Lifestyle Coaching

Lifestyle Coaching One-on-one Interventions for Health Behavior Change ORC Western Occupational Safety and Health Group June 15, 2006

Harvard Business Review “An ounce of health is worth a pound of health care…” “Companies that take this approach gain some control over seemingly uncontrollable health care spending and create a win/win situation…”

The Economic Burden of Lifestyle Risks • More than 50% of disease is preventable – due to lifestyle • Total costs of obesity in 1995 exceeded $99 billion • Research connects inactivity with: • Depression • Cancer • Heart disease • Stroke • osteoporosis

Empowering Behavior Change • Start with proven behavior change models • Stages of change • Social cognitive theory • Theory of planned behavior

Applying These Models toLifestyle Coaching • Self-management education • Goal to assist health care consumers in improving their confidence in their ability to manage challenges associated with living a healthy life or with chronic disease • Motivational interviewing • Expressing empathy, avoid directive or confrontational language • Develop a discrepancy between current behavior and overall goals and values

Adapted from Bodenheimer et al. JAMA. 2002, 28 (2469 – 2475)

Critical Skills and Ongoing Strategies • Assessment of behavior • Build self-efficacy • Goal-setting and problem-solving skills • Support and make individualized plan

Research Supporting Behavior Change Interventions • Meta analysis of treatments with motivational interventions show significant impact for lifestyles such as diet and exercise • Self-management programs also effective for chronic diseases

Coaching Relationship • Quality of relationship critical to effective change • Collaboration rather than confrontation • Beyond simple information delivery, training in health behavior change, motivational interviewing, self-management education

Goal-Setting and Action Plans • Emphasizes short-term, achievable goals • Success enhances motivation for additional change • If not confident in ability to reach goal – modify it • Action plans incorporate problem-solving techniques

Dealing With Barriers to Change • Counselors help identify personal barriers that could result in failure • Plan around barriers in advance • More accepted by people who have been discouraged by information-only interventions

Measuring Success • Self-report often used • Validated measures of health behavior – weight loss, change in nutritional habits • Importance of measuring change process, i.e. self-efficacy • People who report greater confidence in ability to be physically active have higher levels of physical activity

Low and moderate risk (0-4 risk factors) High-risk (5+ risk factors) Existing chronic conditions HRA data feed to data management warehouse HRA data feed for incentive fulfillment Web lifestyle and behavior change programs Telephonic lifestyle coaching programs Disease management programs Data integration (claims, etc.) Incentive eligibility and fulfillment Guiding Participants to Telephonic Programs Health Risk Assessment

HRA Intervention Report Provide telephonic counselors with relevant data on high-risk individuals for follow-up intervention

Lifestyle Coaching Lifestyle Coaching Confidence General health Outcome Healthy practices

Participation Projection Model

Corporate Culture Considerations • Assess current sensitivities • Trust issues impact receptivity to consent

Mayo Clinic TelephonicLifestyle Coaching Programs Personalized treatment plans and counseling for key lifestyle issues: • Mayo Clinic Tobacco Quitline • Mayo Clinic Weight Advisor • Mayo Clinic Exercise Advisor • Mayo Clinic Nutrition Advisor • Mayo Clinic Stress Advisor

Lifestyle Coaching Model • Integrated with Mayo Clinic HRA • Focus on high-risk individuals • Collaborative self-management model drawing upon Stanford research and Mayo expertise

Collaborative Self-Management Model • One-to-one relationship with counselor • Participant generated goals and action plans • Internal motivation more effective than external motivation • Building confidence through self-efficacy model • Leading to sustainable change

Behavior Change Facilitation –Series of Calls Over 6 Months • Review progress towards goals – set new goals for next call • Check confidence level for achieving set goals • Coach on barriers, triggers, learn from successes • Arm with relapse prevention strategies • Participant may contact counselor between calls for additional support. • Outcome Calls –at Program Conclusion and at 6 Months • Outcomes measured are module-specific and includes satisfaction, efficacy, behavior change and goal achievement Intake Call Participant enrolled if ready, or directed to resources to help move along behavior change continuum. • Education Call • Resources reviewed specific to participant risk factors • Encouragement to call when ready to enroll • Assessment Call • Behavior change counselor conducts 30-minute assessment • Reviews risk factors, identifies medical conditions, medications • Provides detailed explanation of how program works and benefits of program • Goals are set based on participant input Lifestyle Coaching Process Flow

Lifestyle Coaching Qualifications • Intake workers – initial call • Customer service experience • Counselors • Four-year degree in psychology, social work, sociology, nursing or counseling • Trained in motivational interviewing techniques and self-management education principles

Lifestyle Coaching Training • Training with content experts and medical consultants • Motivational interviewing training from nationally certified trainer • Preceptor training with veteran staff • Ongoing access to content and medical experts

Lifestyle Coaching Reports • Eligible participants • Unable to contact • Contact but decline • Enrolled • Enrollees by program • Program satisfaction • Program outcomes

Mayo Clinic Healthy Weight Advisor Six-Month Outcomes • 49% lost weight and maintained weight loss • 35% of those who lost weight, lost more than five pounds • 57% increased confidence in ability to manage their weight

Mayo Clinic Exercise Advisor Six-Month Outcomes • 64% increased the amount of time they spent exercising • 38% maintained weight loss as a result of being in the program • 37% increased their confidence in their ability to increase their physical activity

Mayo Clinic Nutrition Advisor Six-Month Outcomes • 61% increased their healthy eating choices • 39% lost weight and maintained weight loss • 61% increased their confidence in ability to maintain healthy eating habits

Mayo Clinic Stress Advisor Six-Month Outcomes • 62% increased confidence in ability to manage stress • 75% experienced fewer stress-related physical symptoms than at the beginning of the program • 57% increased the total amount of stress-related techniques used

Mayo Clinic Tobacco QuitlineOutcomes Industry leading quit rates: • 42% at 6 months • 37% at 12 months % of enrollees 6 Months 12 Months

Yes Maybe No Don’tKnow Refused Lifestyle Coaching Program Satisfaction 90% of participants would recommend program to others 2% 2% 1% 5% 90%

Trend to Offer Incentives for Participationin Behavior Change Programs • Educational • Benefits-linked • Cash • Gift certificates • e-Gift certificates • Paid time off • Drawings for trips • Mayo Clinic books

Employees Favor Benefit-Linked Incentives for Healthy Change Source: Wall Street Journal Online/Harris Interactive Health-care Poll. Dec. 2005. N = 2,007

Identify company-specific cost drivers (HRA) Give programs adequate breadth, depth and reach Leverage existing resources – buy-in at the top Integrate (teams, efforts and data) Use incentives Use a multimodal communications approach Measure and analyze outcomes to guide program decisions Know your data (costs, risks, etc) and how to integrate it Keys to Effective Lifestyle Risk Reduction

Questions

Lifestyle Coaching