Article originally posted on HealthTeamWorks.org

 

by Lisa S. on 10/31/2011 8:49:47 AM MST

 

The patient-centered medical home (PCMH) is all about helping patients achieve and maintain optimal health … and sometimes you need a coach to get there.

Westminster Medical Clinic’s health coaching program gives individualized attention to patients with chronic conditions. Some may not fully understand their illnesses or what they can do to manage them. Others may have trouble sticking to their care plans or lose focus on their health goals. Eligible patients meet with a health coach in six one-hour visits over three months to address their physical, emotional, nutritional and exercise needs. The program aims to prevent serious events that can arise from unmanaged chronic disease.

 

Health coaching part of whole-person care

Beth Neuhalfen, PCMH project manager at Westminster Medical Clinic, developed the health coaching program. (A similar effort, Passport2Health, is being launched in Lakewood’s Belmar Family Medicine with help from Caitlin Barba, Westminster Medical Clinic’s practice manager.) “I had done health coaching at [another medical home] and I wanted to align this program with our mental health effort — Advancing Care Together (ACT) — so patients could get health coaching and mental health care. We strive to be a full-service practice,” Neuhalfen says. Under ACT, the practice has a licensed clinical social worker on site three days a week to provide mental health treatment.

Physicians determine which patients are appropriate for health coaching — perhaps a diabetic having difficulty fitting exercise into her schedule, an overweight man who doesn’t understand good nutrition or a woman with cardiovascular disease who doesn’t recognize the dangers of high blood pressure. The physician introduces the patient to Neuhalfen and explains the help she can offer. “I’ve never had anyone not sign up for the program,” Neuhalfen says. “I encourage spouses to come because you will be more successful if you attend with the person you live with.”

 

Coaching covered by insurance under "800 rule"

Most insurance companies cover health coaching visits under the “800 rule” created by the Colorado Medical Society in 2010 and adopted by the state legislature. The rule allows unlicensed healthcare personnel to provide certain services with a physician’s direction. Ideally, the program will pay for itself. Westminster Medical Clinic uses CPT* code 98960 to bill for the visits (the patient must have an accompanying diagnosis). Neuhalfen has hired a full-time health coach to help her; insurance reimbursement should cover the salary.

 

Patients' goals are the goals that matter

Westminster Medical Clinic has enrolled 25 adult patients in health coaching since the program started in September. Their diagnoses include diabetes, cardiovascular disease, metabolic syndrome, obesity and asthma. The program’s goal “is to take pressure off the providers,” Neuhalfen says. “They don’t have the time to spend an hour with every patient to teach them about their conditions. Coaching is about reaching patients’ goals. Patients often repeat what the doctor wants them to say [about their health goals], but it’s not necessarily what they want. People are more likely to achieve a goal if it’s their goal.”

For example, one obese patient told Neuhalfen that he wanted to lose weight to achieve his dream of piloting an airplane. A woman with metabolic syndrome said, “I want to be there for my grandchildren.” At each visit, the health coach reviews the patient’s progress toward goals and together they may set new ones.

“Health coaching isn’t technical,” Neuhalfen continues. “It’s giving patients the tools they need to live a healthy lifestyle. We give them a roadmap, and often they’re amazed at how easy it is. They just didn’t have the right information.”