The use of health coaches in a physician-led, team-based care model has been shown to help improve outcomes for patients with chronic conditions such as type 2 diabetes and hypertension. One multispecialty practice explains how they implemented the idea and the critical ways these new team members advance care.
Union Health Center’s history of looking for new ways to help patients stretches back to its 1914 establishment by the International Ladies’ Garment Workers’ Union in the wake of the tragic Triangle Shirtwaist Factory fire. Now recognized as a level three patient-centered medical home, the Manhattan-based practice says its health coaches—all medical assistants—are succeeding in its care model thanks to proximity, flexible scheduling, standardized tracking and evidence-based communications approaches.
Proximity. This is an important element of the practice’s approach, as detailed in a STEPS Forward™ practice improvement module on health coaching. For every three clinicians, there is a designated health coach across the hall to see patients and take a smooth handoff. That first meeting is all about educating the patient on the health coach’s supportive, long-term role in care. The health coaches work with patients treated by primary care physicians as well as those referred by Union Health Center specialists in areas such as endocrinology, pulmonology, cardiology, podiatry and ophthalmology.
Flexible scheduling. In addition to face-to-face meetings, Union Health Center’s health coaches often take appointments by phone so that busy patients can get the information they need without traveling to the clinic. Health coaches can schedule their own appointments, and their calendars are available to anyone with access to the practice’s electronic health record (EHR) to arrange patient-health coach meetings. The frequency of appointments can vary by patient needs and progress, from six months to a year. Patients may also resume meeting with health coaches if their outcomes worsen. Patients often contact the easy-to-reach health coaches with concerns about managing their chronic illnesses that they are unsure merit a physician appointment.
Standardized tracking. Consistent, thorough documentation of visits is made possible through use of customized templates to track health coaches’ encounters with patients. This enables health coaches to pick up right where they left off with patients without missing a beat. It also makes it easier for physicians and other clinicians to track the coaching’s impact and how well patients are meeting care goals.
Evidence-based communications skills. Patients with limited English proficiency often can speak directly with health coaches in their preferred language, because the health coaches are bilingual in Spanish, French-Creole or Chinese. In addition to literally speaking patients’ language, the health coaches have been trained to use evidence-based communications approaches when educating patients.
One of these methods is the ask-tell-ask approach. Using this technique, health coaches spark a dialogue by asking patients about their health goals. They might ask about patients’ No. 1 medical concern, what they know about diabetes or what they understand about how to lower their A1c level. The coaches then incorporate the patients’ responses to provide actionable information—this is the “tell”—that is geared specifically to the patient’s need and knowledge level. Then, the coach asks a follow-up question to confirm the patient’s understanding.
Another communication technique the health coaches use is teach-back, also known as closing the loop. Using this method, health coaches take the time to ensure that the information they have provided is actually understood by patients, who are asked to repeat in their own words the instructions or information the coach has offered. If the patient’s own explanation shows a misunderstanding, the health coach looks for another way to convey the concept and again asks for the patient to teach it back.
Finally, health coaches use action planning to help patients take a granular approach to changing their health behaviors. Research has shown that simply telling patients to stop an unhealthful behavior is unlikely to succeed. Instead, the health coaches work with their patients to cut down on the behavior—reducing sugar-sweetened soda consumption from five cans a day to two, for example.
The STEPS Forward module offers the concrete information needed to help other practices learn more about health coaching and what it takes to recruit, train and mentor coaches, as well as how to track their progress. A separate module can help your organization create, implement and evaluate a professional development program for medical assistants.
The modules may also be completed for continuing medical education credit. There are seven new modules available from the AMA’s STEPS Forward collection, bringing the total number of practice improvement strategies to 43; several thanks to a grant from, and collaboration with, the Transforming Clinical Practices Initiative.