3 Health Coaching Models for Behavior Change

Thursday, October 1st, 2009
This post was written by Melanie Matthews

Roger Reed, chief consumer engagement architect for Gordian Health Solutions, describes three key health coaching models that engage patients and bring about successful behavior change.

As we move down this path toward “health coaching 3.0,” we note some of the foundations that have to be in place before you can develop a good model of engagement and behavior change through coaching. Some models having more impact than others are stages of change or transtheoretical model, which has been around for quite some time; positive psychology, patient activation and the enhanced collaborative care model. The components of a successful coaching model are going to blend all of these things with self-efficacy and risk perception, values, experiences, barriers and resources. In fact, there have been several researchers over the last decade who have tried to create a unified theory. Ralf Schwarzer attempted that in Germany, and Michael O’Donnell did some work in that area as well. You try to envision a person holistically, and look at how all of these theories come into play for any particular individual. We’re not quite there yet, but it’s an interesting mental exercise.

Positive psychology is a new field of psychology developed by Martin Seligman, probably the preeminent psychologist in the world today. Positive psychology is the study of the conditions or processes that contribute to the flourishing of optimal functioning of individuals, families, groups and organizations. His research has proven that personal belief, optimism and strength, which is a sense of personal control, are protective factors psychologically for mental health, and physically for physical health. He has a full array of information around building on strength, helping people learn optimism and take control of their lives.

Dr. Judith Hibbard can be credited with the Patient Activation Measure™ (PAM), which stages a patient or participant across four stages. If you can figure out where this person is using the PAM survey instrument, that gives you insight into the strategies you need to employ for that person, for their education and support. That’s a promising new area of study.

David Wennberg at Health Dialog has published a white paper on the enhanced collaborative care model. Its model is based on shared decision-making, when all options are known and considered, including advanced analytics for outreach and coaching. In a one-year study, they randomized 170,000 people and put them through this enhanced collaborative care decision-making support coaching model. It showed a decrease in hospitalizations and a reduction in medical expenses, and much of the savings that they measured came from preference-sensitive conditions. Those are conditions in which the individual, knowing all the facts about treatment options, made a decision based on their life preferences for a specific treatment modality. In terms of analytics, ROI and metrics, we’re all marching with Healthcare Effectiveness Data and Information Set (HEDIS) measures and URAC and National Committee for Quality Assurance (NCQA) measures that have denominators around specific evidence-based guidelines. When you start moving into areas of preference sensitivity, you’re going to have individuals who elect not to follow an evidence-based guideline because of the potential impact it would have on their future health or future social well-being. They may in fact choose a method of treatment that isn’t evidence-based, because that’s their preference. That starts to raise questions: Do we have the right denominator in that situation? What would the metric be if that individual’s choices are personalized for themselves?

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3 Health Coaching Models for Behavior Change

Thursday, October 1st, 2009
This post was written by Melanie Matthews

Roger Reed, chief consumer engagement architect for Gordian Health Solutions, describes three key health coaching models that engage patients and bring about successful behavior change.

As we move down this path toward “health coaching 3.0,” we note some of the foundations that have to be in place before you can develop a good model of engagement and behavior change through coaching. Some models having more impact than others are stages of change or transtheoretical model, which has been around for quite some time; positive psychology, patient activation and the enhanced collaborative care model. The components of a successful coaching model are going to blend all of these things with self-efficacy and risk perception, values, experiences, barriers and resources. In fact, there have been several researchers over the last decade who have tried to create a unified theory. Ralf Schwarzer attempted that in Germany, and Michael O’Donnell did some work in that area as well. You try to envision a person holistically, and look at how all of these theories come into play for any particular individual. We’re not quite there yet, but it’s an interesting mental exercise.

Positive psychology is a new field of psychology developed by Martin Seligman, probably the preeminent psychologist in the world today. Positive psychology is the study of the conditions or processes that contribute to the flourishing of optimal functioning of individuals, families, groups and organizations. His research has proven that personal belief, optimism and strength, which is a sense of personal control, are protective factors psychologically for mental health, and physically for physical health. He has a full array of information around building on strength, helping people learn optimism and take control of their lives.

Dr. Judith Hibbard can be credited with the Patient Activation Measure™ (PAM), which stages a patient or participant across four stages. If you can figure out where this person is using the PAM survey instrument, that gives you insight into the strategies you need to employ for that person, for their education and support. That’s a promising new area of study.

David Wennberg at Health Dialog has published a white paper on the enhanced collaborative care model. Its model is based on shared decision-making, when all options are known and considered, including advanced analytics for outreach and coaching. In a one-year study, they randomized 170,000 people and put them through this enhanced collaborative care decision-making support coaching model. It showed a decrease in hospitalizations and a reduction in medical expenses, and much of the savings that they measured came from preference-sensitive conditions. Those are conditions in which the individual, knowing all the facts about treatment options, made a decision based on their life preferences for a specific treatment modality. In terms of analytics, ROI and metrics, we’re all marching with Healthcare Effectiveness Data and Information Set (HEDIS) measures and URAC and National Committee for Quality Assurance (NCQA) measures that have denominators around specific evidence-based guidelines. When you start moving into areas of preference sensitivity, you’re going to have individuals who elect not to follow an evidence-based guideline because of the potential impact it would have on their future health or future social well-being. They may in fact choose a method of treatment that isn’t evidence-based, because that’s their preference. That starts to raise questions: Do we have the right denominator in that situation? What would the metric be if that individual’s choices are personalized for themselves?

Related Posts:





Comments are closed.