Upload
buidiep
View
214
Download
0
Embed Size (px)
Citation preview
A Paradigm Shift from Providing
Education to Engaging
Employees in their Health and
Wellness
• Stacey Lane RN, BSN, MA, HSMI, CCP/HC
• Eileen Lawless RN, BSN, CCP/HC, CHPN
• Carmela Valentino MPH, CHES, CPHQ
Objectives
• Identify Strategies to Motivate Intrinsic
Behavior Change and Participant
Engagement
• Identify Strategies for Sub-Populations
that Address Cultural Diversity
• Realize Methods to Quantify Measures
that Demonstrate VOI/ROI
The Case for Wellbeing: Key Points
Approximately 75% of U.S. healthcare costs are due to chronic diseases, many of which can be prevented or controlled by lifestyle modification.
32% of U.S. population hypertensive, 36% obese, 33% pre-diabetic, 8.3% diabetic-29.1 million in 2012 are diabetic.
Engagement with basic recommendations for control of cholesterol and hypertension is poor. In the U.S. less than half of those with elevated LDL cholesterol receive treatment, less than half with hypertension have the condition under control.
Opportunity is significant. Short-term and long-term impacts, impacts beyond direct medical costs.
Progression to diabetes among the 33% of Americans with pre-diabetes can be reduced by 58% with a reasonable lifestyle modification.
YNHHS Culture of Health Progression
2010 2011 2012 2013 2014 -2015 2007 2008 2009
YNHHS goes tobacco free
Tobacco use surcharge on annual medical plan premium
--Preventive services: 100%
coverage under YNHHS plans
--On-line HRA (completion = $50 gift card)
--Active Health telephone coaching 42 conditions + prenatal care
-- livingwell CARES pilot launched - focus on diabetes
Get Active, YNHHS! team fitness challenge with special website
--livingwell program launched
--Disease management (6 conditions) coaching by medical plan
Tobacco cessation program
livingwell vision: Taking Care. Giving Care.
Taking excellent care of our employees. Giving excellent care to our patients.
--
Screenings + on-line HRA = $500 credit on 2014 medical plan premium
--livingwell
CARES
program
expansion – asthma, CAD, COPD, etc.
livingwell
livingwell
livingwellCARES
Employee and Family Resources
Know Your Numbers
Plus
RedBrick Wellness
Portal
Quit for Life
Conifer Health
Solutions
Nutritional Counseling
Financial Wellness Programs
Physical wellness Programs
• A partnership that is semi-directed
• The goal is to develop
discrepancies
Motivational Interviewing
The Principles of Motivational
Interviewing
• Express empathy
• Support self-efficacy
• Roll with resistance
• Develop discrepancy
Stages of Change
• Pre-contemplation
• Contemplation
• Preparation
• Action
• Maintenance
• Relapse/Recycle
15
Stages of
Change
Description Goal for Motivational
Interviewer Suggested Questions
Pre-
contemplation
No intention to change Help develop ambivalence What are the risks if you follow your
current lifestyle?
What benefits would you gain if you
made a change?
Contemplation Change is thought about but
may not be ready to commit
Evoke reasons for change
Support change as possible
What would be some positive
reasons to change your lifestyle?
What makes it difficult?
What is getting in the way?
Preparation Ready to change Help with planning
Setting an agenda
What goals do you want to set?
How could you set yourself up for
success?
When do you plan to start?
Action Change gets put into play Provide support, guidance and
assistance with problem-solving
How will you track progress?
How will you measure success?
Maintenance The change becomes familiar
and automatic
Help define sense of self and
life priorities to prevent lapses
from turning into relapse
What else might keep you going?
What strategies will help you stay
on track?
Relapse/Recycle Revert to prior behavior, lifestyle
choices
Instill new hope and
commitment
What pulled you off track?
What was working for you?
What steps can you take to get
back on track?
Open Ended Questions
Invite elaboration and thinking more
deeply about an issue
Create forward momentum used to help
the client explore the reasons for and
possibility of change
Affirmations
Providing effective affirmations focuses on patients efforts, provides support and empathy and empowers patients to take charge of their health. “I appreciate that you took an interest in learning more about your diabetes”. “Even though it has been a tough few days, you found a way to start planning to improve your situation”.
Reflections
Reflective listening is an effective communication strategy that lets the
client know you hear them and understand their message.
Effective reflections are statements vs. questions, capture the meaning
of the message, are short rather than long and allow the client to know
that you “get it”.
•Patient: Like I just told you, I was going to start that exercise program
but my back gave out on me again and I’m in such pain!
•Coach: So it may be more important to get your back feeling better.
Would it be helpful to spend a few minutes talking about ways to
address the pain.
Pitfall: Resist the Righting Reflex
• Keep your fix it hat off
• Listen with empathy and acceptance
• When a person feels accepted for who
they are and what they do, it allows
them the freedom to consider change
rather than needing to defend against
Activity
Mary Smith
• What phase of change is Mary in?
• What is the first thing you are going to
ask or say to Mary to get her to tell you
her story and her perspective
regarding her health history?
• What open-ended questions would you
ask Mary to evoke change talk?
Activity
John Valentino
• What phase of change is John in?
• How would you explore John’s cultural and family traditions?
• How would you explore the barriers John has to making some changes to his lifestyle?
• What open ended questions would you ask John to evoke change talk?
Group Total PMPM Avoidable
Admissions/1K
ED
visits/1K
EBM
Compliance Admits /
1K
Diabetics not
Participating 750 $1.4K 10% 246 76% 207
Diabetics
Participating
Telephonically
(AHM)
52 $2.4K 15% 336 80% 504
livingwellCARES
Initial Group 259 $1.2K 8% 327 82% 109
Source: Advisory Board Compass 10/2014
Quantifying Measures that
demonstrate ROI
28
Utilization Population Reference Comparison
ER Visits/1000 98.17 81.33 101.71
Hospital Admits/1000 47.52 24.10 52.43
Hospital
Discharges/1000
47.52 24.10 52.43
Average LOS 5.66 9.75 5.27
Quantifying Measures that
demonstrate ROI YTD
Source: Conifer 5/2015
Participant Clinical Outcomes
7.57
6.0
Mean Hbg A1C
Mar-12 Apr-1498.7
83.2
Mean LDL Cholesterol
Mar-12 Apr-14
Participant Clinical Outcomes
126
127
128
129
130
131
132
0 1 2
Syst
olic
Blo
od
Pre
ssu
re (
mm
Hg)
Years Since Start of Wellness Program
Systolic Blood Pressure Over Time
Control Group
Participants
Participant Clinical Outcomes
75
76
77
78
79
80
0 1 2 Dia
sto
lic B
loo
d P
ress
ure
(m
m H
g)
Years Since Start of Wellness Program
Diastolic Blood Pressure Over Time
Control Group
Participants
Participant Satisfaction
Questions 1-6 % Agree or Strongly
Agree
My care coordinator explains things to me in a way that is easy
to understand 99%
The information provided to me by my care coordinator has
helped me manage my health problems 98%
I have made changes in the way I take care of myself as a
result of working with my care coordinator 97%
When I have questions, I am able to reach my care
coordinator 95%
Participating in this program has made a positive difference in my health 96%
I would recommend this program to other YNHHS employees or their
families 97%
Participant Satisfaction
“I am grateful for this opportunity. The timing could not have
been more perfect as I was just diagnosed with diabetes and
looking for more education and support. My care coordinator is
great! She has educated me, made referrals, tracks my care,
assists with interpreting results (labs) for me, and recommends
stress reduction techniques and more. I now feel more in
control of managing my illness. And when unexpected things
pop up I know she is available to assists with this revolving circle
of changing needs. Thank you!”
YNHHS Program Expansion
Wellness Coordinators/Health
Coaches
Evaluation and Improvement of
external software
Increase employee and dependent
engagement
Focus on improving unnecessary health-
care utilization
Bring YNHHS wellness model to
market
The Future
Potential Impact for YNHHS
• 20,000 employees
• 8.5% diabetic (1,700 individuals)
• Yearly cost of an inadequately managed diabetic patient: $20,700
• Yearly cost of a well managed diabetic patient: $7,800
• Difference: $12,900
• Best (very best) case scenario savings yielded by optimal management of 1700 individuals with diabetes: $21.9 million.
38
Moyers, T. B., Martin, T. M., Hendrickson, S. M., & Miller, W. R. (2005). Assessing
competencies in the use of motivational interviewing. Journal of Substance Abuse
Treatment 28, 19-26.
Martino, S., Ball, S., Nich, C., Canning-Ball, M., Rounsaville, B. J., & Carroll, K. M.
(2010). Teaching community program clinicians motivational interviewing using expert
and trai-the trainer strategies. New Haven: Addiction.
Martino, S., Haesler, F., Belitsky, R., Pantalon, M., & Fortin, A. H. (2007). Teaching brief
motivational interviewing to Year three medical students. New Haven: Medical
Education.
Miller, W., & Rollnick, S. (1995). What is motivational interviewing? Behavioral and
Cognitive Psychotherapy, 23, 325-334.
Lane, C., Huws-Thomas, M., Hood, K., Rollnick, S., Edwards, K., & Robling, M. (2005).
Measuring adaptations of motivational interviewing: the development and validation of
the behavior change counseling index (BECCI). Patient education and Counseling,
166-173.
National Center for Health Statistics, Centers for Disease Control and Prevention.
(2013) Summary Health Statistics for the U.S. Population: National Health Interview
Survey, 2012. Accessed at http://www.cdc.gov/nchs/data/series/sr_10/sr10_259.pdf
Centers for Disease Control and Prevention. The Power of Prevention. (2009)
Accessed at http://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention.pdf
References