Imagine your patient Annette works upstairs from your clinic at a company employing 500 people. Since she can easily pop downstairs between meetings for a sameday appointment to see you, you’ve seen more of her this year than her previous provider did during the past five years combined. She has kicked cigarettes, set goals for her exercise and diet, and lost 23 pounds. Healthier than ever, she is taking pride in living a lifestyle to fend off bigger health problems, such as heart failure or diabetes.
Combining proximity with coaching, Vera Whole Health is improving health and lessening the need for more critical care—and the costs that go with it. Many health organizations are developing ways to increase efficiencies while they deliver care, and Vera Whole Heath, in Seattle, has a model that is also getting health results. First, by embedding their clinics within corporate walls (or in very near proximity), they’re seeing patients who might not have previously sought care. Second, by pairing physicians with health coaches, they see greater patient activation.
THE COACH APPROACH
“Having launched many fitness organizations, both nonprofit and forprofit, I have always been passionate about helping people live well and transform their health,” says CEO Ryan Schmid. “While I don’t have a medical background — I was a student athlete with a business education — I knew that the lifestyle and behavioral-change angle was where I could make a difference.” With 70% of costs lifestyle-related,* patient behavior is an important part of the equation — but one that providers have little control over.
Vera started as a fitness organization. “A lot of people would show up to make good on a felt need to get in shape, but a lot of what is really going on for them is ‘between the ears.’ At Vera Whole Health, we realized an opportunity to build relationships that coach people into lifestyle change,” says Schmid. Leveraging that insight, Vera Whole Health now contracts with medium-to-large employers, in parallel to an employer’s insurance plan, embedding primary care clinics on-site that feature the pairing of physicians and health coaches. Employers pay a per-member, per-month fee for their employees and their families to use Vera’s clinic services free of charge. For something Vera does not offer—an MRI, for instance—Vera can refer to the most cost-effective local resource, where patients can use their insurance plan benefits.
WHAT IS A HEALTH COACH?
Vera has two kinds of coaches: Care providers such as PAs, NPs, physiologists, or dieticians who have been specifically trained in coaching, as well as coaches who are not licensed providers of any kind. To ensure the quality and consistency that is required, Vera’s entire care team completes a rigorous, proprietary certification process that includes 150 hours of hands-on training for integrating health coaching into their practices.
Vera teaches that one of the key differences between a provider and a coach is that “the physician is doing the ‘telling’ by providing expert medical guidance; the coach is doing the ‘asking’ by drawing out of the patients the goals they think they can accomplish to address the required changes in health that are required,” says Schmid. “The provider can spend an hour with the patient to develop a care plan, then take them to meet their coach.” Their coach sits with them to determine their health goals and the behavior changes that will help them become realized. Then the physician and coach will meet and compare notes. “They are very much a team; it is not a disjointed referral.”
Ryan feels that physical and mental health are completely intertwined. “A good coach will sit down with a patient to get a clear understanding of what’s going on with them mentally first, then address their health issues.” A good coach is also not prescriptive, but taps into which stage of change the patient is in — whether contemplation, preparation, action, etc. Once they understand the patient’s mind-set, the coach draws out the patient’s goals, addressing obstacles. For instance, if patients say, “I’ve never lost 50 pounds, how am I going to do this?” their coach may ask them what skills or disciplines they used to achieve their biggest goals at work, looking at how they can accomplish things that initially seemed daunting. Patients gain confidence, then, by realizing how they already get themselves from point A to point B to reach goals.
“You may help someone lose 10 pounds, but what happens six months down the road during a stressful event? Life is going to happen, so our objective is to help people develop the skills to selfmanage, to be confident about managing themselves down the road," says Schmid.
As in much of health care today, data is central. Vera tracks its own data, plus uses third-party software to access claims outside of Vera. “Since we are contracting with employers on top of their health care plans, we have captive audiences. They are microaudiences, actually. We have access to their employee claims data and can slice and dice that data to target groups with which we can make the biggest impact,” says Schmid. They look at risk stratification levels, targeting risky and costly patients. But even with the ability to segment their micro-populations, Vera concentrates on engaging 100% of them. “We can have specific messages or treatment plans by group. It is really exciting that we can take the best practices in population management and apply it to these micro-groups,” he says. Time and again, Vera makes the biggest impact on the higher-risk patients with the highest health care costs—bringing down costs by improving their health and helping them thrive.
AWARENESS AND EXPOSURE
Schmid reminds us that the non-users of medical care are not necessarily healthy. In fact, often they are an emergency medical situation waiting to happen. “In some cases, close to one-half of the people on a plan do not generate a claim. Controversially, these stats get translated into the assumption the patients are healthy,” he says. Vera discovers, as it begins to engage with these new patients, that many of them are walking around with conditions that are behavioral in nature. He says that when you do finally engage these nonusers, they are often shocked to realize they have skin cancer, hypertension, Type II diabetes, or the like.
Vera’s close proximity to patients enables the clinic to provide more engaged, proactive, and preventive care; the care team is able to get very tuned-in to the effect daily life is having on their patients’ health. “Our providers are so connected to the organizations and their people. We treat each company as its own ecosystem. And due to our proximity, awareness and exposure are fundamental parts of our business model’s success,” says Schmid.
Doctors like this model of primary care because they are able to spend more time engaging with each patient, averaging 8-10 patients a day. They feel they are being paid to do what they wanted to do in the first place—take care of people, not adhere to production quotas.
What’s in it for the employers is that they have healthier, happier, and more productive employees. With convenient access to same-day visits and predictable, consistent care, employees are thriving. As for costs, self-funded employers saved 10-12% in their health care costs, with fully insured employers seeing 8-13% in premium reductions. For most companies, the Vera Whole Health benefit is also a great recruiting and retention tool.
“It is a bold statement for an employer to say, ‘We want to take care of you as best as possible,’” says Schmid. He is particularly proud to list Seattle Children’s Hospital as one of Vera’s flagship clients. It says a lot that the people who take really good care of other people believe this model is the best way to care for their own.
*“Everyone Wins When Healthcare Is a Game,” Accenture, accessed May 14, 2014,