Publication/Presentation Date
7-25-2014
Abstract
Abstract
Populytics, an independent subsidiary of the Lehigh Valley Health Network offers various Population Health Management and Advanced Analytic services. Among these services is the Chronic Condition Management Health Coaching Program for members of the Lehigh Valley Health Network's self insured plan, Choice Plus. This Health Coaching program is free to all Choice Plus members, including spouses and dependents of Network employees, identified through predictive modeling tools as low, moderate, or high risk for one or more of eight chronic conditions, including asthma, chronic obstructive pulmonary disease, hyperlipidemia, hypertension, obesity, vascular disease, and diabetes. Registered Nurse (RN) Coaches call these members on the phone and offer healthy lifestyle coaching that is developed based on each member’s particular condition(s). The purpose of this program is to encourage members to self-manage, before frequent clinical interventions are necessary, leading to unnecessary or preventable costs for the member and the Network. However, Populytics has noted low rates of active engagement for this program. This quality improvement project seeks to answer by way of telephone surveys why the RN Health Coaching Program offered to Choice Plus members, spouses, and dependents is not effective in motivating members to actively engage in healthy lifestyle changes.
Background
Fortunately, due to the advancement of modern medicine, development and widespread use of vaccines, good sanitation, etc., infectious diseases that once dominated the list of leading causes of death in the United States, such as tuberculosis and diphtheria, have become far less common (1999). However, chronic conditions are on the rise in this country, and they are taking over as the leading causes of death. The Centers for Disease Control and Prevention (CDC) reports that in 2012, about half of the adult population had one chronic disease and about one in four adults had two or more chronic diseases (2014). In addition to causing premature death, chronic conditions often force those affected by them to utilize healthcare services far more often then those who are not chronically ill, driving up healthcare costs for all. Unfortunately, even a network of colleagues comprised of some of the best healthcare providers in the country is not immune to chronic diseases and their implications.
For this reason, Populytics Care Management offers health coaching as a free service to eligible LVHN Choice Plus members. Engaged members set goals over the phone with RN coaches to improve their health and discuss self-management. RN coaches encourage engaged members to visit their primary care providers regularly and follow their care plans. The program is an additional resource available to assist members on their journeys to better health, and in turn, reduce healthcare costs. Unfortunately, member engagement in the program is low.
Despite the push back from some Choice Plus members, telephonic disease management programs are not something Populytics has newly invented. In fact, the State of Florida implemented a rather successful telephonic disease management program in 2001-2004 through its “Florida: A Healthy State (FAHS)” Medicaid program (Afifi, Morisky, Kominski, & Kotlerman, 2007). This program was found to reduce hospitalizations, length of hospital stays, and emergency room utilization in patients who engaged in the disease management program compared to those who did not (Afifi, Morisky, Kominski, & Kotlerman, 2007). Studies also suggest that the development of information technology supports self-management of chronic conditions by increasing knowledge and self-efficacy among individuals dealing with these illnesses (Solomon, 2008). Informed patients can do more for themselves to be healthier. Currently, there is very little online information available to Choice Plus members about Populytics’ Chronic Condition Management Health Coaching Program. Two great opportunities for improvement are online informative resources and an effective health coaching program.
Methodology
This quality improvement project began with simple observation to understand the processes, strengths, and weaknesses of Populytics’ Chronic Condition Management Health Coaching Program. One initial observation that became apparent was the complexity of such an organization and its many stakeholders. Before taking action on any tasks for this project, it was necessary that all stakeholders agreed.
Another observation was that as Populytics has rapidly evolved over the past few years, the letters used as a secondary mode of communication with members in the Chronic Condition Management Health Coaching Program have not been kept current. A list of every type of letter was collected. Members and their primary care providers each receive different letters for different situations, for example when a member declines or completes the program. Each different letter was then updated, redrafted, and submitted for approval for implementation.
Because there is not currently detailed information about the Chronic Condition Management Health Coaching Program available to Choice Plus members via their MyPopulytics.com web portal, intranet content was drafted from scratch. The content was developed based on common questions one might have about any new program they are committing to. It was also submitted for approval. See the proposed content in Appendix 1.
After gaining a good understanding of the program, a list of questions was created based on speculation as to why so many members are choosing to decline this free service. Approval was obtained to make telephone calls to moderate and high risk members who had completed or declined the Chronic Condition Management Health Coaching Program in the 2014 calendar year and survey them about either their experience with the program or their reasons for declining the program. Scripts used when speaking to members who completed or declined the program can be found in Appendices 2 and 3, respectively. A computer-generated list that included a member’s name, phone number, and chronic conditions was obtained for the 30 members who had completed the program and 275 members who had been offered but declined the program in 2014. Members diagnosed with asthma only were excluded, as these members could have been children. A few members were not called due to conflicts of interest to the caller such as the name was recognized on a personal level or the member had previously requested with the RN coaches not to be contacted. These special cases aside, a total of 207 calls were made to members on the list of declines, and 16 calls were made to members on the list of completions. Member’s responses to each open-ended question were recorded. While the members were encouraged to elaborate on answers and provide opinions, similar or commonly reported answers among members were tracked in a simplified form for the purpose of reporting data. Member’s names and identifying information were removed from their responses once the phone call was ended.
Results
Of the 207 total calls made to members who had declined the program, 119 voicemail messages were left. In 21 cases, the caller was unable to leave a message, and in 20 cases the phone number provided was incorrect or no longer in service. The caller reached 47 members who had declined the program, 23 of which agreed to the phone survey and 24 of which declined the survey.
Of the 16 total calls made to members who had completed the program, 9 voicemail messages were left. In 3 cases, the caller was unable to leave a message, and in 1 case the number given was incorrect. The caller reached 3 members total, all of which agreed to participate in the phone survey, none declining the survey.
Member Surveyed
Member indicated the program was good, but not necessary for him/her at the time.
Member mentioned he/she or a family member was a clinician.
Member mentioned another wellness program he/she was involved in.
Was the program fully explained to you?
Could the program be more "user friendly?"
Would you be more inclined to participate in the program if the materials and nurse coaches were available online?
Do you think LVHN colleagues are aware this program is available to all eligible Choice Plus members for free?
Would you recommend the program to others?
1
yes
no
no
yes
no
yes
yes
yes
2
yes
no
no
yes
no
yes
yes
yes
3
no
no
yes
yes
no
yes
not an LVHN colleague
unsure
4
yes
no
yes
yes
no
yes
unsure
yes
5
no
no
no
yes
no
no
unsure
unsure
6
yes
no
no
yes
yes
no
unsure
yes
7
yes
no
yes
yes
no
yes
yes
yes
8
yes
yes
n/a
n/a
n/a
n/a
n/a
n/a
9
yes
no
no
yes
no
no
not an LVHN colleague
yes
10
yes
no
no
yes
no
no
unsure
yes
11
yes
no
yes
yes
no
no
yes
yes
12
yes
n/a
n/a
n/a
n/a
n/a
n/a
n/a
13
yes
no
no
yes
no
no
unsure
yes
14
no
yes
n/a
n/a
n/a
n/a
n/a
n/a
15
yes
no
yes
n/a
n/a
n/a
n/a
n/a
16
yes
no
no
yes
yes
yes
no
yes
17
yes
no
yes
no
yes
n/a
unsure
unsure
18
yes
no
yes
yes
yes
no
unsure
unsure
19
yes
no
yes
yes
no
no
not an LVHN colleague
unsure
20
yes
no
yes
yes
yes
no
unsure
yes
21
yes
no
yes
yes
yes
yes
unsure
yes
22
yes
no
no
no
no
no
unsure
unsure
23
yes
yes
no
yes
no
yes
unsure
yes
% answered yes
87%
14%
50%
89%
32%
44%
21%
68%
% answered no
13%
86%
50%
11%
68%
56%
5%
0%
% answered unsure
n/a
n/a
n/a
n/a
n/a
n/a
58%
32%
% answered not LVHN
n/a
n/a
n/a
n/a
n/a
n/a
3%
n/a
Table 1. Similar and Commonly Reported Answers Among Members who Declined the Program
A table for similar and commonly reported answers among members who completed the program was not created, as only three members responded. However there were some answers at least two of the members gave:
- Two out of three members felt the program should be longer than one year, as chronic illness lasts a lifetime for many.
- All three members would recommend the program to a colleague.
- All three members reported they worked on their goals between phone calls with nurse coaches.
- All three members felt the program was explained fully to them.
- All three members reported the program was “user-friendly,” however one also made some suggestions for improvement based on an experience with a new nurse coach the member felt was inexperienced.
- Only one member mentioned the reduced copay plan for diabetic members who engage in the program. He stated that it was the reason he agreed to the program, but it was also an inconvenience when the program ended to have to begin to pay full price again.
Limitations
First, understanding this is a quality improvement project simply aiming to interpret members’ motivations to engage in this program, the survey did not follow perfect research methods. Specifically, the sample of members who completed the survey was very small as well as not representative for a few reasons. First, members who were in the process of the completing the program were not contacted. Also, all phone calls were also made during the standard workday, when many members were likely working and unable to take phone calls. Some members also claimed to have been falsely identified with having a chronic condition, implying a gap in the computer data systems that compile this information.
Secondly, the answers members gave were intentionally left open ended. This will allow for Populytics Care management to review in the future the exact responses given by members. However, it became up to the caller to translate responses to simple reportable data, a task that was not completely objective.
Discussion
Perhaps the most surprising of the results of this study is that, among those surveyed who declined the program, most implied that the program was probably useful to others, they just did not need it at the time it was offered to them. This is somewhat inconsistent with the negative comments nurse coaches have reported from some members. It seems apparent that the important question here is now not “what is wrong with the how the program is designed,” but rather “how can the program be better communicated so members understand that it will be beneficial to them?”
Further research and progress should be focused on educating members about the benefits of the program. Members who feel doubtful that they need the program should be encouraged to understand that any amount of help and guidance could have a positive impact on their health. Members who complain about their privacy to nurse coaches should receive a letter that is easy to understand and explains how their insurance works, including why the nurses are able to access some of their medical information. Coaches should work on tactfully explaining to members that regardless of what they know, what they think they know, or what their clinical background is, they probably could find some benefit from the support of the program.
One way to aid in this process of educating members is to complete the process of revising and utilizing new letters and intranet portal materials. These mediums provide different options for members to get involved, based on their preferred communication style.
Another way to reach more people may be to expand the program. As mentioned before, chronic illness typically lasts longer than the length of this yearlong program. The service could also be expanded to include more incentives or penalties. Currently, members are not penalized for declining this program. However, this may be something to consider if chronic conditions continue to increase as a financial burden for the Network’s self-insured plan.
Conclusion
Chronic Condition Management has been proven effective in reducing negative health outcomes. At LVHN, Populytics could observe similar outcomes by carefully executing some adjustments to its Chronic Condition Management Health Coaching Program. These adjustments should focus on comprehensive education about Choice Plus insurance and the Care Management services available to members as a part of their benefits. As part of the health care infrastructure, employees could also benefit from an understanding of the challenges businesses in the United States face today in managing escalating health care costs and sustaining their business model. Any improvement in self-management by a covered member contributes to the well being of the population of LVHN employees and to the financial viability of the network.
Appendix 1
POTENTIAL INTRANET CONTENT
- Link in MyPopulytics for Chronic Condition Management
- Topics under this page from link include:
REGISTERED NURSE HEALTH COACHING - A free service available as a part of your Choice Plus benefits.
What is RN Health Coaching? - RN Health Coaching is a FREE program offered to ALL eligible LVHN Choice Plus members, including LVHN employees, spouses, and dependents.
Who is eligible for RN Health Coaching? - RN Health Coaching is available to Choice Plus members who have been diagnosed with or are at risk for one or more of the following eight chronic conditions: Asthma, Congestive Heart Failure, Diabetes, Hyperlipidemia (high cholesterol), Hypertension (high blood pressure, Coronary Artery/Vascular Disease (diseases of blood vessels in the heart and body), Healthy Lifestyles (excessive weight management), & Chronic Obstructive Pulmonary Disease
(COPD).
How do I become enrolled in the RN Health Coaching Program? - If you are a Choice Plus member with a chronic illness, you may have already received a letter from Populytics inviting you to join the Health Coaching program. If not, you may be receiving a letter or a phone call soon. You can also call the Nurse Coach Team at 484-884-0417 Monday through Friday between 7:30am and 8:00pm at a time that works for you. If the nurse coaches are unable to answer your call right away, please leave a message on our confidential voicemail. In your message, please include your full name and the best phone number to reach you. If you have a hearing or speech impairment, please use a TYY/TDD telephone to call 711 for a relay service in your state.
Can children participate in this program? – Yes. However, currently only children with Asthma are eligible to participate.
What if I am not sure if I am eligible for this program? - You can talk to your doctor about the program, and you can call the Nurse Coach Team at 484-884-0417. Even if you do not qualify for the RN Health Coaching, the nurse coaches may be able to direct you to another helpful resource.
What can I expect if I become enrolled in the RN Health Coaching Program? - For most cases, this program uses phone communication. Your nurse health coach will schedule phone sessions with you based on what you and your nurse decide is appropriate. During the initial phone call, your nurse health coach will ask you questions about your overall health and how you manage your health. She will then ask you about goals. You will work with your nurse coach to set goals that fit your needs, are realistic for you, work in your schedule, and of course, benefit your health. You can design an action plan that will help you to make progress on your healthy lifestyle goals before your next phone call with your nurse coach.
How will this program benefit me? - As you know, your health affects all aspects of your life, and in today’s world we sometimes struggle to find time to devote to our own health. Managing a chronic condition may make maintaining your health more of a challenge and affect your ability to enjoy your usual activities. If you feel you are ready to make changes to benefit your health and overall wellbeing, you do not have to do it alone. Your nurse coach will help you take the steps you need towards a healthier, happier, more successful lifestyle, without taking up too much of your time. Depending on your situation and what you and your nurse health coach decide, you may have phone sessions once a month or once every three months for one year. In certain cases, enrolled participants are eligible for prescription cost reduction incentives. You can ask your nurse coach about this when you call.
Success stories – Need to contact members who have used coaching and been successful: get permission to publicize their story and/or quotes/reviews of the program
EMMI – A tool for understanding your care
Link to EMMI catalog – work with EMMIM representative and IT to implement this
Self-Care Basics – an overview of and simple suggestions for managing each chronic illness (would need nurse input to elaborate on this)
Asthma – carry your inhaler and any other necessary medications with you everywhere you go
Congestive Heart Failure -
Diabetes – check your sugars regularly; try to incorporate more fresh foods into your diet
Hyperlipidemia (high cholesterol) – try to watch your saturated fat intake, add exercise into your routine, take the stairs
Hypertension (high blood pressure) - exercise
Coronary Artery/Vascular Disease (diseases of blood vessels in the heart and body) -
Healthy Lifestyles (excessive weight management) – swap one processed snack per day for a fruit or vegetable
Chronic Obstructive Pulmonary Disease (COPD) -
How Health and Happiness Go Hand in Hand – a different look at wellness
Habits of Happy People
How Health and Happiness are related
Health Tip of the Week/month – could be a tip, challenge, theme, activity, etc. that would get updated regularly – ideally people will check in with the website more often.
Appendix 2.
Good morning/afternoon _______________. My name is Kristen Dziedzic and I am a Research Scholar working in Populytics Care Management. How are you today? I am working on a Quality Improvement Project for the ChoicePlus Chronic Condition Management RN Health Coaching Program, formerly known as Health Services Health Coaching. My goal is to look into what is working and what is not working about the program so we can strive to improve it. I see that you have recently completed this program. Do you mind if I ask you a few questions about the program?
(if agrees) Great, thanks. So I am going to ask you some questions about your experiences in the program as well as some questions about what motivated you throughout the program. I want to let you know that all of your answers to these questions will be anonymous. In other words, after the call anything you say will have no connection to your name. We just want to gain some knowledge about what ChoicePlus members think about the program.
- What did you like and dislike about the program, and what changes would you recommend for the program?
- What did you think of the letters you received in the mail regarding the program? Did it help to engage you in the program, was it easy to read, and would you prefer these materials coming in the mail or coming in electronic form through email?
- Was there anything about the program you felt was confusing or was not explained fully to you? If so, which part?
- Was the Health Coaching Program "user friendly,” and if not, how could it become more "user friendly?"
- Did you meet any goals you set with your nurse coach during the program? If yes, could you briefly describe the goal(s)? What helped you reach those goals? If no, why not?
- Did you spend time on your goals in between phone calls with your nurse coach? Did you ever plan goals then not act on them?
- What motivates you and what would motivate you to actively engage in the program and work hard to reach your goals? What do you think would motivate colleagues to participate in the program? What kept you going and motivated you to complete the program?
- Do you believe this program is beneficial to you, your family, or the LVHN? Why or why not?
- Do you think the Health Coaching Program is easy to access and use for spouses and/or dependents?
- Would you recommend the Health Coaching Program to a colleague? Why or why not?
- Is there anything else you would like us to know about your experiences with the program, or do you have any other suggestions?
Thank you so much for you time and patience. Your feedback will be very helpful.
Appendix 3.
Good morning/afternoon _______________. My name is Kristen Dziedzic and I am a Research Scholar working in Populytics Care Management. How are you today? I am working on a Quality Improvement Project for the ChoicePlus Chronic Condition Management RN Health Coaching Program, formerly known as Health Services Health Coaching. My goal is to look into what is working and what is not working about the program so we can strive to improve it. I see that you have recently declined participation in the program. Do you mind if I ask you a few questions about this?
(if agrees) Great, thanks. So I am going to ask you around 10 questions about why you declined participation in the program and what might motivate you to reconsider. I want to let you know that all of your answers to these questions will be anonymous. In other words, after the call anything you say will have no connection to your name. We just want to gain some knowledge about what ChoicePlus members think about the program.
- Why did you decline participation in the program?
- What motivates you most and what do you think would motivate you to participate in program?
- When you were offered to participate, was there anything about the program that was not explained fully to you? If so, which part?
- How could the Health Coaching Program become more "user friendly?"
- What did you think of the letter mailed to you regarding the program? Did you understand the letter?
- Would you be more likely to participate in the program if you received materials electronically or if you could communicate with your RN Health Coach through email?
- Do you think your colleagues know that this program is available to all eligible ChoicePlus members for free?
- Do you think the Health Coaching Program is easy to access and understand for spouses and/or dependents of LVHN ChoicePlus members?
- Even though you did not participate in the program, why would you or why wouldn’t you recommend the Health Coaching Program to a colleague?
- Is there anything else you think we should know about your experience with the enrollment phase of the program or do you have any other suggestions?
That is all the questions I have for you. Thank you so much for your patience. Would you like the phone number for the nurse coaches so that if you decide you want to participate you can just call? 484-884-0417
Thank you again for your time we really appreciate it!
References
Afifi, A.A., Morisky, D.E., Kominski, G.F., & Kotlerman, J.B. (2007). Impact of disease management on health care utilization: Evidence from the “Florida: A Healthy State (FAHS)” Medicaid Program. Health Education and Behavior, 505 (36). Retrieved from: http://heb.sagepub.com.proxy-um.researchport.umd.edu/content/36/3/505.full.pdf+html.
(1999). Achievements in Public Health, 1900-1999: Control of Infectious Diseases. MMWR Weekly, 48(29);621-629. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4829a1.htm.
(2014). Chronic Disease Prevention and Health Promotion. Centers for Disease Control and Prevention. Retrieved from: http://www.cdc.gov/chronicdisease/overview/index.htm.
Solomon, M. R. (2008). Information technology to support self-management in chronic care: A systematic review. Disease Management & Health Outcomes, 16(6), 391-401. Retrieved from http://search.proquest.com/docview/221168879?accountid=14696.
Published In/Presented At
Dziedzic, K., Cook-Altjoni, D., (2014, July, 25) Evaluating Engagement in the Populytics Chronic Condition Management Health Coaching Program. Poster presented at LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network, Allentown, PA.
Department(s)
Research Scholars, Research Scholars - Posters
Document Type
Poster
Comments
Mentor: Deb Cook