and prevention work more efficiently and cost-effectively toward a solution than does any attempt to quench a dire situation later.
With his letter, Franklin launched a wellness and prevention program of his own aimed at managing and containing one of the critical health and safety issues of his day. Franklin personally coached a group of men on effective use of equipment and appropriate actions to be taken at every fire. The brigade met monthly to discuss fire prevention, and eventually spawned other fire-safety groups. To foster a sense of personal accountability, homeowners were mandated to have leather fire-fighting buckets in their houses. Franklin’s integrated coaching technique continues to impact us today: fire safety is second nature in our culture.
As today’s policy makers continue to hammer out the specifics of health care reform, it is already apparent that wellness and prevention programs are viewed as an area of importance. Many individuals engage in lifestyle behaviors that lead to poor health, such as poor diet, physical inactivity, and inadequate management of chronic health conditions. By focusing on wellness and prevention, individuals may improve their overall health which can lead to reduced health care costs.
Currently, chronic illness is estimated to affect 138 million Americans, a figure estimated to rise to 164 million by 2025. With the large number of people being diagnosed with a new chronic condition each day, the emerging clinical and economic burdens are not sustainable, and traditional disease management resources may not be robust enough to handle this increasing demand.
Bringing the Science Know-How and the Technology Together
Digital Health Coaching in the 21st century offers the benefits of tailored coaching to wellness and prevention programs just as Ben Franklin did for fire safety. The personalized, scalable nature of Digital Health Coaching features can provide productivity savings and positive return on investment (ROI). Due to the availability of modern science and technology, primary prevention targeting healthy individuals, identification and management support of preventable health risks (including education and support for chronic disease) and improved management of high-cost chronic disease through tertiary prevention are all not only possible, but imperative.
For health plans and employers, Digital Health Coaching harnesses current innovations and technology and combines them with advanced behavioral science to aid individuals in making better health choices. The programs are highly personalized, scalable to a population of any size, available 24/7, confidential, and cost-effective to deliver.
For the individual, Digital Health Coaching emulates a live health coaching or counseling session. With personalized action plans, interactive guidance, and support tools, participants can change their behaviors and learn the skills they need to help manage their own health.These coaching programs begin with questions about the participant’s unique personal situation, motivation, self-confidence and perceived barriers to success with changing the behavior or managing a condition or health issue. The programs create specific personal action plans tailored to each participant based on her or his responses. Digital Health Coaching plans leverage multi-disciplinary clinical expertise in the area of the participant’s focus (from lifestyle issues like weight management and insomnia to health issues such as diabetes and chronic pain), as well as evidence-based behavioral change models designed to target and motivate personal engagement and behavior change. Finally, participants receive personalized tools and resources to help them achieve specific goals.
Numerous research studies have been conducted on Digital Health Coaching. In a 2008 study, Highmark Blue Cross Blue Shield and HealthMedia, Inc. conducted research focused on health plan members who participated in a foundational, online coaching program designed to teach participants the skills they need to help manage many chronic conditions. Among the reported results, within one year of providing the online program, hospital admissions among participants decreased 30 percent and there was an 8% reduction in estimated health care expenditures.
Participation Planning Strategy
To be more effective, Digital Health Coaching solutions should be combined with a comprehensive participation strategy designed to address the distinct needs of each organization and its employees.
An organization should create customized communications tools – focused on its unique population health initiatives – to improve participation in Digital Health Coaching programs, as well as other wellness and prevention programs and services being offered.
Customizable communication tools can include letters, newsletters, email content and posters. For example, one health system creatively reached out to its own employees by incorporating the power of story into its communications plans, by using personal staff member videos to motivate other employees to actively participate in their own health management. Following this initiative, one out of every four employees on average completed at least one Digital Health Coaching program for wellness, behavioral health, or disease management each year.
With Digital Health Coaching programs, an organization is able to create custom communications targeting individual participants. The advanced technology behind Digital Health Coaching enables the programs to analyze HRA data, claims data, personal health records, and electronic medical records in order to identify participants who have an epidemiological need and are ready for change. Based on the findings, customized communications can be created for each individual participant. These participants then receive unique messaging based on their self-reported stage of change, motivation, self-confidence, perceived barriers, and demographics. Through e-mail, direct mail, or Interactive Voice Response (IVR), these messages direct participants to effective behavior change programs at appropriate times to enhance behavior change outcomes.
Outcomes Demonstrate Success and Projected Productivity Savings
The Digital Health Coaching solution provides an opportunity to collect aggregated de-identified health data. Self-reported data on personal health history, weight, biometrics such as HDL and LDL, exercise, nutrition, mental health, and a myriad of important data points can be used to influence the design of a wellness and prevention program. Validated methods are used to measure outcomes including claims-based studies, randomized control trials, time 1 / time 2 comparisons, and self-reported outcomes.
An analysis of self-reported data collected from program participants in August 2010 demonstrates positive outcomes as well as estimated productivity savings. The following data, from a sample of 18 Digital Health Coaching programs, shows self-reported outcomes at six months after starting the program. For productivity savings estimates, WPAI questionnaire was utilized using a 40-hour work week and $50,000 average annual salary.
57% reported losing weight (N = 19,690)
28% reporting a BMI of 30+ at baseline reported losing at least 5% of their body weight (N = 4,608)
$465 estimated productivity savings per participant per year (N = 15,012)
37-minute average reported increase in sleep time (N = 2,760)
25% reported reduction in fatigue levels (N = 2,717)
$2,840 estimated productivity savings per participant per year (N = 1,730)
Average reported A1C levels dropped from 7.23 to 6.78 (N = 788)
90% said they were able to better manage their diabetes (N = 788)
$2,500 estimated productivity savings per participant per year (N = 505)
59% reported that they quit smoking (N = 3,608)
81% of those who reported quitting, said they had high confidence that they would remain non-smoking (N = 2,909)
Depression Symptoms Management
39% reported decrease in average CES-D scores (N = 2,253)
5.25% average increase in the confidence to manage depression (N = 2,173)
$2,770 estimated productivity savings (N = 1,572)
Other Digital Health Coaching programs have also demonstrated positive outcomes.
Progressive, Comprehensive Approach
In this article, we identified the value of Digital Health Coaching; it is effective, scalable to entire populations, and works seamlessly across wellness, behavioral health, and traditional disease management by offering a holistic solution for each individual. In addition, it offers confidential, convenient, and consistent delivery of high-quality coaching to each individual. Finally, the technology behind Digital Health Coaching provides the ability to measure outcomes with meticulous detail utilizing analytical reporting.
Whether you’re talking fire safety and prevention in the days of Benjamin Franklin or innovative health care solutions in the 21st Century that use Digital Health Coaching, one ounce of prevention is worth a pound of cure, indeed.
About The Author
Kevin Wildenhaus, Ph.D., is Director of Behavioral Science & Data Analytics at HealthMedia, a Johnson & Johnson company and part of the Wellness and Prevention business. Dr. Wildenhaus is a clinical psychologist specializing in health behavior change and practical, effective health intervention programs. He completed his doctorate from Wayne State University, with a major in clinical psychology and a minor in industrial & organizational psychology.