Pro-Change’s Comments on the Rand Study “Do Wellness Programs Work?”
June 28th, 2013
South Kingstown, RI – June 27, 2013. A growing number of sources are suggesting that wellness programs do not work. Can we answer in the affirmative that wellness programs do work? The Rand Report
(http://www.rand.org/pubs/research_reports/RR254.html) clearly indicates that such a sweeping claim cannot be supported. But why would one assume that such a heterogeneous field – filled all too often with fads, fashions, and far too few facts – would be found to have much impact?
The more critical question is: Can wellness programs work? Here we can respond affirmatively and with confidence. A national Task Force for Community Preventive Services (CHES) has been developing bodies of evidence for recommendations, predictions, evaluations, and innovations for population-based health promotion or wellness programs (Zaa et al., 2005; Soler et al., 2010). The Task Force relies on an impressive range of criteria on which confidence can be based. These include the number of studies, the consistency of results in the same direction, the magnitude of the effects and the consistency of the magnitude, the type of study design, the quality of the study implementation, and length of follow-up. To these criteria, we have added the number of replications across different types of populations, diverse sub-populations and multiple health risk behaviors, and the percentage of participants in programs. We also added strength of outcome measures. Simply measuring improvement is not as strong as the percentage of participants who progress from being at-risk at baseline to not-at-risk at long-term follow-up (e.g., from smoking to not smoking).
A Task Force team applied their original criteria to employee health promotion programs that included HRA assessments with feedback reported at least twice plus at least one additional health promotion program. Across 51 studies, they found average participation rates of about 50% and average follow-ups of about 2 ¾ years. They had confidence in concluding that these wellness programs can produce important effects with exercise (a median success rate of 15.3% from 15 arms from 12 studies) and smoking cessation (a median abstinence rate of 17.8% from 30 arms from 24 studies). Smaller effects were found with high-fat diets (median decrease of 5.4%) and no effects for fruit and vegetable consumption).
Building on the Task Force’s body of evidence, we found much higher impacts for all four of these behaviors with results from 26 arms of population-based RCTs. These results are included in a paper that will be published soon
(http://online.liebertpub.com/doi/abs/10.1089/pop.2012.0094). Unfortunately, the Rand Study did not build on the CHES body of evidence nor did it include the range or rigor of criteria that were used in their review of wellness programs. It is well known that the easiest way to prove the null hypothesis (e.g., wellness programs do not work) is to rely on weak studies. The poorer the studies, the more error and noise is produced, preventing the likelihood of detecting adequate signals of significant effects. The companies reviewed by Rand were as small as 50 employees. As with any program, product or service, there are various levels of quality and one cannot conclude that wellness programs don’t work because the “average” results aren’t impressive. Employers need to use best practices to increase the probability their efforts will reap positive outcomes. One best practice is to use programs that have been scientifically tested and shown to work and not fall to marketing claims that lack peer-reviewed evidence of their offerings.
The Rand review reports that “employers are using incentives” to increase employee engagement in wellness programs. We have been using plan design incentives with our clients for more than a decade and have been able to consistently achieve over 80% of participation rates.
What we can conclude from the Rand Report is that employers need such growing bodies of evidence, based on a broad range of rigorous criteria, in order to benchmark alternative wellness programs. With such benchmarking tools, employers will be able to predict whether they are providing high impact programs, average impact programs, or programs that will produce minor impacts and major disappointments.
Pro-Change, Care New England, and VAL Health to Pilot an Innovative Smoking Cessation Program
June 12th, 2013
South Kingstown, RI – June 12, 2013. This month, Care New England will launch a pilot of an innovative smoking cessation program for its health plan members. The program integrates Pro-Change’s evidence-based behavior change program, including individually tailored text messages with VAL Health’s unique approach to incentives.
Pro-Change’s Smoking Cessation Program (www.prochange.com/smoking-cessation-program) is built for smokers who are not ready to quit, getting ready to quit, ready to quit, in the process of quitting, and staying quit. The URAC award-winning program has an impressive cessation rate of 25%-30%. Recent research indicates that adding individually tailored text messages to the program increased effectiveness by 10 percentage points.
The 6-month pilot with Care New England health plan members will be integrated with VAL Health Rewards, an innovative program that applies the principles of behavioral economics to improve the impact and efficiency of incentive programs.
All Care New England’s benefit-eligible employees and their spouses and dependents who smoke will be eligible to participate in the program. A special bonus award is available if more than one member in a household participates.
“We are very excited to be working with Pro-Change and VAL Health Rewards on this new program. Unlike many other smoking cessation programs, this pilot helps to assess how ready a person is to quit and then provides tailored support based upon that assessment. Many, but not all, participants will quit. However, the research shows that most who complete the program will be better prepared to quit” said Domenic Delmonico, Senior Vice President and executive sponsor of the program for CNE.
About VAL Health
VAL Health is a leading behavioral economics consulting firm. Its health related incentive solutions are derived from team members’ rigorous scientific studies that demonstrate how one offers incentives is often more important than the size of the incentive. VAL Health applies behavioral economic science into practice to develop high impact wellness programs for employers and health plans, and customized incentive programs for health-related technology companies to increase participation and engagement. For more information, please visit www.valhealth.com.
About Care New England
Care New England Health System is positioned to transition into the new era of health care delivery with a high quality continuum of care. Its strength are based on complementary programs and distinctive competencies of partner hospitals and agencies including Kent, Butler, and Women and Infants Hospitals, the VNA and the Care New England Wellness Center. For more information, please visit www.carenewengland.org.
Pro-Change’s Lessons Learned on Patient Engagement
May 31st, 2013
South Kingstown, RI – May 31, 2013. From research gleaned through 30 population-based randomized clinical trials, Pro-Change has found that there are six phases and five factors on a continuum of patient engagement.
The six phases of patient engagement are:
REACH → RECRUIT → RETAIN → PROGRESS → SUCCESS → SUSTAIN
The five factors that drive those phases are: proactivity, stage of change, communications, incentives, tailoring, and transforming.
Most health professionals have been trained to passively wait for patients to reach out to them for help with high-risk and high-cost behaviors like smoking, unhealthy diets, and sedentary lifestyles. Unfortunately, few patients reached out because they were not experiencing pain, illness, or distress from these “silent killers.” Now, with Accountable Care Organizations and pay for performance models, health professionals need to be trained to proactively reach out to entire populations, not just those ready to change.
Once recruited, retention is the next challenge. Historically, discontinuation or drop-out from action-oriented interventions ranged from 70% to 80% for weight management and addictive behaviors, and about 50% for use of prescribed medications. The number one factor that predicted who was recruited and who was retained was stage of change. This factor needs to drive the design of behavior change programs and the health communications used to engage patients.
The historic model for behavior change of large percentages of patients (and of professionals) has been an action model, in which individuals are seen as changing when they quit smoking or start taking their medications as prescribed. If professionals are trying to engage them in a disease prevention or management program, patients assume it is action oriented. Why should patients agree to participate in a program for which they are not prepared? Programs need to be appropriate for patients in all stages of change.
Patient communications needs to convey that “Wherever you are at, we can work with that!”TM Using a traffic light as an icon for readiness to change, communications can let patients know “red light = not ready, yellow light = getting ready, green light = ready. Ready or not, we can be of help.” Of course, the program must actually be designed to respect wherever the patients are at.
Incentives are an increasingly important factor to engage populations. Employers particularly rely heavily on such extrinsic motivations, because most employees are not prepared to participate but they are prepared to trade time for money. The problem is that populations can simply go through the motions for money, without putting in the effort. Transforming from extrinsic to intrinsic motivation is the next driving factor. This begins the progress phase, as individuals advance from one stage to the next as a result of having received tailored feedback. Once patients progress, it means they are engaged not just in the treatment process but also in the change process. Historically, we equated treatment with change, but many people can remain in treatment and not progress. Programs need valid, brief measures that assess progress that would not be observable to participants. For example, the sooner patients receive feedback that their cholesterol is decreasing, the more likely they will continue to adhere to cholesterol lowering drugs.
Over time, progress leads to success as patients change their health status for costly behaviors. To maximize success, programs need to sustain engagement from one year to the next. The greater the percentage of populations engaging in treatment and change processes over time, the more programs can reduce risks and costs, and increase health, well-being and productivity.
The bottom line: It’s time to use the lessons we have learned from the science of behavior change to increase patient engagement, rather than repeating history.
Pro-Change At Cutting Edge of Multiple Behavior Change Research: Plays Key Role in Translational Behavioral Medicine Journal’s Special Section
May 2nd, 2013
South Kingstown, RI – May 1, 2013. Kerry E. Evers, PhD, Senior Vice President at Pro-Change Behavior Systems, Inc. is the Co-Editor of the Special Section Multiple Health Behavior Change in the latest issue (March 2013) of the Translational Behavioral Medicine Journal: Practice, Policy, and Research. In her editorial, Dr. Evers comments on the “Advances in Multiple Health Behavior Change Research” and describes the Special Section as “spanning different populations (e.g., adults and adolescents, employees, health clinic patients), methods (e.g., quantitative and qualitative), and modalities (e.g., survey and intervention research).”
Two of the eight peer-reviewed papers published in the Special Section highlight Pro-Change’s programs, one on youth obesity prevention, and the other on adult stress management, weight management, and smoking cessation.
The article by Yin et al., titled “Treatment-enhanced Paired Action Contributes Substantially to Change Across Multiple Behaviors: Secondary Analyses of Five Randomized Trials,” explores different analytical methods to determine the consistency, robustness, and synergy in patterns of multiple concurrent behavior change outcomes. Data from five randomized trials of computer-tailored interventions that simultaneously treated multiple health behaviors were analyzed. Three of those five trials used Pro-Change programs. Yin et al. found that paired action (changes on both behaviors in a pair) contributed substantially more to the treatment related outcomes than changes in just one of the behaviors in a pair. These results help us to understand how Pro-Change programs can increase impacts on multiple behaviors and populations.
The Bottom Line Statement in the Policy Brief by Amy A. Eyler, PhD, of Washington University, states that Pro-Change’s Health in Motion youth program “was not only effective in initiating and maintaining energy balance behaviors, but also in reducing smoking and alcohol acquisition in early adolescents.” Eyler is highlighting Velicer’s et al’s study “Multiple Behavior Interventions to Prevent Substance Abuse and Increase Energy Balance Behaviors in Middle School Students.” Health in Motion has been used by middle and high schools, by dependents of employees, and YMCAs, and could be used by Accountable Care Organizations for families and communities.
About Translational Behavioral Medicine Journal
Translational Behavioral Medicine: Practice, Policy, and Research (TBM) is an official international peer-reviewed publication of the Society of Behavioral Medicine. TBM’s mission is to engage, inform, and dialogue between research, practice, and policy. TBM features original empirical studies on the effectiveness or implementation of interventions which explicitly state the impact of the findings for researchers, practitioners, and policy makers. For more information, please go to
Pro-Change to Develop a Program for the Interstitial Cystitis Association
April 10th, 2013
South Kingstown, RI – April 10, 2013. The Interstitial Cystitis Association (ICA) has subcontracted Pro-Change Behavior Systems, Inc. to develop a Transtheoretical Model-based computer-tailored intervention for patients experiencing interstitial cystitis (IC) (painful bladder syndrome).
The online program will be designed to encourage patients with IC to use a range of healthy strategies to manage or minimize their pain, and to cope with pain that does occur. Healthy strategies will include first-line treatments recommended in the American Urological Association’s treatment guidelines (e.g., education, stress management, pain management, self-care, and behavior modifications), and any second-line and third-line treatments prescribed by their care providers.
The intervention will be accessed via the ICA’s website, ichelp.org, and will:
- Assess and give feedback on level of IC pain and the benefits of using healthy strategies to manage that pain;
- Assess and give feedback on current stage of change for using healthy strategies to manage IC pain;
- Assess and give feedback on current use of each of the healthy strategies for managing IC pain;
- Facilitate use of up to seven stage-matched Transtheoretical Model principles and processes of change shown empirically to facilitate transition to the next stage of change for making positive behavioral changes;
- End with a report that contains all the feedback received during the session, and links to stage-matched information and resources on the ICA website. The report can be printed or accessed online using private login information.
Lee Claassen, Executive Director of the ICA stated, “We are pleased to have the opportunity to have a strong theory-based intervention built for IC patients to help empower them in managing their condition and live the fullest life possible.”
The development of this computer-based self-management tool for IC patients is supported by the Interstitial Cystitis Association’s Cooperative Agreement number 5U58DP002936-02 from The Center for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of The Centers for Disease Control and Prevention.
The Interstitial Cystitis Association (ICA) is the only non-profit health association dedicated to improving the quality of healthcare and lives of people living with IC. The ICA provides advocacy, research funding, and education to ensure early diagnosis and optimal care with dignity for people affected by IC. For more information, please visit ichelp.org.
Pro-Change has the Tools to Promote Patient Engagement
February 27th, 2013
South Kingstown, RI – February 27, 2013. The February 2013 thematic issue of Health Affairs entitled, “New Era of Patient Engagement,” has over 25 articles exploring aspects of patient engagement from the evidence and potential of patient engagement, to the role of clinicians and shared decision making.
According to Susan Dentzer, Health Affairs editor-in-chief, “wherever engagement takes place, the emerging evidence is that patients who are actively involved in their health and health care achieve better health outcomes, and have lower health costs, than those who aren’t… The challenge is to encourage patients and providers alike to embrace engagement and achieve its full potential to improve health and health care.” Pro-Change has designed two solutions to do just that.
Proactive Health Consumer (PHC) is a mobile-optimized, individually tailored behavior change program designed to increase patient engagement in health and health care by encouraging informed decision making; shared decision making; financially responsible use of health services; and engagement in ongoing wellness activities among patients. Like all Transtheoretical Model-based programs, PHC is for all patients – those who are not ready, those who are getting ready, and those who are already proactive consumers. The program includes a dynamic web portal containing interactive activities that build patients’ skills and confidence to be an active participant in their care. To read more about the PHC program, please read this article from Art and Science of Health Promotion.
Pro-Change’s new health care Provider Dashboard helps primary care providers to be experts in behavior change without extensive training. The dashboard is populated with a patient’s data from our Health Risk Intervention (HRI). Once a patient has completed the HRI, clinicians can see a graphic representation of the patient’s self-reported health status, as well as behavior change challenges and priorities on a single screen. The dashboard provides brief, evidence-based, tailored behavior change messages the clinician can deliver to engage the patient in the behavior change process. The inclusion of a patient’s behavior change priorities can promote shared decision making and improve outcomes. The dashboard also allows clinicians to prescribe Pro-Change’s award-winning behavior change programs and follow their patients’ progress over time.
About Health Affairs
Health Affairs is the leading journal of health policy, thought, and research. The peer-reviewed journal was founded in 1981 under the aegis of Project HOPE, a nonprofit international health education organization. Health Affairs explores health policy issues of current concern in both domestic and international spheres. To learn more about Health Affairs, visit their website at www.healthaffairs.org.
About Pro-Change Behavior Systems, Inc.
Pro-Change Behavior Systems, Inc., a certified Women’s Business Enterprise, is a research and development company providing wellness partners with computer- and coaching-based programs for changing health risk behaviors. Based on the Transtheoretical Model developed by founder Dr. James O. Prochaska, Pro-Change programs are for entire populations and are uniquely tailored to each individual. Pro-Change programs have produced unprecedented impacts on multiple behaviors to enhance health and reduce health care costs. In 2009, Pro-Change LifeStyle Management Programs for Stress Management, Depression Prevention, Weight Management, Exercising Regularly, Smoking Cessation, and Medication Adherence won the URAC Gold Award for Best Practices in Health Management. In 2012, the LifeStyle programs were featured on AHRQ’s Innovation Exchange website. For more information, please visit www.innovations.ahrq.gov. For more information about Pro-Change, please visit www.prochange.com.
Pro-Change and Krames StayWell to Collaborate on ACO Patient Engagement Solution
February 13th, 2013
Krames StayWell ACO 360 Suite to include Pro-Change LifeStyle Management Suite featuring Health Risk Intervention, Online Coaching Programs, and New Provider Dashboard
South Kingstown, RI – February 13, 2013. Pro-Change Behavior Systems, Inc. and Krames Staywell (KSW) have reached an agreement to incorporate a special version of the Pro-Change LifeStyle Management Suite into Krames Staywell’s comprehensive communication and engagement package created for accountable care organizations, ACO 360°. ACO 360° meets the outreach, acute patient education, and health management needs of an accountable care organization and is designed to foster patient engagement in the care coordination activities of an ACO by promoting health self-management.
“ACO 360° is a powerful program that includes print and digital newsletters, a patient resource guidebook, multimedia website libraries, and a comprehensive database of over 5,500 patient education articles in English and Spanish that can be integrated into virtually any Health IT system and delivered through the EHR and Patient Portal via the Infobutton Standard,” explained John George, Executive Vice President Krames StayWell. “However, we felt there was a gap in providing solutions to enable ACOs to better manage the overall health of their patient population. The LifeStyle Management Suite, created by the Pro-Change team using a leading behavior change methodology, is uniquely designed to serve the needs of an ACO model.”
Pro-Change was founded by James O. Prochaska, PhD who developed the Transtheoretical Model of Behavior Change (TTM) more commonly referred to as the Stages of Change Model. The LifeStyle Management Suite incorporates the TTM into a Health Risk Intervention that not only assesses risk but also addresses a person’s readiness to make a behavior change and guides the user with stage matched strategies. The Suite includes nine online coaching programs such as smoking cessation, weight management, exercise, nutrition, and stress management that dynamically reassess where a person is on the continuum of making a behavior change and provides tailored guidance strategies to best help the user reduce their health risks. The version of the LifeStyle Management Suite incorporated into ACO 360° also includes an innovative provider dashboard designed to better coordinate and encourage health management interventions and promote communication between the patient and the care team.
“We are excited to be partnering with Krames Staywell,” added Janice M. Prochaska, PhD, President and CEO, Pro-Change. “The combination of our scientifically validated behavior change programs and KSW’s proven patient and consumer engagement tools coming together in ACO 360° creates a powerful lever for any accountable care organization looking to drive success of their efforts via effective patient engagement and accountability in personal health management.”
To find out more about this new program for accountable care organizations please visit www.kramesstaywell.com/aco-360.
About Krames StayWell
Krames StayWell is the largest provider of patient education, consumer health information, and population health management communications in the country. Combining extensive technology and content assets with vast consumer insights and a strategic approach, Krames StayWell is uniquely qualified to engage consumers across the entire spectrum of their health care experience. Our best-in-class health communication solutions integrate print, interactive, and mobile formats at multiple touch points to attract and retain consumers, improve health outcomes, and lower costs. We deliver measurable results for hospitals, health care professionals, health plans, employers, retail pharmacies, government agencies, and association clients with world-class design, commitment to health literacy principles, and a focus on custom development. For more information, please visit www.kramesstaywell.com.
Pro-Change Partners with NADMWP
February 7th, 2013
South Kingstown, RI – February 7, 2013.
Pro-Change Behavior Systems, Inc. has begun a partnership with the National Association of Disease Management & Wellness Professionals® (NADMWP) to provide educational and professional development resources and programs. Members of NADMWP include nurses, pharmacists, dieticians, therapists, and doctors. Pro-Change’s e-Learning program which teaches Basic Transtheoretical Model (TTM) skills will be offered to members at a reduced rate, as well as stage-matched behavior change manuals and the award winning MyHealth LifeStyle Management programs. Members can earn 4 CEs for passing the test at the end of the e-Learning Basic TTM Training.
Steve Potje, RN, CCP, and BS/BA, Executive Director of NADMWP stated: “I wish I would have had this course when I started in the field. The e-Learning program is very easy to follow, provides the core content needed to understand both TTM coaching and MI strategies and how to apply them in guiding a member to behavior changes.”
The National Association of Disease Management & Wellness Professionals®
The National Association of Disease Management & Wellness Professionals® (NADMWP) is a nonprofit professional association for Doctors, Registered Nurses, Registered Dieticians, Pharmacists, Social Services, and Behavioral Health professionals working in the Disease Management & Wellness industry. These professionals are tasked with helping the millions of persons with chronic medical conditions learn to self-manage these conditions and to help the non-diseased population to make lifestyle changes to avoid the development conditions such as Diabetes, Coronary Heart Disease, Hypertension and COPD. To learn more about the NADMWP, please visit their website at www.nadmwp.org.
Dr. Sara Johnson Recognized by the Journal of Nutrition Education and Behavior
January 29th, 2013
South Kingstown, RI – January 28, 2013. Dr. Sara Johnson, Senior Vice President at Pro-Change Behavior Systems, Inc. is receiving an Award for Excellence in Reviewing for her service to the Journal of Nutrition Education and Behavior (JNEB). Dr. Johnson was selected from over 1,000 reviewers based on her dedication to reviewing for JNEB and the quality of her reviews.
Karen Chapman-Novakofski, PhD, RD, Editor-in-Chief, stated that “Dr. Johnson’s contributions are invaluable to the success of the Journal. Her expertise and professional critiques have helped improve numerous manuscripts during her tenure.”
Dr. Johnson’s award will be highlighted in the January/February issue of the Journal.
About the Journal of Nutrition Education and Behavior
JNEB is the official journal of the Society for Nutrition Education and Behavior. It is a refereed, scientific periodical that serves as a resource for all professionals with an interest in nutrition education and dietary/physical activity behaviors. The purpose of JNEB is to document and disseminate original research, emerging issues and practices relevant to nutrition education and behavior worldwide. For more information please visit www.jneb.org.
Pro-Change Releases “The Transtheoretical Model of Behavior Change for Financial Coaching”
January 9th, 2013
South Kingstown, RI – January 9, 2013. Pro-Change Behavior Systems, Inc. recently released a guide for financial coaches, life coaches, or financial planners whose goal is to help clients change financial behaviors. The Transtheoretical Model of Behavior Change for Financial Coaching is a 92-page guide that provides:
- An overview of the Transtheoretical (Stages of Change) Model, a leading model of behavior change
- Questions that can be used to assess client’s readiness to set aside money to pay off debt, follow a budget, save regularly, or change other financial behaviors
- Detailed guidance about specific behavior change strategies that are most appropriate for clients in each stage of change
- Activities and worksheets that can be completed by the client, as well as referrals to best in class online financial tools and information
The guide, written by a team at Pro-Change including Sara Johnson, Ph.D., Carol Cummins, M.Ed., M.L.I.S., and Lynne Broderick, M.P.H., is concise and easy to follow. It includes practice client scenarios that allow coaches or financial planners to test their ability to correctly determine stage of change and recommend appropriate behavior change strategies.