By Kristen Gerencher, MarketWatch -November 9, 2006
Health coaches aim to ease treatment decisions
Insurers offer aides to help members make choices, talk with doctors
By Kristen Gerencher, MarketWatch
SAN FRANCISCO (MarketWatch) -- Confronted with medical decisions that can prove daunting to even the best-educated, more patients are turning to specially trained coaches for advice on how to deal with health problems.
Whether a patient is too intimidated or fearful to ask a doctor the appropriate questions or needs help choosing a treatment, they are increasingly finding health coaches on their sidelines as insurers look to contain costs and improve members' satisfaction.
Companies such as Pittsburgh-based Highmark and Health Net, based in Woodland Hills, Calif., say this personal style of coaching will lead patients to make more informed choices. They also maintain that coaches who build rapport with members can help those with chronic conditions stick with prescription-drug and behavior-change regimens that will boost quality of life and reduce costs at the same time.
Health Net began health coaching as part of a broader support program in early 2004, said Brad Kieffer, public relations manager.
"It was created with the idea of increasing the level of dialogue with doctors," Kieffer said. "Health coaches introduce the various kinds of treatment available [and] help the member determine the treatment they most prefer."
More expansive than nurse advice lines, which tend to be symptom-oriented, a health coach typically stays in contact with the patient through periodic calls and e-mails for as long as needed, he said. Though coaching is relatively new, Health Net doesn't consider it experimental.
"We think we're onto something," Kieffer said. "We think we're on the leading edge of the health-coach phenomenon."
Health Net isn't alone. Highmark's "Blues On Call" program offers about 100 nurses who make and receive a total of 24,000 phone calls a month from the insurer's members. Coaches provide the most-up-to-date scientific information to patients in language they can understand, said Dr. Robert Muscalus, medical director for Highmark.
"This is a lot more than just a toll-free number to call to get some type of medical advice," Muscalus said.
"In some of these situations, some pretty strong relationships develop with these health coaches, and we think that's a good thing," he said. "You start to discover other issues that might not have come up because they're very comfortable talking to this health coach."
A coach may help a person who suffers an injury on the weekend decide whether to go immediately to the emergency room or if it makes sense to wait. Or if a doctor recommends surgery for a herniated disk, the patient may be confused as to whether that's the right treatment option. A coach may then send video tapes or DVDs with patient testimonials detailing the pros and cons of various options as well as scientific materials before having an extended discussion about treatment preferences.
In another example, a member with diabetes either may call a coach for help managing the disease or be identified by Highmark as someone who may benefit from a health coach. The coach would try to stay in contact to make sure the patient gets the needed eye exams and kidney tests to monitor the condition. The coach also may be able to learn whether in addition to having diabetes the patient smokes, suffers from high blood pressure or has a family history of heart disease, all of which may lead to enrollment in complex-case management, Muscalus said.
Additional resource
Both companies said health coaches aren't meant to replace or override doctors but to be a resource and add to the total care the patient receives.
What's more, coaches can make members aware of what's common practice for their condition outside their immediate regional area.
"We know there's a geographic variation in care that's delivered in the country," Muscalus said. "We want to make sure our members are adequately informed. We don't want to talk anyone out of or into anything being done."
The coaching may start when a member calls seeking advice about something relatively minor such as a bee sting and lead to a discussion that reveals deeper medical needs, he said. "It's a coordinated approach where if it's necessary to hand someone off internally, whether that's a health coach or a case manager, we're able to do that in a smooth manner."
The idea behind health coaches is an extension of disease management, which many insurers and employers already use, said Gary Claxton, vice president of the nonpartisan, nonprofit Kaiser Family Foundation. "It's more interaction and fits in with a more aggressive style of believing you can change behavior," he said.
Health Net's Kieffer agreed, calling the trend "disease management taken to the next level." Disease management typically targets complex, ongoing care for five conditions: asthma, diabetes, chronic obstructive pulmonary disease, congestive heart failure and depression.
Measuring returns
Health Net contracts with a company called Health Dialog, which provides about 800 nurses, respiratory therapists and dieticians to coach the insurer's members 24 hours a day, seven days a week. Robyn Chapin, director of the coaching center for Health Dialog in Manchester, N.H., said members who call or are called often need to learn how to have more productive conversations with their doctors.
"A lot of people just don't know what to ask or don't feel comfortable asking, especially the elderly," Chapin said. "They may not want to question the doctor on anything."
Many also benefit from learning how to watch for signs such as weight gain, which signals fluid retention in a heart-disease patient, that require early preventive action in order to stave off hospitalization. Coaching calls can range five minutes to an hour and a half, depending on the circumstances, Chapin said. "The one thing everybody says is 'I can't believe you talked to me this long! I can't believe you called me back.' They're so thrilled to have someone listen."
That's the case for Raul Roa of Sacramento, Calif. A paraplegic who suffered from frequent bladder infections, Roa said he's grateful for the service.
After getting some advice and learning to communicate better with his doctor, he has fewer infections. Even so, he still has pain from the injuries he sustained in a fall in 1990 and has asthma, another area for which the coach gives him tips, he said.
"They're very helpful because they always tell me if I have any questions any time of day or night just to give them a call," said Roa, 62.
Knowing the coaches are there helps him psychologically as well, he said. "They call me like maybe every two months and ask me questions and if I'm having any problems with certain areas of my body....They try to help me any way they can."
Measuring health coaches' return on investment can be difficult, Claxton said. "It sounds perfectly reasonable and makes sense. It's just whether you can identify enough people and early on to justify the effort." Still, such programs likely pay off in more ways than one. "If patients feel better about their encounters with the health system because of something the health plan does, that's got to be good for the health plan in the long run," Claxton said. "Generally they only get noticed when they're in the way."
Kristen Gerencher is a reporter for MarketWatch in San Francisco.
