© HealthFitness 2012 Integrated Health Coaching: The Next Generation in Health Behavior Change Management Dennis Richling, Chief Medical and Wellness Officer Kelly Merriman, Vice President, Service Delivery

© 2012 Health Fitness Corporation 2 What You Will Learn Today  The three levels of health coaching within the integrated health coaching model and how individuals are assigned to each level;  How health risk factors and a predictive modeling algorithm are used to determine a person's eligibility for coaching;  How coaches can maximize the interactions between coaching clients and their primary care and specialist physicians;  Tools used by the health coaches to achieve engagement, behavior change and condition management; and  Key metrics used to evaluate the health coaching model, program effectiveness and results.

© 2012 Health Fitness Corporation 3 Dennis Richling, MD Kelly Merriman Chief Medical Director and Wellness Officer Vice President, Service Delivery

© 2012 Health Fitness Corporation 4 Meet at-risk Adam… Adam doesn’t know he’s at risk. Where does Adam belong? 40 years old Married, 2 daughters Manager, works 50 hours/week BMI 28, blood glucose 99 Cholesterol 204, BP 122/88 No longer exercising—no time (kids in sports, plus job demands and normal aches and pains of middle age)

© 2012 Health Fitness Corporation 5 Risks Are Costly Chronic Disease Biometric Risks Risky Absent Healthy Behaviors Risky Present UnHealthy Behaviors Absent Behaviors Bad Behaviors $$ $$$ $$$$ Reducing $$$$ = REDUCING risks Reducing risks = Changing Behaviors Changing Behaviors = -Adding Absent Behaviors -Reducing Bad Behaviors

© 2012 Health Fitness Corporation 6 Health risk factors and predictive modeling algorithm used to determine a person's eligibility for coaching

© 2012 Health Fitness Corporation 7 Health Coaching Traditional DM Today

© 2012 Health Fitness Corporation 8 Right coach for the right person  Health coaching  Advanced practice coaching  Nurse coaching

© 2012 Health Fitness Corporation 9 Lifestyle Interventions New diagnosis/ uncontrolled chronic disease Controlled chronic disease, lifestyle risks Lifestyle risks Nurse Coach Advanced Practice Coach Lifestyle Coach Individual Health Risk Category: % Population Individuals matched to:

© 2012 Health Fitness Corporation 10 Meet Sally… Sally’s Goal: Lose 20 pounds Where does Sally belong? 52 years old Married, two teenage boys Works night shift Struggles with weight Hard to prioritize healthy eating & exercise Diabetes (5 years) Regular physician visits Compliant with meds

© 2012 Health Fitness Corporation 11 When Henry met Sally Sally’s Goal: Lose 20 pounds Secondary coaching goal: reduce medications as a result of the weight loss Where does Henry begin?

© 2012 Health Fitness Corporation 12 Meet Bob… Bob’s Goal: Become healthier so he can go fishing with his grandson Where does Bob belong? 56 years old Acute MI diagnosed in the ED CAD diagnosis; cardiac cath and stent placement No beta blocker prescribed Completed cardiac rehab, afraid he might go off course BMI 32, mild hypertension No regular exercise No dietary changes to date

© 2012 Health Fitness Corporation 13 When Nurse Nancy met Bob Bob’s Goal: Better heart health Secondary coaching goal: reduce risk of future MI and worsening CAD Where does Nancy begin?

© 2012 Health Fitness Corporation 14 Remember at-risk Adam? Adam doesn’t know he’s at risk. Where does Adam belong? 40 years old Married, 2 daughters Manager, works 50 hours/week BMI 28, blood glucose 99 Cholesterol 204, BP 122/88 No longer exercising—no time (kids in sports, plus job demands and normal aches and pains of middle age)

© 2012 Health Fitness Corporation 15 When Coach Karen met Adam Adam’s Goal: Stay healthy, boost energy Secondary coaching goal: reduce risk of future chronic disease Where does Karen begin?

© 2012 Health Fitness Corporation 16 Tools To Achieve Engagement, Behavior Change and Condition Management Motivational Interviewing Positive Psychology Appreciative Inquiry Stages of Change

© 2012 Health Fitness Corporation 17 Smarter Coaching Through Technology Integrated View of Participant Health Status and Goals Participant Priorities Biometric Results HRA Results Coaching Goals Program Data Incentive History Benefit Design

© 2012 Health Fitness Corporation 18 Goal: Active, sustained engagement

© 2012 Health Fitness Corporation 19 Integrated Coaching Reduces Risk by Changing Behaviors 17% Reduction in High-Risk Participants 10% Reduction in # of Risks for Participants IndividualPopulation High-touch primary coach model Opt-in enrollment Participant choice (on-site, telephonic, online) Goal progression framework (behavior and/or clinical) Ongoing participant assessment to ensure accurate coach assignment Improve health and control costs

© 2012 Health Fitness Corporation 20 Metrics to Evaluate the Health Coaching Model Participation Change in Risk Cost Reduction Measures of program effectiveness and results

© 2012 Health Fitness Corporation 21 Multiple Risk Factor Summary–Risk Churn Low T1: 3,319 (59.9%) T6: 3,797 (68.5%) Moderate T1: 1,832 (33.0%) T6: 1,513 (27.3%) High T1: 393 (7.1%) T6: 234 (4.2%) 564 Low to Mod 216 High to Mod 98 High to Low 983 Mod to Low 39 Low to High 116 Mod to High 2,716 Remained Low 733 Remained Mod79 Remained High Low = 0-4 Risks Moderate = 5-6 Risks High = 7+ Risks Low = 0-4 Risks Moderate = 5-6 Risks High = 7+ Risks All Employees: T1/T2/T3/T4/T5/T6 (n=5,544)

© 2012 Health Fitness Corporation 22 All Employees – T1/T2/T3/T4/T5/T6 (n=5,544) 8.9% Reduction 5.4% Reduction Risk Factor Employees T1T2T3T4T5T6 Blood Pressure 28.8%27.9%25.8%24.0%22.8%20.8% BMI 78.2%78.9%79.1%79.5%79.4%79.6% Cholesterol 81.5%83.1%81.0%80.8%81.1%80.0% Depression 9.1%8.0%6.6%6.3%5.7% Fitness 64.1%59.8%58.6%58.1%57.9%58.2% Glucose 28.4%31.4%30.4%29.7%31.3%30.8% Stress 10.2%8.8%7.6%7.9%7.4%8.0% Tobacco Use 17.9%16.9%15.4%14.2%14.4%14.1% Average Number of Primary Risk Factors Primary Risk Factors 6.6% Reduction

© 2012 Health Fitness Corporation 23 Biometrics T1/T6 changes tested using McNemar Test Significant changes are coded with an asterisk (*) *T1/T6: p< *T1/T6: p= *T1/T6: p< T1/T6: p= All Employees – T1/T2/T3/T4/T5/T6 (n=5,544) Company’s Custom 14 Risk Factors

© 2012 Health Fitness Corporation 24 Behaviors T1/T6 changes tested using McNemar Test Significant changes are coded with an asterisk (*) T1/T6: No Change *T1/T6: p< Company’s custom 14 Risk Factors All Employees – T1/T2/T3/T4/T5/T6 (n=5,544)

© 2012 Health Fitness Corporation 25 Successful Programs Offer On-Ramps and Off-Ramps

Dennis Richling, MDKelly Merriman Chief Medical Director and Wellness OfficerVice President, Service Delivery