Health coaching is becoming more popular because of the realization that physicians can't do all the things expected of them - they don't have the time, and it doesn't make sense from a financial point of view.
“Put me in coach, I’m ready to play,” are opening lines to the chorus in John Fogerty’s hit song Centerfield. The song has become a staple as background music to a host of baseball highlight reels. And it might not be long before those lines are heard in more than a few physician offices.
If that happens, the credit would go to health coaching, the process by which clinicians help patients gain the knowledge, skills, tools and confidence to become active participants in their care. It’s a process that works. According to a report by the Iowa Chronic Care Consortium, 88% of professionals trained in health coaching reported an increased ability to engage patients as a result of the training.
And in so doing, positively impact their medical practice’s bottom line.
“Health coaching helps to drive patients into primary care settings for preventative visits, for closing care gaps, for managing chronic conditions,” explains William Appelgate, PhD, executive director of the Iowa Chronic Care Consortium. “What happens, then, is you accelerate the business of that practice. Through labs and office visits, you can dramatically increase practice revenue.”
Appelgate says the concept of health coaching is becoming more popular because of the progressive realization that physicians can’t do all the things that are expected of them. They don’t have the time, and it doesn’t make sense from a financial point of view. There is also the realization that “we’re not going to get to where we need to be in health care until we inspire patient accountability.” That’s where health coaching comes in.
The aim of health coaching, also called team-based care, is to replace care that is episodic and initiated due to patient illness with care that is coordinated, continuous and proactive. Stephen Eckstat, DO, former physician leader of primary care for Mercy Medical Center in Des Moines, has extensive experience incorporating health coaching into his practice.
Instead of one-on-one care, Eckstat says they are managing populations of patients—primarily those with chronic disease. Though just 20% of patients, they spend 80% of the money, he points out.
“I think the best invention we ever came up with was the health coach, realizing that we need someone to work the registry, we need to know who these people are, and we need to get in touch with them and bring them in and do what we do best as physicians,” Eckstat says.
Working the registry
Eckstat says the first thing his health care organization did was develop a registry, which he calls the essence of managed care.
“To manage chronic disease you have to have a registry,” he says. “It’s the essence of knowing where your patients are, and who needs to come in and be seen.”
Once his staff started working with the registry, they realized that there were a lot of patients who hadn’t been in for quite some time, and who were not in control. They began reaching out to those patients and in a very short amount of time — six months to a year — those patients’ health numbers were phenomenal. For example, the hemoglobin A1Cs, the blood pressures, were improving sometimes as much as 50% or more.
“The story I tell is that the doctor did not get 50% smarter to get that kind of increase in outcomes,” Eckstat says. “It was the fact that we identified the patients who needed to be seen and brought them in. But we had the health coaches do pre-chart review. All the things that had to be done for the patient to improve their quality of care, and their outcomes, now we had a team member that was doing all the pre-work and getting everything ready.”
Numbers do the selling
Eckstat says there was a lot of resistance at his clinic system when the topic of health coaching was first broached. The clinic, he explains, was on a virtual private practice system, meaning that everyone is employed, but that each clinic is its own cost center, so they could make their own decisions about how many nurses they wanted per physician, and so on.
“The docs were pretty reluctant when we came in and told them to use a health coach; to hire them as another body,” Eckstat recalls. “But we had a few folks who took a leap of faith and, sure enough, it turned out that the health coaches paid for themselves within a matter of days.”
Since then, Eckstat says the word “noncompliant” has been removed from the clinics’ lexicon.
“There’s no such thing as noncompliant patients,” he says. “It’s only patients for whom we have not yet met their needs. It’s our job to meet their needs. And health coaches are an essential ingredient to doing so.”