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Does Coaching Mean Savings?

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Call them disease management's proactive younger siblings. Health coaching programs are health plans' latest offering to members who need help navigating the healthcare system and employers looking to improve their workers' health. Rather than monitoring a chronic condition, today's advocacy programs typically connect members via telephone with nurses or health educators who provide accountability to help them improve their level of wellness."In the 1990s, the focus was around identifying people who already had a significant health issue; now it's about mitigating the progression of those conditions," says Chris Coloian, vice president of health advocacy strategy and products for Bloomfield, Conn.-based insurer CIGNA HealthCare. Roughly 8 million of CIGNA's members are eligible for one of several types of advocacy programs ranging from diabetes management to weight loss and smoking cessation, Coloian says, but the health coaching programs are "growing in triple-digit fashion." Coloian attributes much of the expansion to employers' interest in controlling health costs in their benefit plans-and pushing payors for solutions. Consumerism is fueling the move as well, he says. "As employers look to engage consumers in their own healthcare choices, they feel need to provide them a deeper set of resources to take that responsibility."Logic may imply that lower healthcare usage should follow a healthier membership, but hard evidence of savings has been difficult to find. Long Beach, Calif.-based SCAN Health Plan introduced its advocacy program in 2005, helping about 5,000 of its 98,000 members transition out of the hospital. SCAN aims to decrease the frequency of readmissions, as shown in a University of Colorado study upon which their model is based. Chronically ill elderly patients in the study who were coached had lower re-hospitalization rates and lower hospital costs than control subjects. Anecdotal evidence already suggests positive results for members-like one patient who stayed home for four consecutive months after having nine admissions in the previous nine months. The challenge now, says Barbara Bennett, SCAN's director for geriatric health management and monitoring and disease management, is to develop outcome measures to document savings. -Kara Olsen