As part of the Alternative Payment Model (APM) Pilot, clinics have been taking part in a learning collaborative focused on Advanced Care Models (ACM). This blog is going to profile some of the ACM topics being discussed by the group and how the clinics are going about implementing new approaches.
What if the person giving you medical advice was more like your friend or a trusted mentor and you weren’t limited to 5 minutes? That’s the idea behind an approach called “health coaching” that is spreading in the world of primary care to help patients understand their chronic conditions and learn self-care.
Health care has four principles that are considered the “golden rule” of ethical care: beneficence, non-maleficence (i.e., do no harm), respect for patient autonomy, and justice. Many have said that our current system of care does not allow doctors and other health care providers to actually achieve these four principles—and that’s one of the reasons some systems are establishing health coaching for their patients.
Too often, it is low-income or ethnic minority patients who have the most barriers to understanding clinical information provided by a physician. Coaching shifts the care model—instead of a brief visit with a clinician being the source of all information, the critical health information comes from a support person, who is given more time, is trained in communicating well, and can make a personal connection with the patient.
What Is Health Coaching?
The essential idea behind health coaching is to help patients gain the knowledge, skills, tools, and confidence they need to actively take care of themselves. Because physicians, nurse practitioners, and physician assistants typically see patients for a very short amount of time, health coaching is done by another member of the care team. Health coaches might be nurses, clinical pharmacists, health educators, trained medical assistants, or even other patients (called peer coaches). Patients identify their own health goals during the process so they are invested in making healthy decisions, and the primary care doctor and health coach coordinate their messages to the patient.
Coaching is more complicated than a physician cheering with a bull horn from the sidelines. A training session presented at a recent Advanced Payment & Care Model learning collaborative broke health coaching down into five areas: understanding, knowing the numbers, shared decision making, behavior change, and medication adherence.
- One reason that people do not follow doctor’s orders is they simply do not understand what they are supposed to do. In some studies, almost 50% of the people repeated doctor’s instructions incorrectly. A health coach asks the patient to repeat the instructions and clarifies the correct home care and medication directions, creating a feedback loop.
- When patients know their HbA1c (a measure of diabetes), blood pressure, and cholesterol numbers, they are more likely to act to change them. Health coaches make sure patients know their levels and know how to get from their current numbers to their goals.
- Shared decision making leads to more engaged patients. Coaching takes more of a question and answer format to explain what the patient really needs to know and do.
- Changing unhealthy behaviors takes more than just being told information such as “eat less sugar and exercise 30 minutes day.” A health coach helps patients set realistic target goals and find of plan of action at which they can succeed. This kind of dialogue takes more time than a clinician has for the typical office visit.
- A patients do not take their medications as directed or at all. Going back to the first goal of health coaching, coaches start by making sure a patient understands how to take their medication. A health coach also establishes a relationship of shared decision making since it is one of the most important contributors to successful medication adherence.
Peer coaching, instead of coaching by a clinician or nurse, has proved effective in helping patients care for themselves. The idea is that patients can learn from their peers more effectively because they can offer empathy and support, act as a positive role model, and advise others how to handle the challenges of self-care. In fact, one study showed that peer coaches in a diabetes management program also improved their own care. That is encouraging news for clinics who are thinking of adopting a peer coaching program for their population.
Several of the clinics in the APM Pilot are discussing how to incorporate health coaching into their models of care. The shift in payment model has allowed clinics the flexibility to think about care as a whole picture. And in fact, they will ultimately be measured on the health of their population. Health care teams are hoping that health coaching is one way to potentially improve the health of even more patients.
(For more information and resources visit the Oregon Primary Care Association’s Alternative Payment & Care Model Resources page.)