The patient is probably the greatest untapped resource in healthcare, and professionals need to partner with them to improve patient outcomes.
That’s the key premise behind Healthcare 3.0, William Applegate's vision for the healthcare industry, which he shares in Health Coaching's Value in Accountable Care and Medical Homes, a June 19th, 2013 webinar, now available for replay from the Healthcare Intelligence Network.
In this webinar, Appelgate, executive director of the Iowa Chronic Care Consortium (ICCC), discusses how evidence-based health coaching focus drives returns in a value-based payment delivery system, by transforming the conversation between patients and healthcare providers, and ultimately transforming care processes. This helps to build a population health capacity, which is the goal of both patient-centered medical homes (PCMHs) and accountable care organizations (ACOs).
Instead of healthcare professionals being accountable for treating the sick who present themselves, or Healthcare 1.0, or accepting accountability for proactive prevention, education and care management of their patients, or Healthcare 2.0, the future calls for healthcare professionals to inspire accountability at the level of the patient by partnering with them to create a care management plan that prompts improved health behaviors and builds self-care skills, or Healthcare 3.0, says Appelgate.
And where health coaches can step in is by inspiring accountability at the patient level, and proactively caring for lower risk patients so they don't progress to the next level. “Because no matter how good our systems, if we don’t have the partnership and the utilization of that often untapped resource, patients, we are not going to get to where we really want to be,” he says.
What’s responsible for the gap between where we are and where we need to be? he asks. Three things:
- A system oriented to acute disease that isn’t working for patients or professionals when chronic conditions are often most costly and can be managed;
- The misappropriation of education as an end game when patients benefit most from activation to self care;
- Lack of patient skill or accountability in self management of chronic conditions which often lead to high cost.
Ways that health coaches can help healthcare begin to transform itself is by “asking, listening, and inspiring patients to do the kinds of things that they need to do to change their health behaviors, because it is the lack of patient skill, or accountability in self-management that leads to high costs and exacerbations, he says.
Employing population health management practices can also help transform the healthcare field, by realigning payment and incentives towards prevention and value versus volume, and committing to technology for tracking quality and outcomes.
Appelgate goes on to list the competencies primary clinical health coaches need, and ways to pay for them, including the many health plans and Medicaid programs providing care coordination payments for PCMHs, and incentive payments for enhanced outcomes for patients with chronic conditions.
How to find a health coach? Nurses were generally the preponderant pick, said Alicia Vail, R.N. health coach at Ochsner Health System, who trained in clinical health coaching at ICCC and joined Appelgate on the webinar, sharing an overview of Ochsner's health coaching program at eight clinics within its value-based healthcare system.
"The health coaches are utilized within the clinic as a resource to help patients become self-activated, engage and motivated to take an active role in managing their health," Vail says. To overcome barriers to utilizing health coaches, physician and management buy in is crucial, she says. Once the support is established, coaches provide patients with the tools, skills and resources to help them achieve their self-identified goals, and manage their populations via follow up calls, emails, appointments and patient registries. And they track outcomes through HEDIS measures and registries.
But ultimately, the true measure of health coaching's effectiveness remains with the patient, because most healthcare occurs outside the office, Appelgate says.