Health coaching in employee wellness - past present and future

Today’s Webinar Team

Rajiv Kumar, M.D.
Founder & Chief Executive Officer
rkumar@shapeup.com

Shawn LaVana
Vice President of Marketing
slavana@shapeup.com

Elise Meyer
Marketing Associate
emeyer@shapeup.com


Join the Conversation on Twitter

@shapeupdotcom

#healthcoaching


ShapeUp’s Mission Statement

Creating a healthier world by
leveraging social influence to
engage people in healthy activities


Today’s Agenda

1. Why Health Coaching
2. Telephonic Coaching
3. Online Coaching
4. Peer Coaching
5. ShapeUp’s Approach
6. Discussion


Why Health Coaching?
A Response to Rising Health Costs


Employers = 1/3 of All Health Spending
U.S. Healthcare Expenditures, 1960-2020

$0.1T $0.1T $0.3T $0.7T $1.4T $2.5T $4.5T
100%

Out-of-
Pocket
Out-of-
Pocket
Other
Private

80

Private Health
Insurance
Total
Private

60

Other
Public
40

Medicare
Total
Public
20

Medcaid/
SCHIP
0
1960 1970 1980 1990 2000 2010 2020
Year

Note: ―Other Public‖ includes TRICARE, VA and all public health initiatives. Source: CMS; CBO; KFF/HRET Health Employer Health Benefits Survey, 2011; US Census Bureau


Large Employers Are Mostly Self-Funded
Percent of Covered Workers in Partially or Completely
Self-Funded Plans By Firm Size, 1999-2011
CAGR
('99-'11)
100%
5K+ 4%

80 1K-5K 2%

60

200 to
0%
999

40

20
3 to
0%
199

0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010

Source: Kaiser Family Foundation; US Census Bureau
2011


Lifestyle Conditions Are Driving Costs
Cost of Healthcare, # of People Afflicted, and Nutrition Index by Condition

Manageable with
Lactose
diet & exercise Celiac Intolerant
Disease Metabolic
Syndrome
Osteoporosis Obesity/
Overweight
Hyper- High
Diabetes
tension Cholesterol
Inflammatory
Bowel
Disease
Irritable
Bowel
Syndrome
Heart Disease
Cancer
Heartburn

$60B
Alzheimer's/
Healthcare
Sleep Cost
Dementia

0
Not manageable 0 25 50 75 100 125 150M
with diet & exercise
Number of People Afflicted

Source: Center for Disease Control; National Institutes of Health; Department of Health and Human Services; Illinois Department of Public Health; National Commission on Sleep Disorders Research;
American Heart Association; American Diabetes Association; Alzheimer’s Association; Epilepsy Foundation; Heart Rhythm Foundation; Celiac Sprue Association; International Osteoporosis Foundation;
American College of Gastroenterology; MedicineNet; Pharmacy Times; Sleep Disorders Guide; Physician’s Postgraduate Press


Telephonic Coaching
Examining a Traditional Model


Discussion #1: Telephonic Coaching
• What has been your experience with telephonic
coaching?

• Does the level of engagement justify the cost?

• Have you seen measurable health improvement?

• Is this approach best suited for certain employee types?

• Should employers stick with this model or ditch it?

If you’d like to respond, please type the discussion number and your
organization name into the question box on the GoToWebinar control panel.


Telephonic Coaching Can Really Work

A Randomized Trial of a Telephone Care-Management Strategy

• Objective: To assess the effect on medical costs and resource utilization

• Methods: Randomized study of 174,120 subjects. Health coaches contacted at-risk
individuals about shared decision-making, self-care, and behavior change.

• Results: After 12 months, the average monthly medical and pharmacy costs per
person in the enhanced group were 3.6% ($7.96) lower than those in the usual support
group ($213.82 vs. $221.78), driven by 10.1% reduction in hospital admissions.
Intervention cost less than $2 per person / month

• Conclusion: Targeted telephonic intervention reduced medical costs and
hospitalizations in a large population with a positive ROI.

http://www.nejm.org/doi/full/10.1056/NEJMsa0902321


But Telephonic Coaching Has Limits

The effect of a telephone-based health coaching disease
management program on Medicaid members with chronic conditions

• Objective: To examine impact on healthcare utilization and expenditures in this population

• Methods: Examined changes in hospital utilizations, emergency department visits,
ambulatory care, and Medicaid expenditures among participants for 1 year before and 2
years after enrollment vs. a control group.

• Results: Changes in acute hospitalizations, ambulatory care visits, and Medicaid
expenditures were the same in both groups. After the 2 nd year, ED visits were lower in the
coaching group (8% vs. 23%).

• Conclusion: Telephonic coaching did not demonstrate significant effects on healthcare
utilization and expenditures in this population.

http://www.ncbi.nlm.nih.gov/pubmed/21993059


Is Telephonic Coaching Inconvenient?
―Doing The Telephone Tango‖

―Ella doesn’t recognize the number that shows on her caller ID.
She lets the call go to voice mail. The vendor rep leaves a
cheerful, but cryptic message. Ella doesn’t call back. Even
though the rep used our company name, and she vaguely
remembers a wellness program brochure, she’s not 100%
convinced it’s legit. In addition, she’s in the middle of making
dinner for her family, and the cable box is on the fritz. She’s got
more important things to worry about.‖

http://ebn.benefitnews.com/news/telephone-tango-2710663-1.html


Telephonic Coaching: Employer Opinions

―We’ve seen a savings of $869 per person per
year for the 530 people who have been
enrolled for two years. Telephonic coaching is
difficult, although for people who are struggling
with a certain issue, this type of support can
lead them to the next level.‖

ShapeUp Annual Employer Wellness Survey, 2012



―Overall, we’ve heard good things from
our employees, but we would like to
switch to virtual coaching if we found a
model that works‖




―We can’t tell if people are just checking
the box so to speak to get incentives
versus if this is something that is really
useful and that they are learning from.‖




―Some vendors don’t get it. A couple of
calls and a letter won’t have an impact on
engagement.‖




―I ask myself, how effective is telephonic
coaching itself? Given the small number
of participants, we pay a lot for it --
almost $500,000 for 3,000 people.‖




―It’s unclear what the effect is. Utilization
is low – in the single digits.‖




―We pulled the plug on telephonic health
coaching—only a small percent respond.
It’s not a very motivating model.‖



Key Points About Telephonic Coaching
 Studies have shown that telephonic coaching can
produce health improvement and a positive ROI

 Other studies have shown little impact
 Some employers report positive outcomes and
employee feedback
 Low participation and high cost are cited often

 Employees may prefer other methods of contact
 Some employers are looking for alternatives


Discussion #1: Telephonic Coaching
• What has been your experience with telephonic
coaching?

• Does the level of engagement justify the cost?


• Is this approach suited for particular employee types?

• Should employers stick with this model or ditch it?



Online Coaching
Understanding Its Efficacy


Discussion #2: Online Coaching
• Have you used any form of online coaching in your
workplace?

• Did employees prefer this method of communication vs.
telephonic/in-person?

• How did the cost compare to telephonic/in-person?

• Do you prefer human coaching or virtual coaching?




Automated Coaching via the Web

Web-based Weight Management Programs in an Integrated
Health Care Setting: A Randomized, Controlled Trial
• Objective: Assess the efficacy of automated coaching for weight loss
• Methods: 2,862 overweight and obese members of Kaiser Permanente
randomized into a tailored automated coaching system or information-only
web-based weight management materials. Weight assessed via self-report at
3 and 6 months.
• Results: Automated coaching participants lost 3% of baseline weight,
information-only participants lost 1.2%. Automated coaching participants said
it was more personally relevant, helpful, and easy to understand.
• Conclusion: Automated coaching can produce weight loss outcomes.

Rothert, Kendra et al. Obesity. Vol. 14 No. 2 February 2006


Human Coaching via the Web

Effects of Internet behavioral counseling on weight loss in
adults at risk for type 2 diabetes: a randomized trial
• Objective: Compare effects of an internet weight loss program alone vs. with
additional of e-mail coaching for one year
• Methods: 92 overweight adults, randomized to basic internet program or
behavioral e-counseling and feedback from a counselor
• Results: Coaching group lost more weight at 1 year (-4.4kg) than control
group (-2kg).
• Conclusion: E-mail coaching significantly improved weight loss outcomes

Tate et al, JAMA 2003.


Human vs. Automated Coaching

A randomized trial comparing human e-mail counseling,
computer-automated tailored counseling, and no
counseling in an Internet weight loss program

• Objective: Compare human and automated coaching
• Methods: 192 obese adults randomized to 3 groups: no coaching,
automated coaching, human e-mail coaching
• Results: At 6 months: no coaching group (-2.6 kg), automated group (-4.9
kg), human email coaching group (-7.3 kg)
• Conclusion: At 3 months automated and human email coaching were as
effective but at 6 months human coaching was more effective.

Tate et al, Arch Intern Med Aug 2006.


Key Points About Online Coaching
 Online coaching is more scalable and can be more cost
effective than telephonic coaching

 Both human and automated online coaching appear to
produce clinically significant results

 Human coaching may produce better outcomes than
automated coaching but at an increased cost

 Online coaching offers the convenience of asynchronous
messaging (e.g. email, SMS)

 Some employers say that online coaching is
inaccessible to their offline employees


Discussion #2: Online Coaching
• Have you used any form of online coaching in your
workplace?

• Did employees prefer this method of communication vs.
telephonic/in-person?

• How did the cost compare to telephonic/in-person?

• Do you prefer human coaching or virtual coaching?




Peer Coaching
Exploring a Promising Approach


Discussion #3: Peer Coaching
• Have you tried using peer coaching at your company?

• How did your employees respond to this approach?

• Did this produce higher or lower engagement than other
types of coaching?

• What was the health impact?

• Should more employers adopt this approach?



Peer Coaching & Engagement
An Online Recovery Plan Program: Can Peer
Coaching Increase Participation?

• Objective: Evaluate whether addition of online coaching
from a peer specialist increased participation in a bipolar
disorder program

• Methods: 118 participants recruited, randomly assigned
to online peer coaching vs. control group

• Results: Peer coaching participants were more likely to
return to the website after registration (71% vs. 44%) and
continue using the program after three weeks (38% vs.
9%)

• Conclusion: Peer coaching led to greater program
engagement and retention

Simon et al, Psychiatric Services, Vol 62 No. 6


Peer vs. Nurse Coaching for Diabetes
Diabetes Control with Reciprocal Peer
Support Versus Nurse Care Management
• Objective: Compare peer-support with nurse care
management

• Methods: 244 men with A1c > 7.5%, randomized. Half
matched with peer coach for weekly sessions, other
half matched to nurse care manager.

• Results: A1c decreased (8.02 to 7.73%) in peer group,
but increased (7.93 to 8.22%) in nurse group.

• Conclusion: Peer coaching holds promise as a
method for diabetes care management.
Heisler et al, Annals of Internal Medicine, 2010.


Peer Coaching via Recruitment & Support
Benefits of Recruiting Participants With Friends and
Increasing Social Support for Weight Loss and
Maintenance

• Objective: Determine the benefits of social support for weight loss
and maintenance

• Methods: Recruited participants (N = 166) either alone or with 3
friends or family members and then randomly assigned them to a
standard behavioral treatment with and without social support
strategies.

• Results: Participants recruited with friends and given social support
had greater weight losses at 4-months (20 lbs) and 10-months (19
lbs) than those recruited alone (15 lbs and 12 lbs). In those recruited
alone, 76% completed and 24% maintained weight loss in full through
month 10. When recruited with friends and social support, 95%
completed and 66% maintained weight loss in full.

• Conclusion: Recruitment with friends and social support led to
greater weight losses and longer-term sustainability.

Rena R. Wing and Robert W. Jeffery, 27 July 1998.


Peer Coaching via Team Challenges
A Statewide Intervention Reduces BMI in
Adults: Shape Up Rhode Island Results

• Objective: Evaluate weight loss outcomes

• Methods: Measure weight loss achieved among 3,311
participants in Shape Up RI, a 16-week workplace-based
exercise and weight loss team competition.

• Results: 7 lbs, 30% achieved clinically significant weight
loss of 5%, shifted the BMI distribution from mean of 29.4
to 28.2 and reduced the obese population from 39 to 31%.
Weight loss maintenance at 10 months was 73%.

• Conclusion: Team-based, weight loss competitions can
produce weight losses in large numbers of participants
and may be sustainable long-term.

Rena R. Wing, et al , Obesity (2009) 17 5, 991–995.


The Social Influence of Peer Coaching
Teammates and Social Influence Affect Weight
Loss Outcomes in a Team-Based Weight Loss
Competition

• Objective: Investigated the effects of teammates and social
influence on individual weight loss and exercise outcomes

• Method: 12-week, team-based wellness competition

• Results: Overweight/obese completers lost 4.2% of initial body
weight. Weight loss was similar among teammates. Having a
greater percentage of teammates in the weight loss division
and reporting higher social influence for weight loss were both
associated with greater weight loss. Clinically significant (5%)
weight loss tended to cluster within teams.

• Conclusion: Weight loss and the behaviors that lead to it are
likely contagious, and harnessing and maximizing social
influence for weight loss enhances outcomes.

Tricia Leahey et al, Obesity, Feb 2012.


Key Points About Peer Coaching
• Peer coaching can lead to higher participation and retention

• Peer coaching can produce significant health outcomes

• Peer coaching is the most cost effective approach

• Peer coaching is most effective when the coach shares similar
health issues and goals

• Outcomes via peer coaching have been shown to be
contagious, spreading from person to person

• Peer coaching can have limitations related to the lack of formal
training of the coaches


Discussion #3: Peer Coaching
• Have you tried using peer coaching at your company?

• How did your employees respond to this approach?

• Did this produce higher or lower engagement than other
types of coaching?

• What was the health impact?

• Should more employers adopt this approach?



ShapeUp’s Approach to
Coaching


Empowered Peer Coaches for Everyone
• Turning colleagues into peer coaches
through the role of Team Captain

• Peer coaches empowered to recruit,
motivate, and hold peers accountable

• Allowing every member to serve as a
peer coach through support
mechanisms and user-generated
challenges

• Leveraging your potent employee
network at a low cost


Online Fitness Coaches for the Motivated
• Provide additional expert support,
guidance, and education for motivated
individuals and teams (opt-in model)

• Focus on physical activity, nutrition, and
weight management

• Asynchronous messaging, integrated
into our social engagement platform

• Coaches drive utilization of the
platform, social interactions, team
cohesion, and healthy outcomes


Key Takeaways from
Today’s Webinar


Key Takeaways from Today’s Webinar
 Coaching is a dominant approach for employee wellness

 Various studies have showed that each method of coaching can be
clinically effective

 Many employers are looking for alternatives to telephonic coaching

 Online coaching models offer greater reach, scalability, convenience,
and cost-effectiveness

 Peer coaching holds promise as a low-cost, highly effective model for
harnessing the power of social networks

 Further research is needed to understand the long-term impact and
sustainability of health coaching on behavior change


Health coaching in employee wellness - past present and future

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Health coaching in employee wellness - past present and future