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1 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Health coaching in employee wellness - past present and future

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Is telephonic coaching losing favor as an employee wellness component? Recent reports show that some large employers view telephonic coaching as expensive and having limited reach. If this is true, what are the other options? If not, what role should it continue to play? And what does the future of health coaching look like? Learn more by view these slides and watching the webinar at http://www.shapeup.com/lp/health-coaching-past-present-and-future

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Page 1: Health coaching in employee wellness -  past present and  future

1 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Page 2: Health coaching in employee wellness -  past present and  future

2 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Today’s Webinar Team

Rajiv Kumar, M.D.

Founder & Chief Executive Officer

[email protected]

Shawn LaVana

Vice President of Marketing

[email protected]

Elise Meyer

Marketing Associate

[email protected]

Page 3: Health coaching in employee wellness -  past present and  future

3 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Join the Conversation on Twitter

@shapeupdotcom

#healthcoaching

Page 4: Health coaching in employee wellness -  past present and  future

4 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

ShapeUp’s Mission Statement

Creating a healthier world by

leveraging social influence to

engage people in healthy activities

Page 5: Health coaching in employee wellness -  past present and  future

5 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

1. Why Health Coaching

2. Telephonic Coaching

3. Online Coaching

4. Peer Coaching

5. ShapeUp’s Approach

6. Discussion

Today’s Agenda

Page 6: Health coaching in employee wellness -  past present and  future

6 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Why Health Coaching? A Response to Rising Health Costs

Page 7: Health coaching in employee wellness -  past present and  future

7 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

0

20

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100%

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U.S. Healthcare Expenditures, 1960-2020

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

Total

Public

Total

Private

Out-of-

Pocket

Employers = 1/3 of All Health Spending

Page 8: Health coaching in employee wellness -  past present and  future

8 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

0

20

40

60

80

100%5K+

1K-5K

200 to999

3 to199

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9

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1

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2

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3

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4

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('99-'11)

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Source: Kaiser Family Foundation; US Census Bureau

Percent of Covered Workers in Partially or Completely

Self-Funded Plans By Firm Size, 1999-2011

Large Employers Are Mostly Self-Funded

Page 9: Health coaching in employee wellness -  past present and  future

9 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Lifestyle Conditions Are Driving Costs

0

0 25 50 75 100 125 150M

$60BHealthcare

Cost

$60BHealthcare

Cost

Number of People Afflicted

Heart Disease

Alzheimer's/Dementia

Obesity/Overweight

HighCholesterol

Diabetes

Cancer

Hyper-tension

Heartburn

IrritableBowel

Syndrome

LactoseIntolerant

MetabolicSyndrome

Osteoporosis

Sleep

CeliacDisease

InflammatoryBowel

Disease

Cost of Healthcare, # of People Afflicted, and Nutrition Index by Condition

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

Manageable with

diet & exercise

Not manageable

with diet & exercise

Page 10: Health coaching in employee wellness -  past present and  future

10 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Telephonic Coaching Examining a Traditional Model

Page 11: Health coaching in employee wellness -  past present and  future

11 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

• 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?

Discussion #1: Telephonic Coaching

If you’d like to respond, please type the discussion number and your

organization name into the question box on the GoToWebinar control panel.

Page 12: Health coaching in employee wellness -  past present and  future

12 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

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.

Telephonic Coaching Can Really Work

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

Page 13: Health coaching in employee wellness -  past present and  future

13 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

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 2nd 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.

But Telephonic Coaching Has Limits

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

Page 14: Health coaching in employee wellness -  past present and  future

14 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

―Doing The Telephone Tango‖

Is Telephonic Coaching Inconvenient?

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

―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.‖

Page 15: Health coaching in employee wellness -  past present and  future

15 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

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

Page 16: Health coaching in employee wellness -  past present and  future

16 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Telephonic Coaching: Employer Opinions

―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‖

ShapeUp Annual Employer Wellness Survey, 2012

Page 17: Health coaching in employee wellness -  past present and  future

17 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Telephonic Coaching: Employer Opinions

―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.‖

ShapeUp Annual Employer Wellness Survey, 2012

Page 18: Health coaching in employee wellness -  past present and  future

18 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Telephonic Coaching: Employer Opinions

―Some vendors don’t get it. A couple of

calls and a letter won’t have an impact on

engagement.‖

ShapeUp Annual Employer Wellness Survey, 2012

Page 19: Health coaching in employee wellness -  past present and  future

19 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Telephonic Coaching: Employer Opinions

―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.‖

ShapeUp Annual Employer Wellness Survey, 2012

Page 20: Health coaching in employee wellness -  past present and  future

20 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Telephonic Coaching: Employer Opinions

―It’s unclear what the effect is. Utilization

is low – in the single digits.‖

ShapeUp Annual Employer Wellness Survey, 2012

Page 21: Health coaching in employee wellness -  past present and  future

21 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Telephonic Coaching: Employer Opinions

―We pulled the plug on telephonic health

coaching—only a small percent respond.

It’s not a very motivating model.‖

ShapeUp Annual Employer Wellness Survey, 2012

Page 22: Health coaching in employee wellness -  past present and  future

22 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

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

Key Points About Telephonic Coaching

Page 23: Health coaching in employee wellness -  past present and  future

23 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

• 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 suited for particular employee types?

• Should employers stick with this model or ditch it?

Discussion #1: Telephonic Coaching

If you’d like to respond, please type the discussion number and your

organization name into the question box on the GoToWebinar control panel.

Page 24: Health coaching in employee wellness -  past present and  future

24 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Online Coaching Understanding Its Efficacy

Page 25: Health coaching in employee wellness -  past present and  future

25 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

• 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?

• Have you seen measurable health improvement?

Discussion #2: Online Coaching

If you’d like to respond, please type the discussion number and your

organization name into the question box on the GoToWebinar control panel.

Page 26: Health coaching in employee wellness -  past present and  future

26 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Automated Coaching via the Web

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

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.

Page 27: Health coaching in employee wellness -  past present and  future

27 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Human Coaching via the Web

Tate et al, JAMA 2003.

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

Page 28: Health coaching in employee wellness -  past present and  future

28 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Human vs. Automated Coaching

Tate et al, Arch Intern Med Aug 2006.

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.

Page 29: Health coaching in employee wellness -  past present and  future

29 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

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

Key Points About Online Coaching

Page 30: Health coaching in employee wellness -  past present and  future

30 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

• 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?

• Have you seen measurable health improvement?

Discussion #2: Online Coaching

If you’d like to respond, please type the discussion number and your

organization name into the question box on the GoToWebinar control panel.

Page 31: Health coaching in employee wellness -  past present and  future

31 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Peer Coaching Exploring a Promising Approach

Page 32: Health coaching in employee wellness -  past present and  future

32 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

• 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?

Discussion #3: Peer Coaching

If you’d like to respond, please type the discussion number and your

organization name into the question box on the GoToWebinar control panel.

Page 33: Health coaching in employee wellness -  past present and  future

33 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

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

Peer Coaching & Engagement

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

Page 34: Health coaching in employee wellness -  past present and  future

34 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

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.

Peer vs. Nurse Coaching for Diabetes

Heisler et al, Annals of Internal Medicine, 2010.

Page 35: Health coaching in employee wellness -  past present and  future

35 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

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.

Peer Coaching via Recruitment & Support

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

Page 36: Health coaching in employee wellness -  past present and  future

36 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

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.

Peer Coaching via Team Challenges

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

Page 37: Health coaching in employee wellness -  past present and  future

37 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

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.

The Social Influence of Peer Coaching

Tricia Leahey et al, Obesity, Feb 2012.

Page 38: Health coaching in employee wellness -  past present and  future

38 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

• 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

Key Points About Peer Coaching

Page 39: Health coaching in employee wellness -  past present and  future

39 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

• 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?

Discussion #3: Peer Coaching

If you’d like to respond, please type the discussion number and your

organization name into the question box on the GoToWebinar control panel.

Page 40: Health coaching in employee wellness -  past present and  future

40 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

ShapeUp’s Approach to

Coaching

Page 41: Health coaching in employee wellness -  past present and  future

41 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

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

Page 42: Health coaching in employee wellness -  past present and  future

42 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

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

Page 43: Health coaching in employee wellness -  past present and  future

43 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

Key Takeaways from

Today’s Webinar

Page 44: Health coaching in employee wellness -  past present and  future

44 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.

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

Key Takeaways from Today’s Webinar

Page 45: Health coaching in employee wellness -  past present and  future

45 Copyright © 2012 ShapeUp, Inc. Confidential & Proprietary.