Business of Well-being

Increasing Chronic Disease Costs Lowered with Digital Health Coaching

Given the continual steep rise in health care costs in an already challenging economic environment, many employers now recognize the strategic business advantage of having a physically and emotionally healthy, engaged and active workforce.

For employers, employees with chronic diseases and conditions - such as heart disease, diabetes, arthritis, and depression - are of particular concern. Research shows that individuals with chronic diseases have higher medical costs and put greater demands on the health care system. For example, health care spending is:

  • 2.5 times greater for a person living with one chronic condition than for an individual with no chronic conditions;
  • 7 times greater for an individual living with three or four chronic conditions compared to someone without any chronic conditions; and,
  • 15 times greater for a person with five5 or more chronic conditions than for an individual who does not suffer with chronic conditions.

Additionally, with the overall aging of the American population, the prevalence of chronic diseases and co-morbidity are growing steadily. From 1996 to -2006, the average number of physician office visits increased 43 percent for diabetes and 51 percent for hypertension, while physical visits for preventive care increased by only 19.2 percent.

Furthermore, the cost of chronic diseases reaches beyond direct health care expenditures. Chronic diseases also seriously impact employee productivity and performance. Asthma, diabetes, and hypertension result in an estimated 164 million work days missed by Americans each year, with an annual cost to employers of an estimated $30 billion.

To help mitigate the effects of rising health care costs and declining employee productivity, forward-thinking employers are strategically investing in comprehensive solutions - such as health and wellness programs - that can favorably affect the health of their employees. This growing trend is creating a demand for new approaches to deliver population health promotion programs that are efficacious, economical, scalable, and sustainable. Digital health coaching is one such approach.

Digital health coaching is an individualized, interactive, technology-based experience that provides individuals with the knowledge and tools that they need to take a more active role in managing their health

Digital health coaching is an individualized, interactive, technology-based experience that provides individuals with the knowledge and tools that they need to take a more active role in managing their health. It is driven by intelligent technology that uses behavioral science models and theories, behavior change techniques, evidence-based guidelines and education and learning theory to create personalized interactions.

The transformative potential of digital health coaching is its scalability to large populations at a relatively low cost, and therefore can reach all segments of the employee health spectrum, from individuals in good health to those with a chronic or severe disease.

Self-Management Approach

Self-management is an approach to chronic care that enhances self-efficacy and teaches problem-solving skills in order to achieve more effective condition management, role management, and emotional management. The self-management framework focuses on the following principles, whereby individuals:

  • Accept responsibility for managing their care;
  • Optimize daily functioning in ways that realistically consider the limitations imposed by their condition and its treatment;
  • Effectively and appropriately adjust their affective responses to their conditions; and,
  • More efficiently manage their care when multiple chronic diseases are addressed in a unified manner.

Research has demonstrated that health management programs that employ self-management concepts are successful in promoting favorable behavior change (e.g. cognitive symptom management, self-reported general health, and social/role activities) and for improving self-confidence in one's ability to manage his or her chronic diseases.

Self-management can also be a cost-effective method, in that it can reduce preventable health events that drive health care utilization (e.g. inpatient and outpatient visits). For example, people living with five or more chronic diseases average 15 medical visits a year compared to 4 visits a year for other patients. Additionally, individuals that suffer with five or more chronic conditions fill almost 50 prescriptions in a single year.

Research data suggest that digital health coaching programs - health promotion interventions that are standardized, personalized, and based on proven behavior principles and techniques - can be an instrumental component of a chronic condition self-management strategy. Digital health coaching programs can be deployed at population level, are relatively low cost and convenient, and work both independently and as complementary resources that scale higher-touch interventions.

Online Chronic Condition Management Strategy Case Study

Highmark Inc. and HealthMedia, Inc., conducted a study that evaluated the economic effect of a scalable, convenient, online intervention designed to enhance the participant's ability to manage his or her chronic conditions, with a particular focus on the development of self-management skills and the mitigation of costs (both direct and indirect).

For the study, researchers reviewed the data of 413 members who participated in the HealthMedia Care for Your Health digital health coaching program, as part of the chronic condition management strategy offered by Highmark. This group was compared to a risk-matched cohort of 360 non-participants.

The intervention included a baseline general health assessment, customized action plan, tailored email newsletter, and follow-up evaluations. The study found that online digital health coaching disease management programs favorably impact employer health care costs. Highmark's chronic condition management services include (but are not limited to):

  • Interactive voice response  (IVR) telephonic outreach to members with chronic conditions;
  • Letter and phone call reminders for clinical preventive exams;
  • Educational resources that include medical management consulting and educational outreach for members and providers;
  • Self-management education; and,
  • Complex case management.

Developed by a team of health care experts and clinical behavioral scientists, HealthMedia Care for Your Health is a tailored digital health coaching program that teaches people to become more independent and active, and to more successfully manage their chronic conditions. This intervention works in conjunction with Highmark health coaches to help members manage chronic conditions, such as diabetes, asthma, back pain, depression, and coronary artery disease.

The program begins with a baseline general health questionnaire, the results of which are used to customize an action plan, three e-mail newsletters, and follow-up evaluations, which are administered at days 1, 30, 90, and 180 after program completion. The following topics are assessed in the baseline and follow-up questionnaires and in the program content:

  • Medication compliance
  • Relationships with physicians and pharmacists
  • Symptom management
  • Lifestyle behaviors
  • Emotional changes
  • Work productivity

Study participants self-reported their medical history on the baseline questionnaire. On average, participants had 2.7 chronic conditions. The most common conditions reported were:

  • Hyperlipidemia (39.5 percent)
  • Hypertension (36.6 percent)
  • Allergies (24.7 percent)
  • Acid reflux/gastroesophageal reflux disease (23.7 percent)
  • Back pain (23.5 percent)

In addition, researchers reviewed the data for specific healthcare expenditure trends in five categories:

  • Inpatient services
  • Outpatient services
  • Professional services
  • Pharmacy services
  • Total health care costs

The Results

The study results indicated that online self-management interventions can be an important and cost-effective component of an employer's population health management strategy. The data showed a reduction in health care costs of $757 per person per year than predicted for employees who participated in the condition self-management and HealthMedia Care for Your Health program, versus employees who did not participate in the program.

Furthermore, participants consistently had lower utilization increases relative to non-participants in all categories except outpatient services. Although the findings showed a higher increase in outpatient services utilization for program participants than for non-participants, the overall outpatient costs and total health care costs were lower for participants.

The higher outpatient service utilization by participants may be a result of the encouragement that members receive through the digital health coaching program to seek regular outpatient care to manage their chronic condition(s). This reduces the need for more aggressive medication and hospitalization. The same result has been found in other studies.

Also, members that participated in the online chronic condition self-management program had fewer annualized total hospital inpatient days and a shorter length of stay per person per year compared to non-participants. Additionally, the estimated cost savings per person by category for study participants versus non-participants include:

  • $313 for inpatient costs
  • $274 for outpatient costs
  • $152 for professional services
  • $71 for pharmacy costs

Note: because of the use of separate predictive models for each category, the sum of these categorical savings does not equal the $757 savings reported for total health care expenditures.


The prevalence of chronic conditions is growing rapidly, which puts further pressure on an already overwhelmed health care system and contributes to the steep increase in health care costs. As a result, there is a growing trend by employers to provide wellness and prevention programs to their employees with the intent to empower individuals to take greater responsibility for their health.

Condition management programs that teach self-management skills and encourage preventative care are believed to yield a positive return on investment (ROI) and help people live healthier, more productive lives. This study illustrates that the application of general self-management principles can produce a measurable ROI for employers.

Furthermore, the study demonstrates the potential benefits that efficient and effective population chronic illness management programs can provide to employees. Technologies, such as digital health coaching, must continue to be developed, tested, and - where effective - applied if we are to address the mounting health care challenges related to chronic disease management and cost containment.

About The Author

Dr. Steven M. Schwartz is Research Director at HealthMedia, Inc., a Johnson & Johnson company and part of the Wellness & Prevention business. Dr. Schwartz received his B.A. in general psychology from Wayne State University, an M.A. in experimental psychology from the College of William and Mary, and a Ph.D. in clinical/health psychology from Virginia Commonwealth University.

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