Integrated Health Coaching: Spanning the Risk Continuum with Health Behavior Change Management
Adam is 40 years old, married, and father to two children. He doesn’t smoke, but he’s overweight, with biometric risks that, if left untreated, could lead to chronic disease.
Sally is 52 years old, married, and mom to two busy teenage boys. She was diagnosed with diabetes five years ago and is diligent about her diet and medication regimen, but she doesn’t exercise and needs to lose 20 pounds.
Bob is 56 years old, suffered a myocardial infarction (MI), has been diagnosed with coronary artery disease (CAD), recently underwent cardiac rehabilitation, but isn't sure he can stay on course.
All three patients require different levels of health coaching, says Dr. Dennis Richling, HealthFitness’ chief medical and wellness officer during a recent HIN webinar, Integrated Health Coaching: The Next Generation in Health, Behavior Change Management. And HealthFitness’ person-centric, integrated health coaching approach addresses participants’ needs across the health continuum — from those needing lifestyle and health behavior changes to those requiring help managing chronic, comorbid diseases, while delivering results via a reduction in healthcare utilization, improvements in clinical and HEDIS measures and a return on investment.
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The integrated health coaching model aligns with many of the key principles of post-ACA care delivery models like the patient-centered medical home (PCMH) and the accountable care organization (ACO), Dr. Richling continues.
He and Kelly Merriman, HealthFitness’ vice president of service delivery, shared key features of HealthFitness' program, from how participants are assessed and assigned to coaches to the program's impact.
First steps include assessing a patient’s health risk factors and using a predictive modeling algorithm to determine patients’ eligibility for coaching, and then matching them with the right one.
“We see our coaching solution as being population-based, so that it’s not a separate silo-type of solution, but a continuum. We did not want a situation where a lifestyle management coach and a nurse worked with an individual at the same time,” explains Dr. Richling.
Which means that Adam, with no chronic disease, but who is at risk and doesn’t know it, will be matched with a health coach. Sally, who is managing her chronic disease, has no other comorbid diseases, but has underlying lifestyle issues, will meet with an advanced practice coach. And Bob, who is not following his care plan, is seeing multiple doctors, and not adhering to medication as prescribed, will see a nurse coach.
Once patients and coaches are matched up, coaches must discern participant values during the coaching intervention, and utilize the art of 'appreciative inquiry' - an essential coaching skill that helps to define an individual's 'exceptionality.'
It’s a step away from the traditional method of disease management to one of active listening, Ms. Merriman says. “We’ve changed the traditional, clinical nurse coaching model by adding the element of positive engagement that really is what motivates people to change,” says Ms. Merriman. By using such tools as motivational interviewing, stages of change, positive psychology and appreciative inquiry, coaches are able to produce change, says Ms. Merriman. And risk is reduced when behaviors are changed.
Ways that technology supports these interactions include monitoring risk and changes in health status and providing information back to the coaches, via a dashboard they can interact with. Providing the patient with tailored educational material is another resource, and even handing the patient off to a more effective source of support, and maintaining strong interactions with primary care and specialist physicians, all lead to reduced risk and utimately reduced utilitization and healthcare costs.
"The keys to a successful population health management offering is effective tools that help align the individual with the right service at the right time," says Dr. Richling. "That type of alignment is really leading to healthier lives in general within a population."
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You'll get to listen to the question and answer session to hear what strategies are working to reach patients/employees and increase engagement in health and wellness coaching, the number of coaching sessions required to be successful, the type of clinical training provided to advanced practice coaches, how to instill a culture of health philosophy within an employee population, the role of advance lifestyle coaches, including exercise physiologists and health educators in an integrated health coaching approach and sustaining patient/employee engagement in coaching.
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