PATIENT OUTCOMES IMPROVE WITH HEALTH COACHING
The American Medical Association recently released a continuing education module to help its members learn about and understand the role of a health coach, and support its members in collaborating with health coaches for the benefit of all parties.
The AMA's stated goal and tagline for this program is: "Help patients take charge of their health, and foster healthier patients with better outcomes."
Here's what the AMA has to say about health coaching:
"Health coaching is a team-based approach that helps patients gain the knowledge, skills and confidence to become active participants in their care. The old saying, “Give a man a fish, and he eats for a day. Teach a man to fish, and he eats for a lifetime” demonstrates the difference between rescuing a patient and coaching a patient. Patients with chronic conditions need to learn how to fish. Health coaching can be supplemented with health literacy strategies and effective communication techniques, such as ask-tell-ask, teach-back and/or action planning to ensure patient comprehension of their care plans and help them achieve their goals."
Within their online learning module (Implementing Health Coaching), the AMA goes on to describe the ways patients benefit when a health coach is a member of their healthcare team.
"Health coaching improves health outcomes by ensuring that patients understand their care plans. Two randomized controlled trials showed improvements in HbA1c and LDL-cholesterol management in patients who received health coaching compared with controls who did not receive coaching. Moreover, health coaching improves medication adherence and increases patients’ trust in their physician. In another randomized controlled trial, patients working with health coaches reported greater satisfaction with their care than patients without health coaches."
American Medical Association | Steps Forward | Module: Implementing Health Coaching
Thomas Bodenheimer, MD, MPH
UCSF Center for Excellence in Primary Care
PHYSICIANS BENEFIT WHEN THEY WORK WITH HEALTH COACHES
In their learning module, the AMA outlines a number of direct benefits enjoyed by physicians who collaborate with health coaches. Here's what they have to say:
"Improved outcomes are a bonus for patient and provider alike. Physicians can rest assured that their recommendations are being communicated in a way that patients can understand and adhere to. Engaged and motivated patients have better outcomes."
The AMA goes on to address the following FAQs that relate to physician practice:
Q: What impact will hiring or training a health coach have on physicians in my practice?
A: Physicians rarely have the time to:
Do collaborative patient education
Close the loop to assess patients’ understanding
Engage patients in behavior-change action plans
These items can be accomplished by a health coach, which can increase available physician time and satisfaction. In a survey of physicians working with health coaches, physicians rated patient visits with health coaches as less demanding than visits without health coaches.
Q. How could a health coaching program impact the business aspects of my practice?
A: Some practices have recognized a positive business case for health coaching. This depends on several factors:
Payment model, for example, a value-based payment model will incentivize focusing on outcomes, which can be impacted by health coaches and other team members
Availability of revenue from patient-centered medical home (PCMH) certification and/or pay-for-performance (CCM Code, Medicare Wellness Visits)
Potential for increased revenue from more visits due to more available physician time
FAQ's addressed by the AMA:
1. Who can be an effective health coach?
"Effective health coaches can have varied backgrounds. Anyone on your care team, including nurses, MAs or even a care coordinator without clinical training, can be an effective coach."
2. What are the goals of health coaching?
"The goal is patient engagement and motivation. Health coaching helps patients build skills they need to take charge of their own health and provides a support system for the teachings to have a lasting impact."
3. How do patients benefit?
"Health coaching is a collaborative approach to care that informs, engages and activates patients to take a prominent role in managing their health. By bridging the gap between the physician and patient, health coaches can help practices improve patient engagement in their care, leading to healthier patients with better outcomes."
4. What does the research show about health coaching?
"Research shows that health coaching has a significant positive impact on patient health. Having a health coach as part of the team may help the practice meet quality metrics, improve patient satisfaction and behavior change and free up physician time."
Research & Papers
References cited within the American Medical Association Steps Forward Module:
Implementing Health Coaching
Ghorob A. Health coaching: teaching patients to fish. Fam Pract Manag. 2013;20(3):40-42. http://www.aafp.org/fpm/2013/0500/p40.html
Thom DH, Hessler D, Willard-Grace R, et al. Does health coaching change patients' trust in their primary care provider? Patient Educ Couns. 2014;96(1):135-138. http://www.pec-journal.com/article/S0738-3991(14)00134-7/abstract
Thom DH, Ghorob A, Hessler D, DeVore D, Chen E, Bodenheimer TA. Impact of peer health coaching on glycemic control in low-income patients with diabetes. Ann Fam Med. 2013;11(12):137-144. http://www.annfammed.org/content/11/2/137.long
Willard-Grace R, Chen EH, Hessler D, et al. Health coaching by medical assistants to improve control of diabetes, hypertension, and hyperlipidemia in low-income patients. Ann Fam Med. 2015;13(2):130-138. http://www.annfammed.org/content/13/2/130.full
Thom DH, Willard-Grace R, Hessler D, et al. The impact of health coaching on medication adherence in patients with poorly controlled diabetes, hypertension, and/or hyperlipidemia. J Am Board Fam Med. 2015;28(1):38-45. http://www.jabfm.org/content/28/1/38.long
Dubé K, Willard-Grace R, O’Connell B, et al. Clinician perspectives on working with health coaches. Fam Syst Health. 2015;33(3):213-221. http://psycnet.apa.org/journals/fsh/33/3/213/
Goldman ML, Ghorob A, Hessler D, Yamamoto R, Thom DH, Bodenheimer T. Are low-income peer health coaches able to master and utilize evidence-based coaching? Ann Fam Med. 2015;13(Suppl 1):S36-S41. http://www.annfammed.org/content/13/Suppl_1/S36.University of California San Francisco Center for Excellence in Primary Care. Health coaching. http://cepc.ucsf.edu/health-coaching. Accessed December 8, 2015.
University of California San Francisco Center for Excellence in Primary Care. Overview of workflow mapping. http://cepc.ucsf.edu/workflow-mapping. Updated 2014. Accessed December 7, 2015.
University of California San Francisco Center for Excellence in Primary Care. Health coaching curriculum. http://cepc.ucsf.edu/sites/cepc.ucsf.edu/files/Curriculum_sample_14-0602.pdf. Updated 2012. Accessed December 7, 2015.
Always Use Teach-back! http://www.teachbacktraining.org/home-of-teach-back-training. Accessed December 8, 2015.
California Healthcare Foundation. Coaching patients for successful self-management. http://www.chcf.org/publications/2008/08/video-on-coaching-patients-for-successful-selfmanagement/terms-of-use/watch-video-on-coaching-patients. August 2008. Accessed December 8, 2015.
University of California San Francisco Center for Excellence in Primary Care. Health coaching protocol. http://cepc.ucsf.edu/sites/cepc.ucsf.edu/files/Health_Coaching_Protocol_14-0603.pdf. Updated 2012. Accessed December 7, 2015.
Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163(1):83-90. http://archinte.jamanetwork.com/article.aspx?articleid=214905
Naik AD, Palmer N, Petersen NJ, et al. Comparative effectiveness of goal setting in diabetes mellitus group clinics: randomized clinical trial. Arch Intern Med. 2011;171(5):453-459. http://archinte.jamanetwork.com/article.aspx?articleid=226822
What is a Clinical Health Coach? http://clinicalhealthcoach.com/what-is-a-clinical-health-coach/. Accessed January 13, 2016.