Evaluating an insurer-based health coaching program: Impact of program engagement on healthcare utilization and weight loss

Abstract

Insurers and employers are increasingly offering lifestyle and weight-loss coaching programs; however, few evaluations have examined their effectiveness. Our objectives were to determine whether level of program engagement was associated with differences in healthcare utilization and weight pre/post coaching. We conducted a retrospective evaluation of enrollees in an insurer-based telephonic health coaching program in Maryland (2013–2014). Our independent variables were program engagement benchmarks (≥3 and ≥6 sessions). Our dependent variables included change in outpatient and emergency department (ED) visits (more visits post program, fewer visits post, or no change pre-post) and associated costs (difference pre-post) using claims data. We calculated mean percent weight change from baseline. We used multivariate-adjusted linear and multinomial logistic regression, as appropriate, to examine the association between outcomes and engagement benchmarks. We included 225 enrollees with mean age 50.7 years, 81.3% women, and mean body mass index of 35.0 kg/m2. Most participants focused on weight management (75.6%) and improving general health (57.8%). Few individuals had outpatient or ED visits, and no significant changes in healthcare utilization were associated with program engagement. Among the weight management subgroup (n = 170), mean weight change was −2.1% (SD 5.1). Participants achieved significantly greater weight loss if they met the 6-session engagement benchmark (β −3.5%, p < 0.01). Weight management is a popular focus for health coaching participants, and these programs can achieve modest weight loss. Programs should consider designing and testing strategies that promote engagement, given that weight-loss success was improved if participants completed at least 6 coaching sessions.

Feasibility and acceptability of a remotely‐delivered behavioural health coaching intervention to limit gestational weight gain

“…49 Increasingly, health care systems, health insurers and employers are utilizing a wide range of "population health" approaches to improve health outcomes for the communities they serve, often through care management and health coaching. [50][51][52] A major strength of H42/H4U is its interface with prenatal care through the initial patient enrollment process and its remote delivery model. In our prior study evaluating the role of health care providers in a weight loss intervention, busy providers appreciated: 1) the remote delivery of the program, 2) having the coach (and not the provider) as the "interventionist" and 3)…”

“…Remotely delivered programs may reduce barriers to participant access and promote sustainability and implementation across multiple practices to ultimately enhance participant engagement 49 . Increasingly, health care systems, health insurers and employers are utilizing a wide range of “population health” approaches to improve health outcomes for the communities they serve, often through care management and health coaching 50–52 . A major strength of H42/H4U is its interface with prenatal care through the initial patient enrollment process and its remote delivery model.…”

Telehealth Technologies in Diabetes Self-management and Education

“…Several health insurance plans, wellness programs, and pharmaceutical and medical device companies have started offering telephonic support in an attempt to help bridge the gap between patients and their health care providers. 9-12…”

Drivers of weight loss in a CDC-recognized digital diabetes prevention program

“…Previous studies have shown an association between coaching and engagement, specifically around selfmonitoring components of an intervention. [11][12][13] Therefore, multivariable regression modeling with normal distribution was performed to evaluate associations between coach-participant messages at 6 months and food logging, weigh-ins, and active minutes per week at 12 months, adjusting for participant characteristics of starting weight, gender, age, education, and engagement status. Multivariable logistic regression was also used to evaluate the association of coaching with the likelihood of being highly engaged.…”

“…[5][6][7][8][9][10] Previous studies have also shown an association between coaching and engagement, specifically around self-monitoring components of an intervention. [11][12][13] Since only 20% of individuals are successful at weight loss maintenance at 12 months, determining factors and self-monitoring behaviors that promote successful weight loss and weight maintenance is essential for diabetes prevention. 14 Livongo DPP is a digital CDC-recognized program offering participants interactive lessons and live personal expert coaching.…”