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Office Nurses & Text Messages – The New Face of Chronic Care

With chronic diseases such as diabetes and hypertension accounting for more than 65 percent of all corporate healthcare spending, these companies have cleverly turned these clinics into channels for reaching and engaging chronically ill or at-risk employees and influencing their behavior.

When I was at PacifiCare Health Systems in the late 90’s, I can recall—very rarely—coming across worksite clinics at large employers.  The care they delivered was pretty basic:  Band-Aids, Tylenol, treatment for simple workplace injuries, etc.  Still, we were often called upon to find a way to integrate their care delivery into the benefit plans we were implementing.

Lauren Weber’s Wall Street Journal article, “The Office Nurse Now Treats Diabetes, Not Headaches,” makes it clear that these clinics are now proliferating at a rapid pace, with 28 percent of large employers using them. The model has evolved substantially as well.

Ms. Weber discusses how, with chronic diseases such as diabetes and hypertension accounting for more than 65 percent of all corporate health-care spending (according to a 2012 Aon Hewitt report), these companies have cleverly turned these clinics into channels for reaching and engaging chronically ill or at-risk employees and influencing their behavior. Clinic operators call and email employees to bring them into the clinic and offer everything from blood and glucose tests to nutrition and lifestyle coaching.

It’s a great approach—taking on the massive issue of chronic disease spending by better reaching the employee onsite and better engaging them through relevant, convenient services.

Outside The Office

In addition to onsite clinics, many employers work with population health management companies to help their employees manage chronic diseases and keep healthcare costs down. These organizations typically provide a wide-range of solutions that include health coaching and counseling, online tools, case management and more. The goal is to help employees improve and maintain their health and reduce inappropriate use of health care resources.

Proactively communicating with employees wherever they are – at home, at work and on the go – is essential to successfully managing chronic conditions. Population health management giants, including Healthways, Alere, ActiveHealth and Carewise, work with Varolii to augment the support provided by nurses and healthcare coaches with text messages, emails, smart phone push notifications and automated voice reminders.

They’re very strategic about how they employ each type of outreach, leveraging automated “channels” to improve program enrollment and remind employees about appointments, medications, screenings and tests. Interactive phone surveys are used to assess employees’ understanding of how to manage their health and gather data on blood pressure, weight and glucose levels.  Within each automated interaction are options to easily transfer to a live staff member.

Leveraging technology to cost-effectively facilitate routine interactions frees skilled, expensive resources, like nurses, to handle more complex conversations, including coaching and counseling sessions and in-clinic services.

This methodology extends the reach of programs in terms of absolute numbers while also engaging a more diverse demographic set. By expanding the mix of communication channels and taking into account individual preferences, the appeal of the programs is increased. Employers and health management organizations can drive better care, improved outcomes, and reduce the overall utilization of expensive heath resources.

And consumers are happy to engage with communication technologies. A recent study, “Engaging the Healthcare Consumer and Improving the Patient Experience,” conducted by Wakefield Research for Varolii, showed that patients enrolled in diabetes, COPD, smoking cessation or other health and wellness programs are highly receptive to digital interaction, with 46 percent desiring email, 27 percent preferring text messages, 15 percent selecting automated voice and another 15 percent choosing smartphone apps as their preferred communication channel.


As just one example, a leading population health management organization Varolii works with saw a seven-fold increase in initial engagement and a 50 percent boost in chronic program enrollment using automated channels to reach employees.

I’m encouraged by the innovative ways we’re making care and health information more convenient for Americans – and improving the efficiency and productivity of these programs while making strides toward reducing inappropriate or unneeded utilization.  Merging the two approaches of worksite clinics and automated outreach seems like a winning proposition for health management.

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Vance Clipson

About Vance Clipson

Vance Clipson, senior principal, industry solutions for Nuance Communications, focuses on vertical-specific strategy and marketing with an emphasis on healthcare, financial services and government. Clipson brings 25 years of experience translating industry needs and data into market strategy and programs for Milliman, PacifiCare Health Systems and other organizations.