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Health Partners has expanded its mail-based services to include telephonic and online health behavior change programs. The service is open to non-plan members as well as members within the Health Partners’ network, according to Jackie Boucher, manager of phone initiatives and outcomes advisor for the health plan’s Health Behavior Group.

Health Partners has expanded their mail-based services to include telephonic and online health behavior change programs. Non-health plan members, as well as members within the Health Partners’ network, can use these programs.

Like all Health Partners’ programs, the new telephonic and online programs are evidence-based, peer-reviewed and thoroughly tested for effectiveness. A new program takes about 18 to 24 months from inception to roll-out, Boucher told participants during a recent audio conference.

"Call to Change"

Health Partners’ "Call to Change" (CTC) phone-based programs are developed from customer input and cover a wide variety of topics, including:

• Cholesterol management

• Blood pressure management

• Diabetes management

• Heart disease management

• Prenatal

• Back health

• Physical activity

• Nutrition

• Weight management

The typical CTC course has three components:

• Structured curriculum

• Tools to help support lifestyle or behavior change

• Personalized counselingm

Participants may be referred to the Health Partners’ program through their healthcare providers. In other cases, Health Partners may conduct a proactive follow-up for individuals identified at high risk during a worksite health assessment. Non-health plan participants can enter the program through self-referral and are charged a retail fee.

Participant screening prior to enrollment is integral to all programs, said Boucher. Program candidates are given a set of standardized questions relevant to the topic area and the person’s risk factors. "Questions typically include information on medical history, lifestyle, readiness to change and internal (versus external) motivation," she explained. "If the assessment identifies the individual as a good candidate for the CTC phone program (versus a community- or clinic-based program), they areenrolled and sent course materials."

Typically, appointments are scheduled two weeks out from enrollment. This allows the person time to receive the materials, understand what is necessary for the assessment or the first course call, said Boucher. Often participants must accomplish activities before the first call. For instance, they may be asked to wear a pedometer for three days to get a baseline of steps or keep a food and activity log.

Enrollees with conditions that could impact their success in a program may receive supplemental material in addition to the course manual. "For instance, if a person enrolled in the weight management phone course is identified by the counselor to have pre-diabetes or diabetes, high cholesterol or high blood pressure; supplemental materials may be sent with the curriculum that discuss how to manage these conditions while managing their weight," she said.

Each course has a set number of calls. Some calls, such as the cholesterol or blood pressure course, are less intense and shorter in duration. Others, like the diabetes or heart disease management programs, can include up to 13 calls. Calls are typically scheduled at one to two week intervals allowing participants time to practice different lifestyle behaviors and work on the goals they set with their counselor.

Other components of the course include:

• A pre-course, a post-course and a six-month post-course evaluation call

• Tools to support behavior change (i.e., pedometer, food and activity log, etc.)

• An action planner for tracking progress toward goals

• A clinic visit checklist to assist the individual in preparing for a clinic visit

• Personalized counseling with appropriate topic experts

Because of the depth and complexity of these programs, Health Partners maintains a diverse staff of counselors and educators. This includes registered dieticians (most of whom are certified diabetes educators), physical therapists, exercise physiologists, Master’s level counselors for stress management or tobacco cessation, even pharmacists who monitor medication adherence and herb/drug interactions.

All counselors are trained in a variety of professionally recognized theories prior to starting work with any Health Partners’ programs. In addition, ongoing counselor meetings are held twice a month to discuss program content and counseling issues.

Health Partners has developed a sizable database to track a variety of resources that may be useful to program participants. This allows counselors to refer clients back to their health plan, worksite or community resources as appropriate for further support.

10,000 Steps Program

Boucher expanded on Health Partners’ "10,000 Steps" pedometry program. Begun in January 1999, there are two options to the program. The "Feel Great" edition focuses on physical activity. The "Lose Weight" version focuses on weight management but emphasizes physical activity in achieving programgoals.

Enrollees in either version of the pedometry program have the option of choosing a standard mail-based program or an online program which provides additional resources such as:

• Place to graph and chart their steps

• Web journal

• Optional daily motivational e-mails and fitness tips

• Resource library with information on how to stay active

In addition to these resources, the weight management pedometry program also provides:

• Daily e-mails with weight loss guidance

• Eating plan based on energy density

• More detailed guidance on muscle conditioning exercises

• Place to track weight and calculate BMI

Evaluation

Evaluation is done at the start of the program, eight weeks into the program, and about six months after its conclusion. Employer groups receive aggregate reports that are program- or account-specific, Boucher said. Individual outcomes vary depending on the program but usually include:

• Demographics: age, gender

• Anthropometric/Biological: height, weight and BMI, HbA1C for diabetes program

• Behavioral: physical activity, pedometer steps, fruit/vegetable and fat intake

• Cognitive: self-efficacy, stages-of-change

• Functional: mental and physical quality of life

• Course satisfaction

Health Partners published its one year outcomes in the International Journal of Obesity. Boucher provided some examples of the study outcomes. In general, participants who started in the program and then completed the program lost about eight pounds. At 12 months, Health Partners was able to contact about 52 percent of the individuals who completed the program. Based on those individuals at the 12 month point the weight loss was about 12.5 pounds. Health Partners is working to publish the two-year outcomes.

Address: Health Partners Inc., 8100 34th Avenue South, Minneapolis, MN 55425; (612) 333-1800, www.healthpartners.com.