If a doctor advised you to lose weight, eat more vegetables and start exercising, what are the chances that you would do it -- and stick with it?

Pretty low, if history is any guide.

To increase the odds, Medica Health Plans is to announce today that it is launching an aggressive program to help people kick the bad habits that can make them sick.

Medica has hired and trained 30 professionals to work the phones as full-time "health coaches" to coax, cajole and inspire others to live healthier lives.

It's the latest evolution in a fast-growing health care field. For some time, businesses have hired health coaches to help employees on diet, exercise, smoking and other lifestyle choices to lower health costs. Many clinics use coaches to help patients with chronic conditions, such as diabetes and depression.

Medica's is more ambitious. It uses a computer program to identify which members of the plan need help the most. They'll get invitations in the mail to take part, at no cost.

The idea, said Dr. Charles Fazio, Medica's medical director, is to "get people working on those hard choices that we make every day that influence our health." That could mean anything from how they handle stress to taking their blood-pressure pills.

He argues that it will save money by keeping people healthier.

Critics, though, complain that it's an example of a heavy-handed bureaucracy overstepping its bounds. "It seems to me like health plans are trying to encroach more and more on the individual's life and lifestyle," said Twila Brase, a health-privacy advocate in St. Paul. "It's sort of like the big health version of Big Brother."

Coaching patients to act

Supporters say it's really about helping people take more responsibility for their own welfare.

"So many of the old models assumed that if you gave people the right information, that they would make a change," said Mary Jo Kreitzer, director of the University of Minnesota's Center for Spirituality and Healing. "It really doesn't work."

Health coaching, she said, helps people discover what really motivates them, and what gets in the way. The university now offers its own health-coach training program.

Today, Medica is rolling out its own ambitious version, after three years of testing.

The insurer studied who among its 1.3 million members was most likely to get sick. Now it's asking some of them if they're willing to talk with a coach about what's going on in their lives.

That may seem like a roundabout way to improve health. But Medica's coaches, many of them nurses and therapists, have taken extra training on how to motivate patients with broad-ranging conversations.

Judith Pinke of St. Louis Park got one of those calls about a year ago, as part of a test group. The call came "out of the blue," she said, and she was both intrigued and cautious.

Although she has several health problems, she said, she wasn't told why her name came up. The voice on the line, coach Holly Link, merely told her about the service and asked if she was interested. "I decided, you know, this sounds like it's worth a shot," said Pinke, 63.

She confided to Link about her sleep problems, that she was exhausted most mornings. They brainstormed and came up with a plan. "I must say she was very good about not pushing me," Pinke said. "She was really following my lead." The plan: no TV after 8 p.m.; and before bedtime, warm milk with honey and an hour playing piano to relax. Now, she says, she wakes up more rested and has resumed exercising.

It helps, she admits, to know that she will be checking in with her coach once a month.

Link, her coach, said it's critical to let patients take the lead in solving their own problems. "It really is about active listening," she said.

Concerns about privacy

In Medica's first test of "high risk" patients, the coaching experiment saved an average of $300 a month per person, Fazio said. "Most of the difference was in [less] use of the hospital and the emergency room," he said. "We created a difference just by calling."

Yet four out of five people refuse to participate, Medica found. "A lot of people say no because they're just not ready," said Leslie Frank, who developed the coaching program as Medica's quality director.

Brase, the privacy advocate, sees other reasons. "The clearest thing that happens when you get the phone call is you realize that people have been looking at data about you," said Brase, who heads the Citizens' Council on Health Care. "You didn't ask them to call you, but now they want to help direct your life. ... Probably what people are going to feel more than anything is violated."

Others worry about hidden agendas, and whether patients who refuse could end up paying higher premiums. "I get increasingly nervous with how much information they have about how we're living our lives," said Dr. Steven Miles, a medical ethicist at the University of Minnesota. "Their fundamental interest is their bottom line, it's not my health."

Medica officials point out that the coaching program is strictly voluntary.

"We've recognized that this is a gap in the health care system," said Frank, Medica's quality director. Doctors simply don't have the time or training, to talk to patients this way.

Eventually, she said, clinics may offer their own coaches. In fact, Medica is working on a pilot project with two Fairview clinics for coaches on site.

At some point, Medica says, it plans to offer coaching to all its members, not just those with health problems.

But no one expects coaching to work for everybody, said Kreitzer, of the University of Minnesota. "If somebody's absolutely not ready to make a changes, there's absolutely nothing that's going to work."

Maura Lerner • 612-673-7384