In the "Peer-reviewed Research" series of blog posts, we review the latest or most important studies published in academic journals on a set of topics, including health coaching, disease management, remote patient monitoring, and healthcare costs.

There is growing awareness that recent studies have linked employee health coaching programs to improvements in health outcomes for many chronic conditions [1,2]. But the study we review today will show that health coaching also leads directly to decreased health care expenditures.

In 2015, a peer-reviewed study was published in Medical Care, titled "How effective is health coaching in reducing health services expenditures?" The study found reductions in health-related costs across multiple care settings [2]:

• Inpatient
• Outpatient
• Number of prescriptions filled

Importantly, these cost savings were identified in a high-risk group of patients with multiple co-morbidities. Administrative claims data have associated this patient demographic with the highest level of health care expenditures. In comparison to a control group with similar medical problems, health coaching participants reported improved quality of life and incurred fewer health-related costs.

What were the major takeaways regarding health coaching in this high-risk demographic?

• 6 months post-intervention, 89% of participants had achieved at least one health-related goal.
• The number of participants with inpatient costs fell by nearly half (from 20.3% to 11.5%).
• Following health coaching as an intervention, the average outpatient cost savings was $286 per person, per month.
• Overall, the total cost savings for all health care expenditures was $412 per person, per month.

Curious to know more about this study? We break down the researchers’ methods and findings below.

What were the goals of health coaching as an intervention?

There were four major elements of the health coaching program’s mission:

1. Improve participants’ ability to navigate the complexities of the modern health care system
2. Encourage patients to take a more proactive role in their own health improvement
3. Create patient-centered health goals that are tailored to their unique needs as an individual
4. Reduce health care costs

Health coaches helped to establish individualized health improvement goals using the SMART (specific, measurable, attainable, relevant, and time-sensitive) framework. Coaches empowered patients will skillsets designed to foster collaboration and effective relationships with their health care providers.

Study participants met with health coaches via telephone at least twice during a 4-week time period. The average amount of time that participants engaged in health coaching was 5.35 months (range 4 – 20.8 months). On average, 5-6 coaching sessions were completed (1 initial assessment, several coaching sessions, and 1 end-of-program evaluation session).

Who were the study participants?

The researchers retrospectively identified high-risk health plan enrollees and separated them into two groups: patients that received health coaching as an intervention (experimental group), and patients that were eligible to receive coaching, but did not (control group). Importantly, both the experimental and control groups were considered to be high-risk based on their number of chronic conditions and their medical costs (as determined by administrative claims data). Some of the most common conditions in this high-risk demographic were as follows:

• Depression
• Congestive Heart Failure (CHF)
• Diabetes
• Hyperlipidemia (High Cholesterol)
• Hypertension (High Blood Pressure)
• Osteoporosis
• Asthma
• Low Back Pain

How was the study conducted?

The study was conducted over a 2-year time period. Out of 114,615 high-risk health plan enrollees, there were 6,940 health coaching participants during the study period. Of these, the researchers identified 1,161 active participants (as defined by meeting with health coaches at least 2x during a 4-week time period). Each individual active participant was matched with another high-risk (albeit non-participating) enrollee using propensity score matching on a one-to-one basis.

All study participants had at least 6 months of health claims data available prior to health coaching and post-intervention (after health coaching). The average number of months of claims data available pre- vs. post-intervention was 20.7 months and 17.5 months, respectively.

What were the results of the study?

Study findings can be summarized according to health care setting:

• Inpatient: the percentage of participants with inpatient costs decreased pre- vs. post-intervention (20.3% - 11.5%, respectively).
• Outpatient: the percentage of participants with an outpatient claim decreased pre- vs. post-intervention (99.1% - 96.1%, respectively).
  • The average cost of outpatient visits (per member-month) was reduced for health coaching participants (from $476 to $354). During the same time period, average costs for outpatient visits increased for matched controls that did not participate in health coaching (from $426 to $580).
  • Average monthly outpatient cost savings were $286 per person, per month.
• Prescriptions: the average number of prescriptions filled each month was reduced following health coaching (1.78 - 1.63).
• Total Cost Savings: overall, total health-related cost savings were $412 per person, per month.

What were limitations of the study design?

This study by Jonk et al. focused exclusively on active participants in the health coaching program. As such, this group may exhibit a higher degree of motivation to change health-related behaviors in comparison to health plan enrollees that were eligible for health coaching, but chose not to participate. It is possible that this introduced an element of self-selection bias into the study’s methodology.

The bottom line for your business:

There is mounting evidence in support of health coaching as not only a means of enhancing employee wellness, but also as a financially attractive investment. The implementation of a health coaching program has the potential to improve employee health outcomes, augment quality of life, and minimize costs for health plan enrollees.

Implementing a health coaching program can be challenging, but Kannact can help. Our program already has the necessary components:

1. Board-certified health coaches who are trained in cultural competence and prepared to support diverse populations with unique challenges.
2. Dedicated health-coaching software that pulls in electronic medical records from all major health systems and enables monitoring and outcome tracing, as well as omnichannel engagement over phone, text, email, and video.
3. An integrated remote patient monitoring (RPM) program for added impact: patients with relevant chronic conditions are shipped bluetooth devices and testing supplies, while coaches help them take and improve their blood sugar and blood pressure readings.

If you want to learn more about how to integrate health coaching into your health plan or provide health coaching to the patients of your clinic, get in touch at hello@kannact.com.

References

1. Lawson KL, Jonk Y, O’Connor H, Riise KS, Eisenberg DM, Kreitzer MJ. The impact of telephonic health coaching on health outcomes in a high-risk population. Glob Adv Health Med. 2013;2(3):40-47.
2. Jonk Y, Lawson K, O’Connor H, et al. How effective is health coaching in reducing health services expenditures? Med Care. 2015;53(2):133-140.