Benefits Products & Services
My pharmacist, my coach
Personal advice that comes with wellness programs is becoming more sensitive to individual needs
By Len Strazewski
My high school friend Teddy Zancha took his diabetes with good humor. Diagnosed as a Type 1 insulin dependent diabetic as an adult rather than as a juvenile, he didn't let the disease interfere with his drive and appetites.
He was a big guy (my size) and liked beer and barbecue and took multiple shots of insulin each day to control his blood sugar. He laughed about his medical care and health coaching.
"These nurses," he told me once, after I had been diagnosed as a Type 2 adult-onset diabetic, "don't know nothing. When they were teaching me to inject, they told me to practice on an orange—like that would be anything like sticking a needle in my big gut. They told me to find a spot on my body with a little fat for a needle site. Ha! I could throw the needle in the air and it could land anywhere!"
Teddy retired early from a major retailer where he spent 25 years installing heating and air-conditioning systems. Then he started a successful HVAC trade school to train technicians for one of the most stable employment fields in the country.
Teddy did everything right except manage his diabetes. He died in 2004 at age 50 after two amputations and deadly complications. He had good health insurance and medical care, but lousy disease coaching and education.
Teddy wasn't alone, of course. According to the Centers for Disease Control in Atlanta, nearly half of the nation's adult population has a chronic disease like diabetes, hypertension and high cholesterol. Some of us, sad to say, have all three. And the cost to the health care system is about $200 billion a year.
Employer-sponsored wellness programs are growing in popularity and have their sights on these diseases. They are making some solid strides in controlling complications—but most programs focus on treatment adherence—taking the pills, the shots and, more or less, following the diet. Teddy adhered to the treatment but couldn't make the lifestyle work.
Once he tried one of the experimental appetite suppression drugs popular at the turn of the century (there were a few that all turned out to have cardiac complications). "Hey, it works," he told me. "I eat one Italian beef sandwich and I'm full. But I'm not ready to stop eating, you know."
He needed better, more sympathetic coaching and education but he was a few years too early to get it. Employers and health plans are just starting to figure it all out but could use more guidance from their benefits advisers in developing more humane, practical programs
I've had a health coach provided by my health plan for a few years. She calls every few months and asks me about my biometric screening numbers, but she doesn't have much practical advice. Once, though, she did recommend I eat more walnuts.
There are some good models of practical coaching that employers can emulate or just plain swipe. In Cincinnati, a two-year pilot program conducted by Kroger Co. and the city of Cincinnati's health plan, Anthem Blue Cross Blue Shield (BCBS) of Ohio, indicates that emergency room visits, in-patient hospital visits and total health care costs can be dramatically reduced with one-on-one locally delivered coaching from pharmacists.
Kroger pharmacists serving as health coaches for more than 600 individuals with hypertension, high cholesterol and/or diabetes were identified and recruited to participate in either a heart healthy or diabetes program. Each participant was paired with a pharmacist to assess medication adherence and laboratory screening that can inform disease management tactics.
Frannie McGowan, PharmD, Kroger's clinical development manager, described the program in an industry report. "It is all about helping our patients take charge of their own health. Instead of telling patients what to do, we are helping them set and achieve goals that they identify as important, while actively managing their medications to achieve optimal outcomes."
When compared to a control group, the study showed statistically significant increases not only in medication adherence, but also medication management. In both coaching programs, systolic blood pressure—the maximum pressure—dropped more than 4%. "From a risk reduction standpoint, just a 2% decrease in systolic blood pressure can equate to a 10% reduction in stroke death," explained McGowan.
Patients in the heart-focused program saw ER visits reduced by nearly 40%, compared to a smaller decrease of 16% within the control group. Individuals who participated in the diabetes program saw a nearly 90% drop in cardiovascular-related ER visits, compared to the control group, whose visits increased more than 96% in the same time period.
Cardiovascular-related total medical costs for diabetes patients who participated in the program increased by only 11% year-over-year—compared to the nearly 300% jump in costs for those who did not participate in the program.
The study showed such positive results that Kroger has rolled out the coaching program to all 17 of its store operating divisions. The company, McGowan reports, is also exploring whether one-on-one coaching will impact other chronic diseases, such as asthma and chronic obstructive pulmonary disease (COPD).
The pharmacies are also offering smoking cessation, fitness, nutrition and weight management, health screening and vaccination programs.
Diabetes education programs are also getting more practical in their advice. And medical practitioners are starting to get a handle on the human problems of disease management. In the June 15 update of DiabetesInControl.com, an online newsletter for diabetes educators, a contributing endocrinologist recommended a two-week holiday from an injectable medication that was known to upset digestion when patients complained about nausea and "not being able to eat enough on a cruise to make it worthwhile."
The break allowed users to compare their health with and without the drug. About 90% return to the drug, he wrote.
The Defeat Diabetes Foundation, Inc., in Madeira Beach, Florida, just provided summer travel tips for diabetics that remind travelers to keep their meds on their person in case they can't get to carry-on baggage. The organization also advises injectable drug users to get aisle seats if they expect to need to use the rest room to inject insulin or one of the new GLP-1 drugs—and snacks if their blood sugar drops too low.
I've had both problems when stuck on runways for a couple of hours at a time.
I missed seeing Teddy at our 40th high school reunion recently, but his story is good coaching for me and anyone who designs wellness programs. Disease management isn't just about getting employees to take the medication and do biometric screening. It's about a sensitive, sympathetic voice helping people manage their lives and understand why following the guidance yields a better life.
To start, I can manage without the beer and barbecue.
Len Strazewski is a Chicago-based writer, editor and educator specializing in marketing, management and technology topics. In addition to contributing to Rough Notes, he has written on insurance for Business Insurance, Risk & Insurance, the Chicago Tribune and Human Resource Executive, among other publications.