Integrated Health Coaching: The
Next Generation in Health Behavior
Change Management
Dennis Richling, Chief Medical and Wellness Officer
Kelly Merriman, Vice President, Service Delivery
© HealthFitness 2012
What You Will Learn Today

The three levels of health coaching within the integrated health
coaching model and how individuals are assigned to each level;

How health risk factors and a predictive modeling algorithm are used
to determine a person's eligibility for coaching;

How coaches can maximize the interactions between coaching clients
and their primary care and specialist physicians;

Tools used by the health coaches to achieve engagement, behavior
change and condition management; and

Key metrics used to evaluate the health coaching model, program
effectiveness and results.
© 2012 Health Fitness Corporation
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Dennis Richling, MD
Chief Medical Director and Wellness Officer
© 2012 Health Fitness Corporation
Kelly Merriman
Vice President, Service Delivery
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Meet at-risk Adam…
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•
•
•
•
•
40 years old
Married, 2 daughters
Manager, works 50 hours/week
BMI 28, blood glucose 99
Cholesterol 204, BP 122/88
No longer exercising—no time
(kids in sports, plus job demands
and normal aches and pains of
middle age)
Adam doesn’t know he’s at risk.
Where does Adam belong?
© 2012 Health Fitness Corporation
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Risks Are Costly
$$$$
Chronic
Disease
$$$
Risky
Absent
Healthy
Behaviors
Biometric
Risks
Reducing $$$$ = REDUCING risks
Reducing risks = Changing Behaviors
Changing Behaviors =
-Adding Absent Behaviors
-Reducing Bad Behaviors
© 2012 Health Fitness Corporation
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Absent
Behaviors
Risky
Present
UnHealthy
Behaviors
$$
Bad
Behaviors
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Health risk factors and predictive
modeling algorithm used to determine a
person's eligibility for coaching
© 2012 Health Fitness Corporation
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Health Coaching
Traditional DM
© 2012 Health Fitness Corporation
Today
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Right coach for the right person
 Health coaching
 Advanced practice coaching
 Nurse coaching
© 2012 Health Fitness Corporation
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Lifestyle Interventions
Individuals matched to:
New
diagnosis/
uncontrolled
chronic disease
Controlled chronic
disease, lifestyle risks
Lifestyle risks
© 2012 Health Fitness Corporation
Nurse Coach
Advanced
Practice Coach
Lifestyle
Coach
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Meet Sally…
52 years old
Married, two teenage boys
Works night shift
Struggles with weight
Hard to prioritize healthy
eating & exercise
• Diabetes (5 years)
• Regular physician visits
• Compliant with meds
•
•
•
•
•
Sally’s Goal: Lose 20 pounds
Where does Sally belong?
© 2012 Health Fitness Corporation
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When Henry met Sally
Sally’s Goal: Lose 20 pounds
Secondary coaching goal: reduce medications
as a result of the weight loss
Where does Henry begin?
© 2012 Health Fitness Corporation
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Meet Bob…
• 56 years old
• Acute MI diagnosed in the ED
• CAD diagnosis; cardiac cath
and stent placement
• No beta blocker prescribed
• Completed cardiac rehab,
afraid he might go off course
• BMI 32, mild hypertension
• No regular exercise
• No dietary changes to date
Bob’s Goal: Become healthier so he can go fishing
with his grandson
Where does Bob belong?
© 2012 Health Fitness Corporation
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When Nurse Nancy met Bob
Bob’s Goal: Better heart health
Secondary coaching goal: reduce risk of future MI
and worsening CAD
Where does Nancy begin?
© 2012 Health Fitness Corporation
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Remember at-risk Adam?
•
•
•
•
•
•
40 years old
Married, 2 daughters
Manager, works 50 hours/week
BMI 28, blood glucose 99
Cholesterol 204, BP 122/88
No longer exercising—no time
(kids in sports, plus job demands
and normal aches and pains of
middle age)
Adam doesn’t know he’s at risk.
Where does Adam belong?
© 2012 Health Fitness Corporation
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When Coach Karen met Adam
Adam’s Goal: Stay healthy, boost energy
Secondary coaching goal: reduce risk of future
chronic disease
Where does Karen begin?
© 2012 Health Fitness Corporation
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Tools To Achieve Engagement, Behavior
Change and Condition Management
© 2012 Health Fitness Corporation
Motivational
Interviewing
Positive
Psychology
Appreciative
Inquiry
Stages of
Change
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Smarter Coaching Through Technology
Coaching
Goals
Benefit
Design
Program
Data
Incentive
History
Biometric
Results
HRA
Results
Participant
Priorities
Integrated View of Participant
Health Status and Goals
© 2012 Health Fitness Corporation
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Goal: Active,
sustained
engagement
© 2012 Health Fitness Corporation
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Integrated Coaching Reduces Risk by
Changing Behaviors
Individual
•High-touch primary
coach model
Population
•Opt-in enrollment
10%
•Participant choice (on-site,
telephonic, online)
17%
•Goal progression framework
(behavior and/or clinical)
Reduction in # of
Risks for
Participants
© 2012 Health Fitness Corporation
•Ongoing participant assessment
to ensure accurate coach
assignment
•Improve health and control costs
Reduction in
High-Risk
Participants
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Metrics to Evaluate the Health
Coaching Model
Participation
Change in
Risk
Cost
Reduction
Measures of program effectiveness and results
© 2012 Health Fitness Corporation
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Multiple Risk Factor Summary–Risk Churn
All Employees:
T1/T2/T3/T4/T5/T6
(n=5,544)
2,716 Remained Low
Low
T1: 3,319 (59.9%)
T6: 3,797 (68.5%)
98 High
to Low
564 Low
to Mod
39 Low
to High
High
T1: 393 (7.1%)
T6: 234 (4.2%)
79 Remained High
© 2012 Health Fitness Corporation
Low = 0-4 Risks
Moderate = 5-6 Risks
High = 7+ Risks
983 Mod
to Low
116 Mod to High
216 High to Mod
Moderate
T1: 1,832 (33.0%)
T6: 1,513 (27.3%)
733 Remained Mod
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Primary Risk Factors
All Employees – T1/T2/T3/T4/T5/T6
(n=5,544)
Employees
Risk Factor
T1
T2
T3
T4
T5
T6
Blood Pressure
28.8%
27.9%
25.8%
24.0%
22.8%
20.8%
BMI
78.2%
78.9%
79.1%
79.5%
79.4%
79.6%
Cholesterol
81.5%
83.1%
81.0%
80.8%
81.1%
80.0%
Depression
9.1%
8.0%
6.6%
6.3%
5.7%
5.7%
64.1%
59.8%
58.6%
58.1%
57.9%
58.2%
8.9%28.4%
Reduction
10.2%
31.4%
30.4% 5.4%
29.7%
31.3%
30.8%
7.4%
8.0%
17.9%
16.9%
15.4%
14.2%
14.4%
14.1%
3.18
3.15
3.04
3.01
3.00
2.97
Fitness
Glucose
Stress
Tobacco Use
Average Number of
Primary Risk Factors
8.8%
7.6%Reduction
7.9%
6.6% Reduction
© 2012 Health Fitness Corporation
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Biometrics
All Employees – T1/T2/T3/T4/T5/T6
(n=5,544)
% "At Risk" - Time 1
90%
*T1/T6: p=0.0022
*T1/T6: p<0.0001
% "At Risk" - Time 2
80%
% "At Risk" - Time 3
70%
% "At Risk" - Time 4
% "At Risk" - Time 5
60%
% "At Risk" - Time 6
30.8%
31.3%
29.7%
30.4%
31.4%
T1/T6: p=0.1629
28.4%
80.0%
81.1%
80.8%
81.0%
83.1%
81.5%
79.6%
79.4%
79.5%
79.1%
20.8%
22.8%
24.0%
25.8%
10%
27.9%
20%
28.8%
30%
*T1/T6: p<0.0001
78.9%
40%
78.2%
50%
0%
Blood Pressure
BMI
Cholesterol
Glucose
T1/T6 changes tested using McNemar Test
Significant changes are coded with an asterisk (*)
© 2012 Health Fitness Corporation
Company’s Custom 14 Risk Factors
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Behaviors
All Employees – T1/T2/T3/T4/T5/T6
(n=5,544)
% "At Risk" - Time 1
80%
% "At Risk" - Time 2
*T1/T6: p<0.0001
70%
% "At Risk" - Time 3
*T1/T6: p<0.0001
% "At Risk" - Time 4
60%
% "At Risk" - Time 5
% "At Risk" - Time 6
0%
Alcohol
Fitness
Fruits &
Vegetables
17.9%
16.9%
15.4%
14.2%
14.4%
14.1%
10%
*T1/T6: p<0.0001
*T1/T6: p<0.0001
1.9%
1.8%
1.6%
1.8%
2.0%
1.9%
20%
T1/T6: No Change
10.4%
9.5%
9.5%
9.3%
8.8%
8.5%
30%
64.1%
59.8%
58.6%
58.1%
57.9%
58.2%
40%
72.1%
68.0%
64.2%
62.0%
58.8%
57.6%
50%
Seat Belt
Tobacco
T1/T6 changes tested using McNemar Test
Significant changes are coded with an asterisk (*)
© 2012 Health Fitness Corporation
Company’s custom 14 Risk Factors
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Successful Programs Offer
On-Ramps and Off-Ramps
© 2012 Health Fitness Corporation
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Dennis Richling, MD
Chief Medical Director and Wellness Officer
Dennis.Richling@hfit.com
Kelly Merriman
Vice President, Service Delivery
Kelly.Merriman@hfit.com