Talk about follow-up healthcare
About every two weeks, Joel Tucker, 46, gets a call from a fairly new acquaintance, Debbie, who politely asks about his health and offers some suggestions for how Tucker can better manage his diabetes.
Rather than be annoyed by the intrusion, Tucker says he’s delighted with the phone calls. “It’s like talking to my sister,” he says.
Debbie is actually a registered nurse, one among dozens under contract to Tucker’s employer, UPS. The nurses look through claims data to find employees who have, or are at risk for, chronic illnesses such as asthma, diabetes and cancer. They then contact the workers to offer medical assistance -- advice-laden brochures, tips for remembering to take medication, or help finding a doctor or a clinical trial for a specific condition.
Some Americans might be reluctant to hand over private information to someone who works for their employer or to let their insurer know they may not be controlling their health problems. But not Tucker, nor his colleague Rita Sexton, who speaks to Faye, another nurse who coaches UPS employees, once a month about her diabetes.
Having Faye “is like having a personal trainer,” the Chicago woman says. “For example, Faye reminds me to check in with the eye doctor and the foot doctor.” And, because Sexton has given her written consent, test results are sent to the nurse, who then explains the blood work and recently congratulated Sexton on lower cholesterol levels.
“It’s nice to have a lot more information and time spent with you than just your doctor’s regular appointment,” Sexton says.
Across the country, insurers and self-insured employers are creating programs that employ “health coaches,” usually registered nurses or other health professionals, to help employees manage illnesses and lifestyle issues such as weight loss or smoking cessation. Sometimes they answer questions about insurance benefits available to them when a health problem crops up.
The programs vary. At UPS, nurses initiate the calls, whereas Aetna’s program allows beneficiaries to call in for medical information and assistance. And while some plans limit the coaches to phone assistance, other programs include Web chats, websites and conference calls. Cigna, for example, has a health-coach-run weight-loss program that includes a telephone assessment before beneficiaries start the program, one-on-one telephone or online support from a health coach, a workbook with tips and nutrition guides, a pedometer and access to the program’s website, which lets participants log their food intake and exercise.
Aetna, which insures or administers insurance for millions of people in Southern California, offers disease and lifestyle coaching. CareFirst Blue Shield, which insures or administers health insurance for residents of Washington, D.C., Maryland and Delaware, offers smoking cessation, exercise, weight-loss and stress management coaching.
Experts who follow health trends say health coaching has grown more popular among employers in the last three years as companies try to hold down healthcare costs without skimping on employees’, and often their families’, healthcare needs.
“What we really need in order to improve the health of Americans is for people to take better care of themselves,” says Helen Darling, president of the nonprofit National Business Group on Health.
And data suggest that people do well when they have a person assigned to help them understand their health needs and remind them about small details, such as refilling medications and keeping scheduled doctor appointments, she says.
A popular option
By 2007, 54% of the largest U.S. employers will offer some version of health coaching to employees, according to a recent survey by the National Business Group on Health and consulting firm Watson Wyatt. Now the idea is trickling down to smaller firms.
Cigna, which insures millions of people in Southern California, will be offering the option to employers who have as few as 200 employees for 2007; last year the program was offered only to companies with at least 5,000 employees.
Such hand-holding can have a substantial effect. In a study published in the October issue of the Archives of Internal Medicine, about half of 750 patients older than 65 who had recently been released from the hospital for treatment of an illness were assigned to periodic assistance by a health coach; the other half were not. Of the coached patients, 8% visited an emergency room in the six months after their hospital release, while 12% of the noncoached patients headed to the emergency room during that time period.
Study author Dr. Eric Coleman, an associate professor at the University of Colorado Health Sciences Center, says the program saved $845 in hospital costs per patient for those who did not visit the emergency room.
Lindsay Bishop, a healthcare consultant with benefits consulting firm Hewitt Associates, says insurers are likely to add options to their programs as the data stack up. UPS, for example, will add the coaching benefit for its nonunion employees during 2007 and will let interested employees sign up for the service directly.
Arthur Levin, head of the Center for Medical Consumers, an advocacy group in New York City, says health coaching can help people take charge of their own healthcare, but urges them to find out specifics.
For example, while some programs rely on a different nurse each time you call to help with information, others assign just one nurse to your case. If you like the concept, but not the nurse, ask how you can change your designated coach. Levin also urges consumers to ask whether anyone other than the coaches are given access to data that could identify you as having a health problem, or whether your file is highlighted if you don’t follow the coach’s advice.
Privacy concerns
Insurance experts say companies have taken steps to protect the privacy of workers and their families. The National Assn. of Insurance Commissioners says it is unaware of any instances of health insurance rates being raised due to workers not following the advice of their health coach, says Vanessa Sink, an association spokeswoman.
To add to the privacy protection, many insurers and employers, such as Healthnet, which insures 1.5 million people in Southern California, have contracted with free-standing health coach firms that provide them only with composite data, no specifics.
“Frankly, fear of being sued would keep most to all employers from using the data against employees,” says Ron Mason, a consultant in the Irvine office of benefits consulting firm Towers Perrin. Mason says employees who want an extra measure of protection can ask for a written promise that the information won’t be used against them.
“I don’t see plans in the future for using this as punitive. That would break the trust,” says Christopher Coloian, a vice president at Cigna.
Almost no firms charge extra for the coaching, and most allow participants to take advantage of the coaches when they need them, rather than sign up ahead of time.
Many coaches offer a wide variety of services, including answers to questions such as how to treat fever in young kids in the middle of the night. “The most common question I get is about how to find out information on specific conditions and diseases,” says Andrea Powers, a nurse and health coach with Healthdialog, the health coaching firm used by Healthnet.
Raul Roa, 62, of Sacramento can vouch for the usefulness of a health coach. A retired Campbell’s Soup employee who gets health coverage through Healthnet, Roa periodically gets a call from an insurer-paid health coach. One medical condition for which Roa sought assistance is asthma, and tips he’s gotten include decreasing the amount of milk he drinks, which has reduced his allergy symptoms.
But the most useful advice Roa has gotten is how to handle his catheters, a part of his life since falling off the roof and breaking his spine several years ago. Like anyone with a spinal cord injury, Roa is prone to bladder infections, especially since his insurance limits him to 30 catheters a month, sometimes not enough.
Clear, precise tips from the health coach on washing his hands, using gloves and sterilizing the catheters in the microwave to be reused now lets Roa go for longer stretches between uncomfortable infections.
“I’m very glad that someone is interested in trying to help me,” Roa says. “Someone in my position needs all the help he can get.”
