March 18, 2026
ACHP member OhioHealthy delivers a high-impact Health Condition Management Program that drives better outcomes across six chronic conditions, including diabetes, hypertension and weight management. Powered by coordinated, data-informed care and continuous member engagement, OhioHealthy is redefining chronic disease management through a proactive, outcomes-driven and deeply member-centered approach.
At the heart of this work is OhioHealthy’s Health Condition Management team, a group of dedicated nurse wellness coaches and care managers who support members through personalized, structured coaching. The team meets members where they are, tailoring outreach to individual needs. Members enter the program through multiple identification pathways such as provider referrals, claims analysis, health risk assessments and self‑referrals, ensuring the program reaches those who stand to benefit most.
Once identified, members are contacted for an initial assessment. Regular follow‑up occurs weekly to monthly based on member preference, during which nurse health coaches work with members to set goals, provide education and support behavior change. Most members complete the program in three to six months, with the option to continue longer, if needed. Graduation occurs when care plan goals are met, and both the member and coach agree that meaningful progress has been achieved. The care doesn’t stop there: to measure long‑term impact, members receive surveys periodically post‐graduation to track long-term success.
OhioHealthy’s Quality team closely monitors outcomes tied to the program. Diabetes‑related HEDIS measures, including annual exams, blood pressure control and HbA1c monitoring, are reviewed monthly and reported quarterly to the OhioHealthy Quality Advisory Committee. In the first three quarters of 2025, OhioHealthy saw improvement across all tracked measures, attributing much of this progress to the Health Condition Management Program’s effectiveness and reach.
Despite strong results, the program continues to navigate engagement challenges. Some members hesitate to answer calls from unfamiliar numbers, and some outreach may appear as spam. Even so, clear, detailed voicemails often prompt return calls and successful enrollment. Maintaining consistent engagement can also be difficult for members who prefer in‑person interactions. In addition, some individuals are unaware of their condition or underestimate its impact, particularly before medication is needed. Health coaches meet these moments with strategic education and personalized motivation, helping members understand their risks, activate behavior change and take proactive steps toward prevention.
Despite these hurdles, enrollment and feedback underscore the program’s momentum and success. OhioHealthy has reached more than 7,900 members and enrolled 2,182 participants, delivering a strong 27.47% engagement rate. Feedback is overwhelmingly positive, with members reporting greater confidence in making healthy lifestyle changes, deeper understanding of their condition, stronger control over their health and meaningful progress toward lasting improvement.
One standout success story features a member in his late 60s who joined the hypertension program after receiving his diagnosis. With tailored education, access to appropriate monitoring equipment and ongoing coaching, he successfully graduated. His health coach helped him establish a nearby care team, improving his access to care and identifying new opportunities for physical activity. In the end, his blood pressure was better controlled and he reported improved overall well‑being.
Looking ahead, OhioHealthy remains committed to expanding and refining its Health Condition Management Program to better support members living with chronic conditions. By combining personalized coaching, data‑driven identification and continuous quality measurement, OhioHealthy continues to demonstrate how comprehensive condition management can lead to better outcomes and more empowered members.
