Three years ago, Medica started using "health coaches" to call chronically ill patients and nudge them to adopt healthier lifestyles.
Now there's evidence the program is paying off.
Since 2008, more than 29,000 members of the health plan have gone through the program. Those who stuck with it lost an average of 11.6 pounds and reported they felt better both physically and emotionally, according to a Medica survey of 1,051 participants.
And diabetic patients saw a 35 percent drop in their blood sugar levels, a major improvement.
Dr. Kevin Ronneberg, who helps oversee the program, insists it's not about nagging, as some critics think. The coaches are trained to talk to patients about their own goals: Sleeping better? Handling stress? Reducing pain? And help them find the motivation to change.
"This is not coaxing, cajoling," he said. "It's encouraging them and it's supporting them."
Medica combs through its patient database to identify those who might benefit from coaching. That means patients with multiple chronic conditions such as diabetes and high blood pressure or frequent visits to the hospital or clinic. Not coincidentally, they are patients who run up the highest costs. Then Medica contacts them to offer the chance to talk with a health coach. The service is free.
Even so, nearly 80 percent said no the first year. Now the rate of refusal has dropped to 63 percent. And even that's not as discouraging as it sounds, Ronneberg said.
"The largest response I get is: 'I'm not ready right now. Could you please call me later?'" he said. Sometimes, someone may say no several times before he or she is ready to say yes.
One way Medica was able to cut the "no thanks" rate, he added, was to personalize the invitations. Originally, patients got form letters asking them to take part. Now, the patient gets a letter from the same coach who will be making the phone calls. That was one of the valuable lessons, he said. "We really need to personalize this, because it is a very personal program."
Typically, the telephone coaching sessions last about an hour each. "There is quite an investment in this, we don't go into it lightly," he said. Medica has hired 32 health coaches, who generally check in with their patients every two to four weeks over a period of months.
The conversations, he said, depend on what the patient wants to achieve. If someone is having trouble sleeping, for example, the coach may ask questions about the possible causes and help brainstorm solutions.
The assumption is simple: If people can kick unhealthy habits, manage their stress and start exercising and eating right, they won't need as many visits to the doctor and emergency room. And the numbers bear that out, Ronneberg said.
Medica estimates it saved $19 to $22 a month, per member, with the coaching program. And for patients, the satisfaction rate is about 90 percent, the survey found.
"I think the program has matched, if not exceeded, the expectations," he said. He notes that even pro athletes work with coaches. "There's not anybody who can't benefit from a coaching experience."