High tech to high touch: Taking aim at Type 2 diabetes with virtual coaches
Candace Shaffer had a real challenge, and the only fix was a virtual solution.
When she was named director of benefits for Purdue University last October, Shaffer was tasked with two priorities: tackling chronic diseases, and improving the access of care to the state college’s 12,000 faculty and staffers on three campuses in four locations, with extension programs in all of Indiana’s 92 counties.
It was a challenge that required new partnerships, cutting-edge tools and novel ways of tackling a problem. From high tech to high touch, the Purdue graduate and employee benefits veteran — and EBN’s Benefits Leadership in Healthcare winner — is poised to see the results of her vision.
After being promoted to benefit director following her stint as interim director, Shaffer’s first target was Type 2 diabetes. “It’s one of our top chronic diseases in prevalence and cost,” she says.
Shaffer and her team of around 25 benefits professionals determined that Type 2 diabetes was one of the easier chronic diseases to address because of the multitude of health programs that address the condition through diet, exercise and lifestyle change.
“There are lots of [solutions] out there, so it seemed it might be easiest to start to tackle and then move on,” she says.
After reviewing several health plans that attempt to reduce the risk of Type 2 diabetes, her benefits team partnered with Virta Health to provide online coaching to faculty and staff members. Virta Health aims to reverse the disease without the use of drugs or surgery, relying on virtual coaching to spur program participants into healthy habits.
Type 2 diabetics and pre-diabetic individuals who are interested are advised to adhere to a ketogenic-based diet (low in carbs, high in protein). They receive a scale, literature and nutrition guides and other supplies to help them transition to that way of eating, she says.
Participants can interact with a Virta Health coach via telephone, mobile app or Skype. “You get assigned a coach who works with you on making that shift in lifestyle, and then [you] work on maintaining that lifestyle,” she says. “The focus was Type 2 diabetes or pre-diabetic with a certain BMI.”
According to Virta Health, who nominated Shaffer for the Benny Award, when Purdue signed up for the program, its plan was clinically sound but not yet commercially proven. So far, Shaffer is hearing that the results have been positive and promising.
Of those Purdue employees who enrolled in the Virta Health program, 43% of the high/very high risk diabetics have improved risk comparing higher than those not engaged at 35%. Thirty-six percent of those with a BMI greater than 30 in 2017 have decreased their BMI category in 2018, and 45% of participants with an uncontrolled blood pressure in 2017 have decreased their BP into a controlled range in 2018.
“What we’ve gotten back from employees and Virta is that it’s going well,” Shaffer says. “People are excited and they’re getting healthier.”
Shaffer and her team are not stopping at Type 2 diabetes. They are making plans to improve faculty and staff access to mental health services as well.
“We have employee assistance program system-wide and that doesn’t seem to be a problem,” she says. “The problem is [with] folks who need longer-term counseling. There seems to be a shortage in most of the communities where our employees live with their families.”
Shaffer, who graduated from Purdue with a bachelor’s degree in child development and a master’s in family studies, notes that mental health services have been a growing concern for the state college’s student population, which is covered by a separate program.
“Is there anything to do together to try to get at mental health as a whole? This is something that we’re trying to do, and we’re just now starting to figure that out,” she says.
Shaffer’s second major initiative was improving the primary campus’ onsite clinic. Starting last July, the university partnered with One to One Health, a physician-led healthcare facility management provider based in Chattanooga, to operate the Center for Healthy Living facility on its West Lafayette campus.
Employee engagement with the clinic has increased, and One to One Health has added additional wellness programs. Clinic medical personnel interact and consult with the employee’s primary physician to coordinate care and diagnoses. Just as importantly, the newly energized clinic now accepts walk-ins.
“Before, if you didn’t have an appointment, it was a couple days before you could get one. One to One Health’s management has figured out how to take in walk-ins,” says Shaffer, adding that the school is looking to expand the clinic’s hours and offer train-the-trainer wellness programs.
Capacity from the first quarter of 2018 improved more than 30% year over year, driving a better than 90% satisfaction rate among patients. These results and the positive feedback have spurred Shaffer to offer Purdue employees telecare options in all of the Hoosier State’s 92 counties.
“We still want them to be able to have access to that coaching relationship if they’re willing to do that, and so they can now do telephonic coaching, too,” she says.
Shaffer and her team are constantly checking the results of their initiatives, whether it’s a new clinic management group, the Type 2 diabetes program or the school’s HSA, FSA and other wellness plans.
“Just because you implement something doesn’t mean you stop. We’re always checking and rechecking and auditing. If performance guarantees are applicable with some vendors, we are making sure that they’re doing their part,” she says. “We get constant feedback from employees and from our own internal staff, so it’s an ever-moving process.”
Spreading the word
One of the challenges in delivering innovative healthcare services is not just creating the programs, but also in informing faculty and staff that they are up and running and available. As in a corporation with multiple satellite offices, some Purdue University plan participants are often unaware that certain services are available in the first place. Telling Purdue employees that they have access to family-friendly benefits, including pre- and post-natal care, that they have four options for flexible work arrangements, plus paid parental leave as well as flexible spending accounts and health savings accounts is a full-time job.
“We have [employees] coming straight from high school or college at 18 or 22 all the way to active employees who are in their 70s and 80s,” she says, noting that benefits communication and education is key.
When asked what she loves most about her job, Shaffer says it’s working with her team.
“We hold each other accountable. We’re very transparent and honest about what’s working and what’s not working, and nothing gets left off the table. You can put any suggestion out there,” she says. “When you have that attitude, you can do lots of great things. We’ve been able to do a lot in the last few years, since I’ve had the opportunity to have this position. It definitely would not be possible without all those folks.”