May 2014 Newsletter

Health Coaching - The 'Hottest' Thing in Primary Care  


Health Coaches are an essential part of the healthcare team - their guidance helps lead patients towards their goals, and ultimately, success. Health Coaches act as a liaison between the disease management world of providers and the reality that patients face. In far too many cases, patients are left with the difficult task of understanding and implementing a care plan when they leave a provider's office. A Health Coach is another member of the patients care team in which they help facilitate behavior change - the hardest type of change.


A Health Coach has many roles, and these roles can vary by patient population, location, and services available, but ultimately the goal of the Health Coach is to help patients become active participants in their care so they can reach their goals.


The five defined roles of a Health Coach are:

  1. Providing self-management support
  2. Bridging the gap between clinician and patient
  3. Helping patients navigate the healthcare system
  4. Offering emotional support
  5. Serving as a continuity figure  

A large part of the a Health Coach's role is to provide self-management support. Typically, a Health Coach follows the Self-Management Support 5As: Agree on a goal that is patient directed. Assess the patient's readiness to change, importance of change in relationship to other values, and confidence of success. Advise patients after carefully eliciting what the patient would like advice about. Assist the patient in developing a personal action plan. Arrange follow-up contact with the patient, usually in one or two weeks, to assess how the patient is doing on the plan and to modify it if needed. 


An example of how Health Coaches were used in care  

coordination at Dartmouth-Hitchcock Clinic can be found here. In Colorado, the Westminster Medical Clinic 

has implemented Health Coaches into their Patient-Centered Medical Home practices to help patients achieve and maintain optimal health. They've also found strategies to help pay for a full-time on-site Health Coach. 

CMS Delays ICD-10 Implementation Deadline to 2015  


On April 1, 2014, CMS announced that the deadline for adopting ICD-10 codes would be pushed back until at least September 30, 2015. No official date has been set for implementation by the Health and Human Services (HHS).

What does this delay mean for you?  Estimates by AetnaHealth anticipate financial losses of at least $50,000 for small practices. To capitalize on the planning and preparation already conducted, many organizations are moving forward with ICD-10 implementation.

CMS will host a MLN Connects National Provider Call on Wednesday June 4, 2014 from 1:30-3:00 EST to discuss the freeze on ICD-10 codes, along with an overview of the new coding system. Click here to register.

Motivational Interviewing -  

Follow The 'RULEs'  


Motivational Interviewing, also known as MI, is a counseling style that creates a partnership between the patient and provider. This is achieved through brief motivational techniques. Here are a few RULEs around MI:


R: Resist the Righting Reflex
U: Understand Your Patient's Motivation to Change
L: Listen to Your Patient
E: Empower Your Patient

Remember, you can only help activate the patient through MI techniques, the patient must make the commitment to change. For more information, visit the Motivational Interviewing website, or click here for example videos from the Clinical Training Institute.

CMS Announces Round 2 of Health Care Innovation Plan Opportunity  


The Center for Medicare and Medicaid Innovation (CMMI) recently announced a second round of funding opportunities for the State Innovation Models testing grant. In Spring 2013, Pennsylvania was one of 16 states that was awarded a $1.5 million planning grant from CMMI.

The Department of Health will coordinate the planning process in collaboration with the Departments of Public Welfare, Insurance, Aging, and Drug & Alcohol Programs, as well as the eHealth Partnership Authority.

Pennsylvania's State Health Care Innovation Plan (SHCIP) is aligned with Governor Corbett's Healthy PA plan, focused on access, affordability and quality.  The SHCIP can be viewed here.
Best Practices Spotlight


North Willow Grove Family Medicine trained three of their Medical Assistants (MAs) to act as health coaches. Providers introduce patients to the health coach at the conclusion of the visit, and the patient is moved to a separate room for their first session. The health coaches work with patients to create individual action plans, supplemented with emotional support. Coaches become the point of contact for patients in the office, and follow-up with the patient via phone calls and face-to-face meetings.


By training MAs to become health coaches, practices are better able to manage their highest risk populations and deliver self-management support.

In The Literature

Shared Decision Making and Motivational Interviewing: Achieving Patient-Centered Care Across the Spectrum of Health Care Problems 


Behavior counseling is a very difficult task to master and apply in practice. Shared decision making and motivation interviewing are two methods that can be used in behavior counseling. These tools can be used in a variety of scenarios varying from discussion around end of life, chronic condition management and preventive care. Shared decision making and motivational interviewing are two patient-centered methods, sometimes used in combination, to help a patient and provider reach a goal regarding their health.


Shared decision making is used to help patients and providers come to an agreement. The provider's roll is to inform the patients and help them make the best decision with the greatest benefit for their lifestyle. Motivational interviewing is used to help patients overcome uncertainties regarding behavior around a health issue.


Patient-Centered Medical Home Evaluations: Let's Keep Them All in Context 


In response to multiple manuscripts recently released around the Pennsylvania Chronic Care Initiative (CCI), a response to the critical evaluations was released in regards to the reactions. The authors included the following points:


1. Clinical Innovations, such as the CCI, fail and succeed on both ends. The purpose of innovation is to recreate the strategy, and try again until the desired result is achieved

2. Quality Improvement, especially around the PCMH, is a continuous journey. Efforts need to be dedicated in one area in order to approve or dismiss the resulting evidence.

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