Professional Development

With my BS from NC State University in 1969, I received the Gamma Sigma Delta award for having the highest scholarship rank in the school of Agriculture and Life Sciences, and was inducted into the honor society, Phi Kappa Phi. I completed my MD at Emory University in 1974 and my most valuable training, my Family Practice Residency at Maine Dartmouth, in 1977. I entered the field when it became apparent to me that prevention, not claims management was health care’s best hope. My wellness clients have won numerous WELCOA awards. One was awarded ACOEM’s prestigious Corporate Health Achievement Award.

Demonstrated Success

As medical director of a large construction company, I was asked to help design and implement a wellness program by the CEO to address rising health issues he was observing in team members. From inception, the wellness program was be outcomes based and was designed to;  1) sustain high participation rates (>=80% of employees in meaningful, ongoing behavior change); 2) measure population and individual health risk behavior change (reduction of high risk level and increase in the group’s low risk status to 70%); 3) decrease spend in the participating group. After piloting several models of intervention, we introduced the one with the most promise in mid-2001, a one-on-one, face-to-face health behavior change coaching program. The coaching intervention utilizes the principals of Motivational Interviewing, is incentivized, and is complemented by general health promotion, risk based challenges, and population based health educational interventions. Employee participation grew to 80+% the first couple of years and has remained in that range since. Spouse participation has grown to 50%. By 2005, 70% of participants were in the low risk category and this has climbed to the current rate of 73% despite high turnover common to the construction industry. The percentage of participants in the high risk group has dropped steadily to its current low of 2%. (In fact, in all current clients we have reduced the high risk population by an average of 24% in the first year of the program and the sustained participation rates in the coaching program range from 80+% to 98%.) Using actual company claims dollars spent by the participating group, we have been able to demonstrate a reduction in spending by the group of nearly $10,000,000 over the last 7 years. This spend decrease comes as a result of reducing high risk, high spend members of the population and increasing the low risk, low spend group. It is notable that the participating group, 80% of employees and 50% of spouses, spends approximately 1/3 of the company’s current total annual health care dollars.

Guiding us all along the way were the other WELCOA Benchmarks. CEO support spread to general management support and ultimately led to integration of health and safety as one of the 5 pillars of the company’s business plan. Health has become as important as safety in the company culture and the two topics are the focus of a common organizational committee structure, the SHARE (Safety Health Awareness Raises Excellence) committee, which contributes to the regularly updated operating plan. Working with the company, my organization developed a tracking software which is used to drive, track and review coaching interventions while collecting all data relevant to demonstrating outcomes. Wellness champions, newsletters, internal online wellness information and activities, and jobsite scorecards add to the pervasive wellness environment.

Leadership

Before daylight today, I hauled a canoe down a steep river bank, paddled to “the island”, and set up decoys- all to take my grandson on his first duck hunt- but it was great exercise for me as well. It is extremely important to me to enjoy high quality of life as long as possible- and good health behaviors make that possible. Therefore, I remain an active gardener, bird hunter (actually chasing dogs through the woods), trainer and competitor with our horses, and snowshoer, all of which keeps me moving. I eat a plant based diet, keep my BMI where it belongs, and actively deal with stress. The development and spread of a successful behavior change intervention accompanied by supporting software helped me become recognized as a leader. To lead, you must spread your passion for wellness, demonstrate meaningful program outcomes, remain creative and open to change, and remember that no one on your team is smarter than all of you together!

Innovation

1. Developed wellness tracking software designed to collect and report on all data required to demonstrate behavior/risk change while simultaneously driving and tracking coach interventions and allowing QA on coach performance. The result is reliable, reproducible health behavior change statistics, more uniform coaching interventions with improved risk status change, and ability to demonstrate associated spend decreases.
2. Development and delivery of training curriculum to enhance Motivational Interviewing based coaching interventions. The result is remarkable population changes in at-risk heath behavior.
3. Development of a seamless coach delivered Condition Management intervention to complement primary prevention wellness interventions. The result is CM eligible participation rate in excess of 85% and significant decreases in care gaps per condition.
4. Integrated wellness into Occupational Health and safety interventions. Examples- monitoring early pulmonary function loss -when due to weight or tobacco-coach referral -including hearing protection as a health risk in our HRA.
5. Developed presenteeism/stress intervention modules.

Compelling Vision

Wellness, like healthcare, has become a marketable commodity. A proliferation of programs has blossomed to take advantage of that market, offering glitz and flash without demonstrating substantive outcomes. No outcomes equals unhappy purchasers. The market sours. We lose the best opportunity we have to decrease demand on health care services and improve quality of life for our participants. HERO’s efforts and CDC’s Total Worker Health Initiatives are defining best practices. We need to set program standards to clearly define expected outcomes.

My team will continue to refine the behavior change process, focusing on enhancing each individual’s goal setting process and shifting the individual’s cost/benefit analysis toward change. We will explore health plan changes that enhance engagement. We will determine the best way to define condition management spend impact in these relatively small groups, and identify care gaps whose elimination makes the greatest improvement in disease control and quality of life.