Who wouldn’t want a coach to help with achieving health goals? According to the 2017 Sanofi Canada health-care survey, health coaching is a popular idea: 61 per cent of plan members expressed interest in coaching around personal health goals.
But is health coaching a worthy investment for employers to include as a benefit for their workers?
Painting a picture
When it comes to participation rates, at least, the results at Owen Sound, Ont.-based Hobart Food Equipment Canada have been promising since it began offering the service a few years ago.
“Our participation rates are above 80 per cent,” says Michael Gauthier, manager of human resources at Hobart. “I’m not sure if it’s about 85. So certainly not everybody, every day, but we have an 80 or 85 per cent participation rate. Somebody along the way is using their services in some form or manner.”
Based on a health risk assessment done a few years ago, the main areas of concern at Hobart were weight management (72 per cent of those assessed were above their recommended weight range), reducing the risk of cancer (69 per cent had a higher cancer risk), helping the 63 per cent who showed a need for improved nutrition and decreasing the risk of coronaries (43 per cent had a moderate to high risk).
Gauthier has had his own experience with coaching. After getting his blood pressure checked, he received feedback from the coach on steps he could take to improve it.
He says the appointments with the coach are short but provide useful information.
“My blood pressure has been quite high, so I started getting my blood pressure taken, where I can tell you if this wasn’t here, there’s no way . . . I’d go and buy a blood pressure thing, much less consider it,” he says of the coaching services.
But what exactly does health coaching look like in the workplace? While coaches can deliver their services in a variety of ways, Jennifer Elia, assistant vice-president of integrated health solutions at Sun Life Assurance Co. of Canada, says doing it by phone makes sense for large, complex companies where having on-site visits isn’t always cost- or time-effective.
“But for some employers, if . . . all employees are co-located under one roof, then there’s an opportunity to have on-site health coaching. It’s more cost-effective with a mid-size company, and there are great organizations that offer these services that we can recommend,” she says.
According to Jason Pollack, director of sales and marketing for Toronto-based workplace wellness provider The Health Team, coaching can also be part of on-site health screening clinics, where employees undergo testing for cholesterol levels, blood pressure and other health indicators that give a picture of a person’s risk for issues such as cardiovascular disease, hypertension, obesity and diabetes.
Coaching typically focuses on what Pollack calls modifiable risk factors and deals with subjects like nutrition, exercise, mental health, smoking and alcohol use. It also includes referrals to further support from a doctor.
“So [it’s about] trying to refer them back to their primary care provider or trying to help them find a primary care provider,” says Pollack.
“And then making sure — if they have high blood pressure, [for example] — that not only are they only seeking out the things that they can change themselves, like nutrition and physical activity, but they can also reach out to a professional who could maybe provide them with medication if they need it.”
Meaghan Jansen, corporate program director and co-founder of London, Ont.-based Employee Wellness Solutions Network, notes the role of in-person services in helping to boost engagement and reach the employees most in need of support. The in-person approach also helps to encourage behavioural change among both employees and their families, according to Jansen.
“That’s what it really comes down to. Because as soon as employees start to change behaviour, they start to see . . . changes to their family. They also — we call it the peer influence effect . . . share their experiences with others and the others get excited about quitting smoking or losing weight or what have you and they tell their peers. Their peers participate, and so we start to see engagement numbers really increase and behaviour change really increase, which, at the end of the day, makes some changes on the other end in terms of driving down some of those health costs that are associated with unhealthy behaviours,” says Jansen.
Like Hobart, Libro Credit Union, which has branches situated around southwestern Ontario, has also seen high participation rates for its health-coaching services.
“[In 2016], we had about 650 staff in total, but we had 457 unique users for our health coaching and, with that, there was a 97 per cent attendance rate,” says Shanna Doyle, benefits specialist at Libro.
Libro has seen some tangible results as well. Between January 2016 and May 2017, it saw 66 employees lose a total of almost 100 kilograms, 246 staff members were working out at least one additional time per week, three workers cut back on smoking, 98 were focusing on sleeping better and 109 were working to reduce stress.
Doyle notes family health is a major part of the health coaching offered.
“So if someone is dealing with diabetes at home, they can give you some recipes and you can kind of talk to them about that stuff. So they can give suggestions on things that you can actually bring home, which is big, because if you don’t really have the support at home, sometimes it can be really challenging for people to continue with their wellness goals,” she says, noting the company has also seen a reduction in sick time of about 16 per cent.
Gauthier says softer, less tangible benefits, such as improved morale, attendance and camaraderie, can also result from a more general focus on health through events like cook-offs and learning sessions over lunch.
“We try to do those types of things, so there’s the knowledge portion of it, there’s the promotion of health and wellness portion of it, there’s also a ‘your company cares’ [element], and it’s a bit of [a situation where] we all get to listen to some speaker and have a nice lunch and hang out together, which we normally would be eating in our cubicles or the lunchroom or a park,” he says.
Gauthier notes the company has been supportive of making the program open to all employees. “I’m really fortunate here, because any other place I’ve been, you’d have to cost-justify it to even get considered. Here, we just do it. We’re fortunate we’re a very well-run and profitable plant. We’re not really nickel and dimed to prove that it’s a benefit. The general thought is if they’re talking to someone and they’re doing something to better their situation, they’ll be here more often. And we generally see that.”
The costs of health-coaching services vary widely, according to Alex Boucher, principal and practice leader for total health management at Mercer. Boucher says that in some cases, health coaching comes bundled as part of a wellness platform and can range from a few dollars per month per employee to hourly rates involving experts.
“The services, too, because of the new digital health evolution . . . try very hard to differentiate themselves, so they’re very hard to compare head to head. So their pricing models don’t even have to compare,” says Boucher.
“But the lowest end to get something is probably in the range of a couple dollars per employee per month,” he adds.
Boucher is seeing some interest among plan sponsors in health coaching, particularly when it comes to prepackaged digital services. In-person coaching is much rarer, he adds.
“There were efforts, in the past, to . . . leverage [employee assistance programs]. There is some health navigation and some health coaching through EAP models, but I think the cost-effectiveness of that is where it becomes an issue. And also, I think one of the factors is that in the Canadian market, individuals are . . . still relatively passive consumers of health. We consume health when we’re ill, as opposed to really being proactive. And so when someone questions us, a lot of people are uncomfortable with that. They’d rather start on their own, and the digital coaching and the prepackaged coaching gives them the expert knowledge without really having to answer for it.”
When it comes to implementing health coaching as an option for employees, Boucher says employers tend to buy the services separately from their benefits plan.
“It tends to be a bundle thing that they buy. It’s not added into a flexible benefits plan yet; it’s more aligned with sort of an EAP. They just buy it and offer it to their employees, so it’s a service they get or a discount service, but it’s not something that they get as part of their insured health plan,” he says.
Boucher notes that while employers tend to offer coaching as something workers can take up at their discretion, there’s also interest in figuring out how to share costs or include the services as a voluntary benefit employees can opt into or out of.
A note of caution
Besides helping to support a happier and healthier workforce, health coaches can also help to create awareness of the benefits available to employees. “To me, that’s where the employee then stays at work, because they’re getting the appropriate coaching that they require,” says Lidia Pawlikowski, a senior consultant for health and benefits at Morneau Shepell Ltd. “And then the coach . . . also provides additional resources based on where the discussion is going.
“And then it alleviates short-term disability claims, which is obviously what the employer wants to see. And to be honest, based on my experience, employees really do want to work. They really don’t want to be off. They want the help; they just don’t know how to ask the questions, they don’t know what to ask. And so that’s why we need health coaching to really help bridge and bring all those components together, when it’s done right, and you have the right training in place, which is really key.”
Employers shouldn’t, however, expect a reduction in disability claims to happen overnight, says Shelly Bischoff, founder and director of Calgary-based health, safety, wellness and disability consultancy Ptolemy & Associates Inc. She doesn’t advocate health coaching — unless the organization has assessed its demographic profile and ensured it’s a real need — and notes success depends on expectations.
“To think that you’re going to see a lowering of a metric related to short-term disability would take three to five years,” she says. “It’s not reasonable, it’s not achievable and, unfortunately, if a client goes into this particular component with that expectation, it’s sad, because they feel like that’s one thing they should see right off the hop, within 12 to 24 months. They don’t see it, and they become disengaged in something that could have been extraordinary if they had just looked at measuring it a different way.”
The key is to temper expectations, she adds: “Your expectations need to be reasonable, and the failure for this particular component or any component for health and wellness programs is dependent on how reasonable your expectations are from a client perspective.”
Tania Xerri, director of the Health Leadership & Learning Network, which is part of York University’s faculty of health and home to the Health Coach Institute, believes the benefit of health coaching lies in the convenience it provides as employees can access health services without have to leave work.
“For people who are in their job and maybe can’t get the time away to travel to the family doctor, wait in the office for two hours and then get back to work, talking to their health coach on the phone, having a quick call, is a lot faster, a lot easier for them,” she says, noting the increased availability in comparison to a family doctor.
“I’m not pointing a finger at primary care at all. I’m just saying they’re not situated to be able to provide that more-care, more-often model like a health coach is, especially delivered right in the workplace.”
Marianne Koh, project manager and course developer at York University’s Health Leadership & Learning Network, notes that part of the role of health coaches is to provide support between doctor’s appointments. And while they can’t replace a visit to a doctor, coaching services can help to reduce the number of future medical appointments by helping people to take better care of themselves, says Koh, who notes there’s no accreditation body for health coaches in Canada.
A catalyst for change
Gauthier has seen the benefits and believes coaching is worth the cost to his company.
“If I drop dead of a heart attack tomorrow or have a heart attack and I’m not returning . . . for six or 12 months because I didn’t know my blood pressure was high . . . what’s that going to cost the company versus spending 20 or 30 grand or whatever it’s costing to have the wellness person in?” he says.
“But if you asked me at my last company, I would have told you it was crazy to spend that kind of money on it. But after two years of seeing it first-hand . . . it’s quite a catalyst for initiating a different culture.”
Ryan Murphy is an associate editor at Benefits Canada.
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