One of the most identifiable gaps in care is medication adherence. This is an area where Wellness Coaches/ Disease Management Specialists, hired by employers, have the potential to impact the employer’s population to change behaviors.
Because most physician office visits today are limited to fifteen-twenty minute appointment slots, there is just not enough time for each patient. Unfortunately, the physicians don’t take the time to explain each prescribed medication and the potential side effects. Most patients can’t even tell you what condition each medication they are taking is for.
This is where the role of the Wellness Coach/Disease Management Specialist becomes extremely valuable. They have the time to do the patient education that is lacking in the physician’s office.
There are basically three reasons why people are non-compliant with their medications:
• They forget
• Side Effects
Pre-disease conditions can be managed before they develop into costly chronic diseases. Most employees with elevated cholesterol, elevated blood pressure or those that are overweight don’t normally incur costs to the health plan. But left untreated, these pre-disease risks can turn into high cost diseases. Because people are working longer today, the workforce and the employers are impacted by chronic diseases.
Statistics on adult Americans from the National Institute of Health are staggering:
As part of a Corporate Wellness Program, one of our clients recently sponsored a biometric screening at no cost to their employees. Not only did the employer pay for the cost of the screening, but they were also offering their employees an incentive for participation in the screening. As an additional feature of the program, the employees were to have a session with one of our Certified Registered Nurse Wellness Coaches to review the results of the screening and hopefully engage those “at risk” in ongoing wellness coaching.
One of my Wellness Coaches reported back that she spoke with an employee that expressed dissatisfaction with the “process”. She was actually “put out” that she was inconvenienced to have to fast the night before and then make time early in the morning for the blood draw. In essence, she was turning a company benefit into a chore.
Have you been prescribed medications? Are you taking these medications as prescribed?
What is your understanding of their purpose, the best way to take them, and how to manage their impact on your daily routine?
Some of these answers are easy, such as how to keep medications where you will see them. Some of the answers are more difficult, such as how to stay on a regular routine when you have overtime on the job, are traveling, or what to do when you cannot afford the prescription. Lack of this information can make it challenging to stay on the best medication schedule, which can result in an unnecessary decrease in your level of wellness.
Be proactive and take charge of this aspect of your health by seeking answers. Ask your medical provider and pharmacist about the medication when it is prescribed. Read the medication inserts.
When we hear the word holistic, we tend to project that a less than traditional approach will apply when doing corporate wellness coaching. To the contrary, Registered Nurses have holism as part of their education.
Registered Nurses view patients as more than the sum of their parts, both individually and as members of communities. A Registered Nurse Wellness Coach will provide support and education around the mind, body and have additional education that is complementary to traditional medical care, such as homeopathy (the practice of natural medicine, which usually comes from an organic source. It is believed everybody has a vital force or self- healing response) or naturopathy (a system of treating disease that employs no surgery or synthetic drugs but uses special diets and herbs, vitamins, and massage to assist the healing process).
As we begin the New Year, feeling sluggish and guilty from the holidays, the tendency is to make resolutions for losing weight and getting into shape. Poor weather conditions throughout the country has made it even more challenging, as the inclination is to stay inside, cuddle up on the couch and just watch movies and snack. Now these best intentions are once again sabotaged.
The secret for success is to make resolutions (set goals) that are achievable. In our practice, our wellness coaches have a mantra, and that is “baby steps”. Sometimes it is one small goal at a time, and then when achieved, set another goal. Goals for change have to be realistic and attainable. People have to feel their successes. They need to feel good about themselves.
Possible achievable goals can be:
Lose weight-Lose 5% of current body fat instead of shooting for 15 or 20 pounds. Sometimes this can be accomplished by merely cutting out sugary sodas or energy drinks.
In this age of cost cutting and Employers looking to save money, it seems that they look to the Corporate Wellness Program as the first benefit to cut. Is it because they don’t understand what they purchased? Is it because they are looking for a quick return on investment? Or is it because they don’t see immediate changes in their employee population?
I have seen a number of “Wellness Programs” that are merely “cookie cutter”. They are automated and there is very little, if no, personalization. I don’t see where Wellness Coaches are actively working with participant to set goals and facilitate lifestyle changes.
In a recent conversation with a Client, he expressed an interesting thought, which shows the impact of Wellness Coaching and the Coach/Participant relationship. He had his regularly scheduled monthly coaching session in several days and he was about to reschedule the appointment. Apparently, he had several assignments to complete prior to the Coaching session. He had not completed one of his assignments and he didn’t want to let his Coach down.
Keep in mind; this is a very motivated individual that is very “invested” in his Corporate Wellness Program. He has a very strong relationship with his Wellness Coach. They are constantly evaluating his goals and looking for new and innovative changes to his current nutrition and exercise regimes.
WellChoice, Inc. has been working with a 1000 employee life government account for the past five years. We assigned an experienced Registered Nurse Certified Wellness Coach to be the exclusive Wellness Coach for this account. Over the past five years, the Wellness Coach has worked very hard to establish rapport, gain trust and of course, continually educate the employees and dependents on how to maintain a healthy life style.
This account has gotten no renewal rate increase for the past five years. In fact, the stop loss premium has gone down from $1,000,000.00annually to $600,000.00 annually. This is a group that most carriers wouldn’t even quote on in the past.
Wellness Coaching is a process. Trust is earned. Relationships take time to develop. Results such as this happen over time. The goal is to create a corporate culture of wellness. When this happens, the net result will impact claims costs for the Employer.
We know changing lifestyle behaviors is easier said than done. Our first tendency, especially with family members, is to come down on them (berate) to do things such as quit smoking, lose weight, or simply just get up off that couch and move around. Eventually, they just tune us out, or continue unhealthy behaviors just for spite.
The challenge for wellness coaches is to motivate our clients to make changes. We are trained on motivational interviewing techniques. We assist our clients in identifying areas of possible change and then their willingness to change. We work with our clients to set realistic achievable goals. We are in contact with them on a regular basis to provide support, suggestions, empathetic listening, and work through barriers to changing.
This is the time of the year that many employers are sponsoring biometric screening events. This usually encompasses a lab panel, blood pressure reading and measurement of Body Mass Index (BMI). The BMI calculation usually includes height, weight, and waist circumference.
According to Wikipedia, “The body mass index (BMI), is a heuristic proxy for estimating human body fat based on an individual's weight and height. BMI does not actually measure the percentage of body fat. Body mass index is defined as the individual's body mass divided by the square of his or her height.
I can’t stress enough the impact of employers integrating Wellness Coaching into their Corporate Wellness Initiatives. Just doing a Biometric Screening or taking a Health Risk Assessment alone, without coaching intervention, gives participants information with a lack of knowledge as to long term health impact or support in making appropriate lifestyle changes.
It is important that changes are sustainable. Many individuals struggle with maintaining that instantaneous weight loss or the exercise program. With frequent sessions with the Wellness Coach, goals can be set, barriers to change can be addressed, and participants can get that accountability and support necessary to sustain changes.
“Good coaches look at people who are struggling and see the possibility and opportunity for
healthy change, even transformation. With a good coach, the journey of change is engaging, even fun, more like an adventure than hard work,” according to Margaret Moore, M.A., founder of WellCoaches Corporation.
Most employers offer wellness and disease management programs because they believe the long term benefits are worth the financial expense. If an employer finds effective strategies to motivate the employees, utilization in these corporate sponsored initiatives will increase. Nurse Coaches play a key role in helping individuals identify areas of risk, goal setting and ongoing support and encouragement. Nurse Coaches have the ability to touch and impact a large population.
“Some coaching solutions offer telephonic outreach by Nurse Coaches to initially engage users in coaching. This process successfully engages many more individuals than requiring individuals to opt-in to a program.”
I recently came across a study done by Blue Cross Blue Shield of Michigan that breaks down the health care spending by disease. Chronic diseases are the leading cause of disability and death in this country. Unfortunately, most individuals with chronic diseases have co-morbidities (more than one chronic disease). This only serves to drive up the per person cost for health care. As we know, ultimately, the burden is placed not only on the Medicare/Medicaid system, but on private employers that offer health insurance benefits.
There are health risks that are controllable. We make the choice to smoke. Overweight/obesity can be modified. We can lower the risk of disease by making healthier food choices.
Today, about 20% of Americans report that they get less than 6 hours of sleep on average, and the number of Americans that report that they get 8 hours or more has significantly decreased. (www.webMD.com) A growing list of health risks including heart disease, diabetes, and obesity have all been linked with chronic sleep deprivation.
If you are not getting enough sleep, you can create an environment and adopt sleep habits that encourage a more restful night and lower the incidence of developing health risks.
1. Go to bed and get up at about the same time every day. This strengthens your sleep-wake cycle and can help you fall asleep more easily at night.
2. Don't eat or drink large amounts before bedtime. Eat a light dinner at least two hours before sleeping. Drinking too much liquid can cause you to wake up repeatedly during the night for trips to the bathroom.
3. Avoid nicotine, caffeine and alcohol in the evening. These are stimulants that can keep you awake.
Employers are becoming aware that healthier employees will lower their healthcare costs. One of the proactive ways that employers can create their own culture of wellness is to make healthy foods available at the worksite. This can include vending machines, breakfast and lunch meetings, and the employee cafeteria or lounge.
According to the CDC:
- In 1995, an estimated $9.3 billion in lost productivity associated with morbidity from coronary heart disease, cancer, stroke and diabetes was attributed to diet.
- In 1999-2000, 65% of adults reported being overweight or obese. People who are overweight or obese are more likely to suffer from many chronic illnesses and conditions.
To eat healthier at work, employers should try to select healthier choices for the following:
We all know about the perils of smoking cigarettes. Cigarette smoking accounts for a majority of deaths in the United States due to lung cancer, coronary heart disease and chronic lung diseases. But there exist myths that other forms of tobacco use are “less deadly” than cigarettes. I will address the most common alternatives to cigarettes as well as the risks.
Evidence shows that cancers of the lip, tongue, mouth throat larynx and esophagus are associated with cigar smoking. Cigar smokers that inhale are at increased risk for heart and lung disease. The biggest difference between cigar and cigarette smoking is the degree of inhalation. The health risk difference between cigars and cigarettes has to deal with the degree of inhalation. The exposure to the same carcinogens is the same. The lung cancer risk from inhaling smoke from five cigars a day is comparable to smoking a pack of cigarettes a day.
Fast food is easy: no meal preparation, no clean-up. Plus, there are usually multiple places to stop between work and home, making it really convenient.
When you compare people who eat a lot of fast food with people who don’t, there are several
differences between the two groups. Fast food eaters consume more dietary and saturated fat. They also have more body fat, and they eat fewer fruits and vegetables. Studies have shown this to be true for children, African American and Caucasian adolescent girls, college and middle aged adults according to Steven G. Aldana, PhD.
Fast food consumption is contributing to chronic diseases such as obesity, high cholesterol and diabetes. Most fast foods contain red and processed meats, butter, white flour, high fat dairy products and most importantly, they are fried in trans fats.
Studies have shown a direct link between consumption of trans fats and chronic diseases. Healthy oils such as olive, soybean and peanut actually improve blood cholesterol. Trans fats are thought to be 10 times worse than saturated fats, increasing the risk for heart disease.
We have all seen reports in the news lately about the increase in obesity, as well as diabetes, in the United States. Smoking in teenagers is on the rise. On the plus side, unhealthy behaviors are “front and center” and there is certainly an increased public awareness. But what isn’t as discussed is the financial drain that unhealthy individuals put on the healthcare system. Primarily, the dollars that employers are spending on medical premiums, as well as monies out of pocket for self-insured plans.
The areas of major costs are: tobacco use, sedentary lifestyle (lack of physical activity), and obesity.
The following are some examples and startling statistics according to Dr. Steve Aldana, Professor of Lifestyle Medicine in the Department of Exercise Sciences at Brigham Young University:
Recently I had the opportunity to attend a biometric screening for one of my clients. In addition to the venipuncture draw, the participants had their height and weight measured, as well as a blood pressure check. Quite of few had elevated blood pressures. Many of the comments we heard were:
“These numbers are my norm-it always runs like this so for me it is OK”
“I know it is on the high side but I don’t want to take blood pressure medication”
Or even scarier “my doctor knows about this and he is watching it”
I am concerned that people have a misconception that high blood pressure is OK. Because they are not experiencing any symptoms, then it is acceptable to go through life with high blood pressure. High blood pressure can be a “silent killer”. Untreated high blood pressure can put you at risk for heart failure, heart attacks, strokes, kidney failure or aneurysms.
We are all children at heart. There is nothing more exciting than receiving presents or rewards for positive behaviors. This philosophy transcends into the arena of corporate wellness programs. People on their own are not necessarily motivated to make the changes that will improve their health. A wellness program that is well designed with appropriate incentives will increase employee participation. Increased participation should result in better outcomes; stabilize and lower claims cost.
Eating healthy takes time and creativity, not lots of money. In many cases, it is more economical to eat healthy then to consume fast foods. While the fast food restaurants seduce diners with their convenience and “dollar menus”, it is important to look at the “big picture”. Consumption of unnecessary fats and sugars can be more costly down the road with an increase in medical costs. Excessive intake of fast foods can also contribute to high cholesterol and diabetes.
“Another factor overlooked is the high coast of eating out, both nutritionally and financially. A hefty 37% of the average American food budget goes toward eating out, and in many cities that figure creeps considerably higher. Cook at home, boil some water, and save money, according to Mary Elizabeth Williams, staff writer for Salon.
Is it truly possible to have a happy AND healthy holiday season? Not to be a Scrooge but the holidays can be filled with extreme stress, weight gain and the spreading of colds and flu. Here are some important holiday tips to keep in mind during this most wonderful time of the year!
1. During this season of sharing and giving, please keep your germs to yourself!
- Washing hands regularly, with warm water and soap for at least 20 seconds
- Keep a small hand sanitizer in your pocket or purse to use as needed
- Cough or sneeze into a sleeve or tissue
- Eat foods with plenty of Vitamin C to help build immunity to colds.
2. The hustle and bustle of this season leaves us with so much to accomplish in such a short period of time. Don’t let Midnight Madness shopping and sleep deprivation turn you into a Grinch.
What should your plate look like if you are eating a healthy well balanced meal? Look no further. New U.S. Dietary Guidelines has replaced the old food pyramid with a simple to use, colorful, four-part plate icon.
The new icon, called "My Plate," is split into four sections -- red for fruits, green for vegetables, orange for grains, and purple for protein -- with a separate blue section for dairy on the side.
In the quest for creating a culture of wellness in the workplace, it is imperative that senior level management take the lead. From an early age, we are conditioned to follow the positive examples set by our parents, older siblings and teachers. It is very difficult to get employees to “buy into” a wellness program if senior management isn’t also participating and showing improvement in their personal goals.
How can you expect employees to participate in a program that management doesn’t also participate in? Just writing checks for screenings and incentives does not exhibit the type of commitment and example of leadership that employees expect. Management needs to be visible during the kick-off meetings. Subsequent reminders and program updates should be sent from the emails of senior management. If there are team challenges and competitions, there should at last one manager on each team.
Many people say they don’t have time to exercise. But we overlook one of the most convenient, basic forms of exercising-walking. Walking is available to everyone and doesn’t require any financial outlay for expensive gear or instructors. Walking is good for individuals at all levels and can be started as low impact and increased to a high calorie burning “power walk”. Walking can also be done in short time frames, such as ten minute intervals-three or more times per day. Walking can also be done outdoors as well as indoors during bad weather.
Coupled with a decrease in calorie intake, walking can assist in weight loss. “The key to weight loss is burning more calories than you consume. Because 3,500 calories equals about one pound of fat, you need to burn 3,500 calories more than you take in to lose one pound of fatty tissue. So if you cut 500 calories from your typical diet each day, you’d lose about one pound a week (500 calories x 7 days=3,500 calories)”.
Individuals who tend to be out of shape tend to shy away from corporate fitness centers and gyms. They are very self conscious about their bodies and feel intimidated by muscle bound body builders and cute young girls in scant workout clothes. Now there are telephonic tools to aid in accomplishing fitness goals.
Many companies today have implemented wellness programs. Most start with a biometric screening and a self reported Health Risk Assessment. Through these screening tools, risks for future conditions are identified. The key component then is the Wellness Coach. The Coach reviews all of the data and makes an outbound call to the participant.
The Wellness Coach becomes “the personal trainer”. The process starts with education of potential risks, motivational interviewing techniques, assessment of readiness to change, goal setting and a customized program for achieving the fitness goals.
Wish I had penny for each time I heard a client say, “I don’t take my medication because it costs too much or it’s too inconvenient or I don’t like the side effects or I just simply forgot to take it”. I’d have enough money to pay for all of their medications!
These are just a few reasons why people do not follow their prescription regimes. Failure to adhere to medication instructions, either willful or inadvertent, has been termed “noncompliance” with medication regimens. According to the National Institute of Health, 55 percent of the elderly do not follow the medication regimens prescribed by their physicians.
The results of medication noncompliance are serious and costly. Noncompliance can result in the increased use of medical resources such as nursing homes, emergency room visits, hospital admissions, physician visits, and unnecessary treatments. Noncompliance with medication regimens can cause serious medical events and conditions such as stroke and cardiac arrest when related to cardiac medications.
Have you ever lost some weight, only to find the pounds creeping back on just a few months later? Or tried to eat healthier, but found it too difficult and time consuming to read the food labels or cook?
Having a Corporate Wellness program in place can boost morale, improve health and fitness and increase productivity in the workplace. Corporate Wellness Programs help people overcome their physical and emotional hurdles towards achieving optimal health, by working with a wellness coach.
“A wellness coach is trained to help you break your goal into manageable steps, track your progress, and identify and overcome personal roadblocks," says Karen Lawson, MD, program Director for Health and Wellness at the University of Minnesota.
Wellness coaching is a growing industry. Dr. Mehmet Oz has said “Coaches are crucial in changing the culture of wellness in America. They help people define their health goals and devise a plan with achievable milestones for reaching those goals. They may work with individuals on behavior modification and other lifestyle changes”.
Osteoporosis is a top health concern for women, though rarely mentioned. Osteoporosis is a condition in which the bones become weak and can break from a minor fall or, in serious cases, from a simple action such as a sneeze or bumping into furniture. (National Osteoporosis Foundation) As women, we perform monthly breast checks and watch for changes in moles on our skin, but seldom discuss protecting our bones. Some simple lifestyle choices you make today can lower your risk of developing thinning bones and fractures in the future.
- 1 of 2