University of Delaware's Health Coaching Certificate recipients' presentation. Mike Peterson, top left, Kathleen Matt, Dean of College of Health Sciences to his left; faculty members, Katherine McCleary, Emily Davis, students.
Motivated by a recurring lament among local physicians and health professionals that patients weren’t following through on certain behaviors, the University of Delaware (UD) launched its first Health Coaching certificate program in 2011, and honored its first two recipients at a ceremony this past May. The 18-credit hour post-baccalaureate program prepares health professionals to work in a clinical setting as part of a team that facilitates behavior change among at-risk patients, decreases demand for healthcare services, and reduces morbidity across the life span.
To create this program, curriculum leaders consulted the Delaware Health Sciences Alliance, which comprises the UD, as well as the Christiana Care Health Systems, Alfred I. DuPont Children’s Hospital, and Thomas Jefferson University, a Philadelphia-based medical school. The school received valuable insight from a team of local physicians and health professionals, including nurses, clinical psychologists, nutritionists, behavioralists, and pharmacologists on perceived needs and deficiencies in the healthcare system, and the kinds of skills and competencies they would like to see in a health coach.
According to the report “Market Demand for Certificate Programs in Health Coaching,” from the Education Advisory Program in Washington, D.C., which stated that employer demand for health coaches has grown 408 percent since 2007, with the number of health coach job openings peaking a year after the ACA was passed.
And the top five skills sets employers are seeking in health coaches? Case management, disease management, motivational interviewing, chronic disease, and clinical experience.
Following is our discussion with Mike Peterson, chair of UD’s Department of Behavioral Health and Nutrition.
HIN: What prompted you to offer this program now?
Mike Peterson: We created it to address the primary determinate of health, which is behavior, which accounts for about 40 percent of morbidity, according to the World Health Organization (WHO). Most doctors, because of the current health system, can only spend from seven to 15 minutes with a patient, which really isn’t a lot more than diagnosis and treatment.
The other thing is that most medical professionals, doctors and nurses don’t get any behavioral change expertise, knowledge or skills. They are trained in diagnostics and prescriptive treatment.
HIN: What insights did you receive from physicians and health professionals regarding skill sets and competencies needed for the certificate?
Mike Peterson: They have to have case management, disease management, and motivational interviewing experiences or knowledge. They have to have a basic understanding of chronic disease, which we provide; a course that covers about 20 of the major, common chronic diseases, their ideology, their treatments, diagnosis, pharmacology. They have to understand how to change people’s behavior, have good communication skills and a good working knowledge of basic health promotion and health education principles.
There’s clearly a skill set that’s currently not being taught in the other health disciplines. How do you extract information? How do you work with an individual? How do you motivate an individual? How do you communicate with them in a way that actually gets them to do the behaviors that are necessary to improve their health?
HIN: What recommendations were made on motivational interviewing techniques?
Mike Peterson: Motivational interviewing is important, but it doesn’t work in all cases. It’s somewhat oversold as a panacea for all problems. It’s a good tool to have but not every problem is a nail. Sometimes you need other tools in your toolbox to facilitate behavior change. So we teach other types of behavior change strategies as well: the use of contracting incentives, things to help facilitate and promote behavior change.
HIN: You would like to see health coaches affiliated with doctors’ offices and clinics. Should they be embedded or co-located in the practice or clinic?
Mike Peterson: Yes. We’re trying to get them placed right in the clinical office and become part of the healthcare team, for example, the medical home model where the doctor is in charge and the health coach is part of that team. We see health coaches not necessarily dealing with every patient a doctor has, but the primary, high-risk patients, or people of moderate risk who could have potential for high risk.
HIN: What about reimbursement for them?
Mike Peterson: That’s a good question and the one we’re all wrestling with right now. There’s been a shift in the demand for health coaches from payors to providers; we are seeing health coaches paid right from the insurance industry or hospital; they see that the coach is a good idea and so they decide to fund them privately within their own coffers. And under the new healthcare bill doctors are paid for outcomes. If they get better outcomes with patients they get a percentage of the potential savings reimbursed back to them. Some of those funds could be used to fund a health coach.
HIN: What insights did you receive on recommended caseloads for health coaches?
Mike Peterson: Ideally, if you have a 40-hour work week, about 25 hours could be engaged in client time, one-on-one face time. The other 15 hours would have to be a record keeping and perhaps telephonic communications with previous patients or communications with the medical staff about what’s going on with specific patients. So we figure in any week you could see 25 individuals.
HIN: How can health coaches help to improve care transitions, from hospital to home?
Mike Peterson: Again, going back to their primary role, which is helping people deal with behavior changes, their role in terms of transitions from hospital to home would be to follow up with some of the behaviors that they would need to do, such as out-clinic or out-patient activities. For example, if they just had physical therapy following a knee replacement, it could most likely be due to their being overweight. Health coaches could help them maintain a physical therapy program, and also help them with strategies to lose weight. They would work in tandem with the patient and healthcare professional.
HIN: Where do you see the profession of health coaches in the future?
Mike Peterson: Ultimately, we would like to see health coaches licensed, because too many people now are calling themselves health coaches and not anyone knows what it is. Someone says they’re a health coach and they deal with ADHD and another person says they’re a health coach and they deal with personal training, so they're basically a glorified personal trainer.