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    In their corner: Health coaches support consumer efforts to alter behavior

    The nascent field of coaching gives plans an alternative method to encourage positive habits such as weight and stress management


    When his daughter was born seven years ago, Dan Schach had been smoking and chewing tobacco for 32 years. He knew then that it was time to make a lifestyle change.

    "I was really concerned about getting cancer," says Schach, a 50-year-old shuttle bus driver for Oregon Health & Science University (OHSU) in Portland. "I wanted to make sure I saw my daughter graduate from high school and become a young woman."

    With the help of the OHSU Health Management Services (HMS) and a nurse coach, Schach was able to quit tobacco.

    Through motivational interviewing (see sidebar) and lifestyle coaching techniques, Schach's OHSU HMS nurse coach Laura Cirotski, RN-BSN, empowered him to make changes that were relatively simple, but had a long-term impact on his health.

    "I am much healthier now and have more energy," Schach says.

    Health coaching has kept Schach aware of other health issues, as well, such as managing stress, exercising and maintaining a healthy diet.

    Motivation to change
    "Coaching Dan over the years has been very gratifying," says Cirotski. "He's made the positive lifestyle changes and maintained them over many years."

    Health coaching is a high-touch service increasingly being offered by health plans to help change the behavior of individuals who, like Schach, know what lifestyle or other behavior changes they need to improve in the areas of nutrition, smoking cessation, sleep, weight management and stress management.

    "Health coaching hasn't been universally defined, and there are no set standards or criteria," according to Susan Butterworth, PhD, director of OHSU HMS. "However, in the context of disease management, we can say that health coaching is a service in which providers facilitate participants in changing lifestyle-related behaviors for improved health and quality of life, or re-establishing and attaining health-promotion goals," she says.

    In addition, health coaching emphasizes efforts to provide a behavioral intervention versus simply providing information," explains Butterworth.

    Richard Safeer, MD, FAAFP, medical director, preventive medicine at CareFirst BlueCross BlueShield, agrees. "Health plans are starting to realize that they can't just tell members what they should do to stay healthy; they need to work with members to identify their barriers to achieving ultimate health—that's where health coaching comes in," Dr. Safeer says.

    The advent of consumer-directed care has created a favorable environment for health coaching, says Phil Micali, CEO and founder of New York-based bWell International, a provider of consumer-directed health plan products and consulting services. "Formerly, managed care focused on influencing provider behavior, not consumer behavior," he says. "We are seeing a significant tide change with the focus on consumer health literacy and 'numeracy'—that is, understanding the economics of healthcare and wellness. Health coaching is the antidote that is necessary to transform consumers from healthcare users into healthcare consumers."

    The interest in health coaching is driven by purchasers' desire to lower medical benefit cost through wellness and disease management, according to Steve Richter, senior vice president at Keenan & Associates, Keenan HealthCare division. "This means facilitating behavior change in consumers who know what lifestyle or other behavior changes they need to make, but have not followed through," Richter says.


    Health coaching can include disease management, case management, utilization review and generally applying evidence-based medicine guidelines to care delivery, according to Micali.


    Tracey Walker
    She is senior editor of Managed Healthcare Executive.

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