VetAdvisor, the nation’s expert in veteran-centric holistic care, has rapidly expanded its reach to military veterans through its recent deployment of the SugarCRM customer relationship management (CRM) platform. Leveraging SugarCRM’s advanced open source CRM platform, VetAdvisor is able to provide proactive coaching services across behavioral health, wellness, financial, and all aspects of transition and career development.
SugarCRM has proven to be a a force multiplier for VetAdvisor. We are able to expand and scale services that proactively engage veterans at the right time, in the right place with just the right information, Our hi-tech, hi-touch approach reduces costs and improves outcomes in the lives of the veterans we serve. In this article I would like to outline how we have developed an ecosystem of tools around SugarCRM to provide the veterans we work with the kind of coaching and advice they need to re-integrate themselves back into civilian life after their military deployments.
A Veteran Relationship Management Platform
To support this hyper-engaged model of coaching in a scalable way, VetAdvisor looked for a case management solution that was optimized for communication, outreach and automation. Our solution had to be robust enough to allow coaching experts to build and maintain business rules that trigger automated actions and flexible enough to support personalization and customization required to address the needs of diverse group of veterans. The system also had be Open Source with a healthy community of developers so that we could leverage the benefits of the “crowd” to support product vision, standards adoption, and enhanced security. We also needed a platform that could be hosted in the cloud or government datacenter as many of our customers require behind the firewall deployments.
Veterans Relationship Management Ecosystem
Our initial examination of case management software showed that like most early EHR/EMR solutions, the case management systems excelled at collecting, storing and reporting on data, but lacked many of the engagement mechanisms we needed. We wanted a platform that would help us build and maintain a personal relationship with the veterans that we serve. We quickly determined that Customer Relationship Management suites (CRMs) are at their core personal relationship management systems designed to get customers to buy products and services, and to facilitate customer engagement, would be perfect in a coaching context. We selected SugarCRM, an Open Source leader in the CRM sector as our core engagement platform that we call the Veteran Relationship Management platform or VRM.
Because SugarCRM maintains a healthy Open Source community we were able to quickly find development partners that enabled us to customize and harden the default application to meet our needs. Because SugarCRM is open source, we were able to quickly change the sales focus of the workflows and reports to better fit our social services mission. Within a few months of the project start, we were able to stand up a fully functional coaching platform that acted as the central node in a web of services chosen specifically for their ability to safely and efficiently support our veteran focused coaching services. Figure 1. shows our ecosystem of services with SugarCRM acting as the orchestration and rationalization hub.
Why VetAdvisor Coaching
Our nation has a unique challenge and opportunity represented in meeting the needs our military service members and families. Millions of highly trained, well-disciplined, hard-charging doers are transitioning from more than a decade of war into civil society. These men and women are truly America’s next greatest generation, but they face a dizzying array of challenges that unless met head on will dramatically reduce their ability to thrive in civilian life. This is bad for our veterans and worse for our country.
We live in a professional military era where only about 1% of our population volunteers to serve in the armed forces. But as that one percent cycles through their military service those numbers add up. The VA reported that as of 2013 there are approximately 22 million veterans and though that population is forecast to dip below 15 million in 2043 the challenge of providing care to such a large and diverse group is substantial.
Personal, family, and financial strains can result from deployment or lengthy assignment in dangerous locations. Both private and public sector employers, as well as colleges and universities and non-profits, need to ensure that returning service members have access to support services such as VetAdvisor to address behavioral health, family, and personal issues and provide mentoring as veterans transition back into the workplace.
To be sure there are numerous service organizations and care providers, including the Veterans Administration dedicated to meeting that challenge. In fact, a Google search of “veteran care” returns more than 122 million results demonstrating that there are opportunities for those veterans that can find the specific service to meet their need. Still, this highly fractured, increasingly complex ecosystem of Veteran focused programs is an overwhelming and difficult to navigate. That is where coaching comes in.
The VRM proactive care platform
VetAdvisor is the nation’s expert in veteran-centric integrative care. We leverage technology, people and process to proactively meet the veterans where they are, in what Army Surgeon General Horoho describes as their “life space,” that 99.9+% of time when a person is out living their life not face to face with a care provider.
In traditional coaching practices data is exchanged according to a regular schedule of appointments, usually with long planned quiet periods between sessions. VetAdvisor takes a different approach. Our coaches endeavor to meet the veterans where they are, in their life space, to deliver holistic coaching services and to be the navigational advocates most veterans need.
VetAdvisor provides proactive coaching services across behavioral health, wellness, financial, and all aspects of the transition to civilian life as well as career development. Additionally, our training staff works with organizations to help them more effectively recruit, retain, and interface with veterans We believe Veterans need services that are integrated, veteran-centric, proactive and relevant.
VetAdvisor was founded by Dan Frank, a former Navy officer who wanted to start a different kind of company, one that would harness the power of a dynamic business to solve social issues. Guided by this vision of using technology to foster change, Frank built VetAdvisor around the principle of social goodness: the idea that the bottom line is not just profit but also the social value business can provide.
- VetAdvisor comprehensively supports veterans with complex conditions by fostering a culture of emotional wellness as part of our integrative health strategy.
- Our contact centers are staffed with coaches specializing in occupational, wellness, financial, and behavioral health for veterans, active duty, guardsmen, and reservists. Coaching is about achieving the empowerment necessary for veterans to lead a complete life. To date we have held more than 100,000 coaching sessions with veterans and active duty service members throughout the United States and abroad.
How we deliver care
Most veterans today do not rely on the VA for care, so to reach them we need to reach out beyond the brick and mortar confines of the VA medical and career centers into large corporations, universities, state and local programs to establish first contact. We use technology to reach veterans by text, email, phone and or social media and we leverage the fact that more than 70% of our staff are veterans to break down barriers that many programs are unable to cross.
Using modern technologies to reach Veterans
Our coaches use motivational interviewing techniques to help each veteran craft a specific personal plan, with set goals and timelines to address and resolve their challenges. This can include transition and career assistance such as military skills translation, developing and monitoring wellness goals (e.g., sleep management, smoking cessation, weight management), preparing household budgets and credit analysis, and providing non-clinical behavioral health coaching.
Our services are designed to prevent reintegration issues from arising, to provide motivational intervention for those issues that the veteran has identified, and to educate the veteran in order to provide him or her with the knowledge necessary to engage available resources. This personal touch model leads to Navigational Advocacy: the ability to identify, engage, and solve.
The Problem of Scale
Coaching is an inherently personal business that requires a deep commitment to and understanding of the Veterans we serve. Facing a huge population of returning Veterans and flat budgets, VetAdvisor crafted a strategy to allow our service to scale to meet the increased demand for our services at a price point attractive to our customers in the government and private sectors that have invested in hiring and supporting veterans. Our ongoing challenge is to achieve operational efficiencies that allow our coaches to dramatically increase the number of Veterans they serve while maintaining the “high-touch” personalized service our Veterans deserve.
Applying a Systems Approach to Coaching
We believe that the more engaged someone is the more likely they are to achieve the goals they set. When looking at individual engagement across the entire population of veterans in need of coaching we expect something similar to a normal distribution. This means that some Veterans are highly motivated and effective at meeting their personal goals and require very little external support from coaches. Others have a much harder time setting goals and getting motivated and often reject coaching services entirely. Not surprisingly most Veterans fall somewhere in the middle of what we call the Engagement Spectrum. The veterans in the middle of the Engagement Spectrum represent the greatest potential for positive coaching outcomes because they have a high interest in self-improvement but lack the skills or necessary techniques to become highly effective at attaining their goals.
The Engagement Spectrum
To describe a Veterans’s location in the engagement spectrum we established a quantitative metric called Milestone Velocity™ (MV) to represent their performance and engagement at any given point in time. Just as the entire population exhibits a wide distribution of engagement values, so the individual’s engagement value can and does vary in response to a wide variety of factors. Figure 3 shows the engagement spectrum along with three different levels of touch used to represent general levels of engagement.
We use MV scores to drive rules-based, multi-modal engagements that enable our coaches to apply just the right level of support at just the right time. Highly motivated, self-directed Veterans have higher MV scores and require very little in the way of direct coaching services; often a periodic email or text message does the trick. Similarly, Veterans that exhibit a lack of interest in self-improvement (Low MV) are engaged through a combination of phone, email and text messages that best suit their situation. The majority of Veterans, those that are highly interested in self-improvement but are lacking tools and techniques to succeed, receive higher-touch engagements designed to move them into actively engaged category characterized by higher MV scores where less direct coaching involvement is required for success.
Why Track Milestone Velocity?
Coaching is about providing support and guidance to help another make a change in their behavior to achieve positive outcomes. Understanding a Veteran’s Milestone Velocity is essential to providing effective proactive coaching services that result in better plan completion rates and more positive outcomes. We know that behavior change is not easy and to be most effective coaching interventions must be timely and directed to efficiently support the specific goals of the client.
Measuring Milestone Velocity
In most coaching scenarios, the coach and the client establish a set of goals and a personal plan to help the client to reach those goals in a specific time period. Each personal plan has a series of tasks and milestones that must be met according to an agreed schedule. At each encounter with the client, in person or through automation, the date and MV value is recorded in their case file. Each time a new MV figure is calculated the old value is stored thus providing us a Velocity Trend (VT). By comparing the Veteran’s current MV against their VT we can represent current performance and determine if engagement is waxing or waning and what level of outreach/coaching intervention is required. Figure 4 provides a visual representation of how changes in Milestone Velocity values drive proactive engagement.
Research by Lally from University College London indicates that it takes approximately 60 days to form a new habit, that early repetitions are most beneficial and simple behaviors likely take less time to habituate than more difficult or strenuous behaviors. Like habits, memory retention is similarly improved through spaced repetition techniques that use repeated sessions at varying intervals from short to long as the number of sessions increases. VetAdvisor uses these principles to schedule coaching interventions at optimal intervals based on expected performance and we add interventions based on observed MV so that we can immediately address behaviors that do not support stated objectives in the veteran’s personal plan. We use this technique to drive higher plan completion rates and better outcomes than was previously possible.
Proactive data driven care
Quantified Self Data Supports a Milestone Velocity Approach
Real time, proactive coaching relies on good data that is readily available, consistent and understandable. VetAdvisor recognized the potential value of consumer oriented biometric sensors (wearables) and moved quickly to incorporate them into our coaching protocols. The growing Quantifed Self trend combines self-tracking with discovery and used properly will likely be a key tool in understanding the decisions and behaviors made in a person’s “life space”. From Smart phones to advanced pedometers, watches and sleep monitors the list of biometric devices and mobile self-tracking apps keeps growing as does the numbers of those interested in the benefits of self-tracking.
Self-tracking applications and devices offer a unique opportunity to coaches and clients alike. Nearly all self-tracking applications include a social component that allows the user to share their data with a community of their choosing.
The idea of measuring things to chart progress is not new, but gathering and measuring data to improve the lives of individuals is a relatively new phenomena. We take seriously the marriage between technology and self-improvement, and offer various tools for the quantified self that we believe are the future of health care and can help prevent disease, prolong lives, and reduce medical costs.
Self-monitoring devices allow data to be shared through social media, and offer message boards and groups where friends, coworkers, or peers can exchange encouragement and information. These devices additionally allow for proactive intervention and notification.
Once a veteran opts to share their performance data with their coach, VetAdvisor’s coaching platform ingests that data and feeds it into the MV algorithm used to trigger alerts, drive workflows, game mechanics, automated outreach and scheduling live coaching encounters. The ability to consume and use performance (activity, sleep and nutrition) data from the latest biometric devices and from less structured data on the social web dramatically changes the coaching conversation from one that is episodic and subjective to a more objective real/right time engagement.
For example, a veteran dealing with sleep management might be provided a sleep monitor that automatically transmits information to our Veteran Relationship Management platform. If the monitor shows a pattern of sleeplessness over three nights, a notification is sent to the coach, who then contacts the veteran to discuss next steps.
Devices such as these are proven to increase adherence and motivation. As health-care costs increase, there is likely to be a greater emphasis on monitoring, prevention and maintaining wellness, with patients taking a more active role—an approach sometimes called “Health 2.0.” While we also offer comprehensive coaching services to those who wish to remain “unquantified,” VetAdvisor is proud to be an innovator at the leading edge of this approach to preventative care.
Our clients are responding well to the use of wearables in the coaching context. They appreciate the shift away from the subjective towards a more objective, data driven and relevant engagement with their coach. As clinicians and other healthcare practitioners become more familiar with and appreciative of the data produced by wearable sensors, we will add value by providing therapeutic context and relevance by including it in our case reports and Blue Button datasets.
Clearly biometrics play an essential part of our data driven coaching protocols. As new devices emerge in the marketplace VetAdvisor looks for open APIs that allow for secure, client driven data sharing. We support those device manufacturers that emphasize data sharing through robust APIs. To be truly proactive in our coaching, VetAdvisor subscribes to a growing ecosystem of services designed to improve communications with those we serve.
We use Twillio and Upland Mobile Messaging to reach Veterans on their mobile devices, to send relevant messages based on changes in the Milestone Velocity score, to remind them of appointments and to solicit immediate response to questions. If the Veteran’s engagement score fall below a set threshold the system sends a nudge to encourage them to reengage in their plan. Sustained low engagement can drive enhanced outreach that asks for a response. Eg. “We notice you’re not walking as much lately. Want to talk? Reply YES or NO” The VRM ingests the reply, stores the conversation in the case file and uses it to trigger alerts and actions for the coaching team.
Telax’s hosted contact center solution provides Interactive Voice Response (IVR), automated call distribution (ACD) and includes all call quality, monitoring and workforce management capabilities required to deliver robust tele-care services. We implemented Computer Telephonic Integration (CTI) to ensure that callers are automatically routed to their personal coach based on their calling number and coaches screens “pop” directly to the case record as the phone rings. Our shift to cloud based contact center solutions has increased our agility as a business, we can now rapidly expand our coaching services by adding coaches throughout the country with minor incremental costs.
Our use of the innovative TroopID (ID.me) service, reduced military service verification times from weeks to hours or even minutes. ID.me provides a robust membership and affiliation confirmation service that enables VetAdvisor to quickly confirm that our clients are veterans. Beyond verification, ID.me’s affiliate programs and discounts for veterans allow us to rapidly and cost effectively incentivize our clients to achieve their goals.
Coaching relies heavily on assessments and questionnaires. We chose Clicktools as our survey and assessment Platform as a Service. We deliver our call scripts, assessments and surveys via Clicktools and all data is directly posted into the VRM through published SugarCRM endpoints. Clicktools enables us to respond to the needs of each client by varying the amount of coach driven interaction from very hi-touch, coach delivered assessments to entirely self-reported results depending on the need and preferences of the veteran.
What the future holds for VetAdvisor’s VRM
VetAdvisor has realized significant operational efficiencies with the adoption of a systems approach to coaching. SugarCRM has been a key driver in achieving those efficiency gains that allow our people to save hundreds of hours each year which directly translates to several hundred additional veterans receiving coaching with the same number of VetAdvisor coaches.
We will continue to leverage technologies that extend our reach and improve delivery of care and better outcomes for our clients. Wearables and other personal sensors provide an increasingly granular picture of our client’s behaviors and decisions made as they work to complete their personal plans. Our goal is to use data to inform a human centric, integrative, holistic coaching service between a veteran and their coach that results in improved outcomes for the client.
We are engaging partners in academia to test, validate and ultimately improve our results. We are expanding our use of Blue Button and FHIR to allow our clients and their providers to gain access to coaching histories as appropriate.
We are expanding our use of open, browser based multi-media standards like WebRTC to add an increased set of functionality and richness to the coaching encounter. Finally, the increasing use of social listening tools and services provide us an opportunity to listen for conversations and public behavior patterns that may be useful triggers for proactive outreach. While it is too early to tell if social listening services are useful or welcome in a coaching context, our hi-tech, hi-touch ethos will continue to drive us to engage our clients on their terms, in their “life space” to provide the better outcomes they deserve.