“Health Care Coaches” Improve Health, Cut Costs

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Vital Signs: Vermont Charts A New Course For Health Care

For the last five years, Marathon Health in Colchester has been advising large companies on how to contain health care costs. Part of the plan is assigning "health care coaches" to employees to develop individualized health care plans. By most accounts, this has been a very effective program.

VPR’s Lynne McCrea reports on Marathon’s work with Vermont’s Pizzagalli Construction.

Click listen to hear the report.







(Host) There are lots of pieces to health care overhaul – all designed to improve care and reduce costs.  Some of the ideas are still unproven – but others are in place and showing results.

For the last 5 years, one Colchester company has been working with larger businesses nationwide to improve employee health and save on health care spending. 

VPR’s Lynne McCrea has this profile of Marathon Health.

(McCrea) To understand how Marathon Health works, we start with a visit to Pizzagalli Construction – a company that’s based in Vermont and has about 700 employees.

(Sessions at construction site "Hi guys!")

(McCrea) Mike Sessions is Vice President of Pizzagalli. Four years ago, he began to study how well the company’s health care coverage was working, and he discovered some discouraging statistics.

(Sessions) "I learned that we had about 45% of our employees who had insurance had not used it in 2 years. I also learned that we had a very small percentage of employees that were about 80% of the cost of our total health care bill."

(McCrea) Now, these two statistics are important to understand, because they reflect what’s happening across the nation.  Less than 1 percent of Pizzagalli’s employees – typically, people with severe or chronic conditions – accounted for 80 percent of the company’s health care spending. Could anything be done to reduce that spending?

Well, we’ll get back to this in a minute. It’s the other health care statistic that really bothered Mike Sessions:

(Sessions) "We had great coverage… 45 percent of the people weren’t using it at all-really, were not going to get a physical or doing anything, so they didn’t know what their health was. What we needed to do was to have those people begin to get engaged and to start thinking about their health and take responsibility for their own health."

(McCrea) While it might seem good that people weren’t using their health insurance, what concerned Mike Sessions is that they weren’t getting any preventative care – no checkups for things like high cholesterol or blood pressure.

(Clinic nurse: "We’ll just have you hop up on the scale…Freitas: There’s been a history of heart issues in my family")

(McCrea) Tom Freitas is a worksite supervisor with Pizzagalli. He used to be in that ‘45 percent group’ – employees who never used their health insurance, and never went to a doctor.  

(McCrea) Today, Freitas has stopped by a health clinic that’s actually right at Pizzigalli’s headquarters in South Burlington. The clinic is run by Marathon Health-the company that sets up these workplace sites.

(Reynolds): "I just wanted to see where your blood pressure was from the last time you were in here…"

(McCrea) Alison Reynolds is a nurse practitioner and ‘coach’ with Marathon Health. She sees employees here for things like sore throats and sinus infections.

And once a year, she does a ‘biometric screening’ of any employee who wants one, then follows up with people about their "numbers" – things like cholesterol, glucose, body mass – and talks about how some of those might be improved.

(Reynolds in clinic, ripping off blood pressure cuff) "118 over 78 – that’s great!"

(McCrea) Four years ago, Tom Freitas learned from his health screening that he had very high cholesterol. But today, thanks in part to a better diet, it’s come down dramatically.

(Reynolds) "It was 247…and now his total cholesterol is 171 – big difference.  (Freitas) For someone like myself, being checked periodically has probably brought the awareness to me. Knowing this, I’ve really changed a lot of my eating habits and I think that’s what’s really turned around some of these numbers. 

And hopefully it contributes to my longevity (Reynolds) That’s what your wife’s banking on!"


(McCrea) Stories like this one can be heard throughout Pizzagalli. The company says that in the last 4 years, as a group they’ve reduced cholesterol by 12 percent. Obesity is down by 4 percent, and blood pressure by 2 percent. So how does this happen?

(Ford) "What we do is engage people in a different manner than they’ve ever been touched or broached by the health care system before…"

(McCrea) Jerry Ford is the CEO of Marathon Health. He says the company’s clinicians are also trained as health coaches, and they’re given the time with each patient to talk about risk factors that may lead to future health problems.

(Ford) "And it’s 3 behaviors – smoking, sedentary lifestyle, and poor diet – that lead to 4 diseases that cause 50 percent of premature deaths worldwide. So by getting more people to work on making sure they’re exercising, their diets are proper, they’re not smoking – those simple changes can make so much of a difference."

(McCrea) But what about people who are already in poor health? Think back to that very small group of employees at Pizzagalli who represent 80 percent of the company’s health care costs. Vice President Mike Sessions says about half that group had health problems that weren’t preventable. But it’s possible that the other half were.

(Sessions) "If we could reduce – you know, we’re talking about 10 employees – if we could reduce that 10 to 5 even, it would have a huge impact on our health care costs."

(McCrea) Jerry Ford at Marathon Health says the important thing is to help people manage their chronic condition, so that the problem doesn’t escalate and lead to expensive emergency room visits or hospital stays.

(Ford) "If you are a diabetic, there are certain things you should be having done on a regular basis – foot exam, eye test. A lot of times that’s left to the patient. Also, from a preventative perspective, are they exercising? Are tests being done on a timely basis? So, it’s about mitigating and reducing the risk as much as it is about preventing the risk."

(McCrea) Which points back to nurse practitioner Alison Reynolds, whose whole goal is to support employees- by taking the kind of time that rarely exists at a doctor’s office.

(Reynolds) The difference is, that when a client here comes in, and is here for a sick visit maybe, but maybe not, maybe here just because we’re going over their health review… and they’re overweight: We’re gonna talk about it for half an hour! And talk about ‘why do you think you’re overweight. Are you interested in changing it, how would you go about changing it? I mean when do you have the opportunity to talk for half an hour about why or why not you’re not losing weight, when you know you should be? That’s the great thing about this – is that … I get to spend time on something that we don’t usually take time to talk about. And to me that’s just the gem of it all.

(McCrea) So, if Pizzagalli is any example, this approach clearly helps people improve their health. But what about costs? Marathon Health says that companies see immediate savings from what it calls ‘redirected care’-in other words, a visit to the onsite clinic costs about half of what it would to go to the doctors. And being able to avoid emergency care represents an even bigger savings.

After doing this for 5 years now, Marathon Health says it’s been able to consistently "bend the curve" – that is, to reduce the rate at which a company’s health care costs are going up each year. So, for example, while many companies anticipate their costs to increase by 10 percent a year, Pizzagalli has seen, on average, a one percent increase over the past 4 years.

(Sessions) That’s huge. I haven’t talked to anybody that has that kind of success."

(McCrea) While the control on spending is certainly good news, Mike Sessions says it’s the sense of overall improved health at Pizzagalli that is the best reward.

(Sessions) "Can I say we avoided a heart attack? I don’t know… Maybe 10 years from now, will that employee have avoided a heart attack? I have no idea, but I know that they feel good about themselves, they’re happy they’re making progress, becoming healthier people…"

(Freitas – getting off scale)

(McCrea) For Tom Freitas at Pizzagalli, the convenience and accessibility of the onsite clinic has given him a new level of comfort about his health…

(Freitas) "I’m getting my health in check and I’m improving on some of these numbers…"

(McCrea) And for Jerry Ford at Marathon Health, the best part of this approach is that it makes the patient a part of the solution:

(Ford) "And the more people we can get on that curve, and work together with employers and community, to make sure people realize and are taking responsibility for their own contribution to the health care problem, the better off it’s going to be. I mean you want health care reform? Have people stop smoking, start eating properly, and have people start exercising. That IS health care reform!"

(McCrea) Back at the Pizzagalli construction site, employees have been taking that message to heart. With the help of an onsite health clinic, many have improved their outlook. And now, they can focus on their work.

For VPR News, I’m Lynne McCrea.



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