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

2

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.

5

The livingwell Vision

Creating a Culture of Health

Across YNHHS

Taking care-giving care

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 New Approach

9

• A partnership that is semi-directed

• The goal is to develop

discrepancies

Motivational Interviewing

The Spirit of MI

• Partnership

• Evocation

• Acceptance

• Compassion

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?

Stages of Change

Activity

Critical to Success: OARS

• Open ended questions

• Affirm

• Reflect

• Summarize

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

Speaker/Listener

• Activity

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?

Cultural Considerations

• Religion

• Ethnicity

• Socioeconomic Factors

• Family Make Up

• Other

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?

26

livingwellCARES

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

29

Personal Outcomes

A Great Cheerleader & Support

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

39 QUESTIONS?