Health Coaching: Inspiring Patient Partnered Care

By William K. Appelgate, PhD, CPC
Founder and President Clinical Health Coach®

The Continuing Quest

Healthcare organizations are often in a fervent, yet discerning, quest to find breakthrough ideas. High value ideas enabling practitioners to deliver better health, improve healthcare, reduce cost, and ease the burden on their providers to accomplish accelerating expectations.

Is there something, anything, that is practical, evidence based and affordable that can transform our manner of caring, and yield outcomes we care about?

Informed by a decade of experience in the field, the Clinical Health Coach® has created a proven strategy for training and implementing health coaching in the clinical setting. It is practical, evidence based and affordable. Even more, in a variety of settings, the approach has demonstrated impressive outcomes – clinical, cost, experience.

With Clinical Health Coach® training, several thousand nurses, case managers, care coordinators, social workers, physicians, pharmacists, nursing assistants, PAs, dietitians and CHWs have developed effective coaching skills for the clinical setting – coaching performance skills to partner with patients, build selfcare skills and inspire sustained accountability. In short, coaching has emerged as “patient partnered care” — the therapeutic relationship between provider and patient healthcare has long sought to achieve.

The Harsh Realities

Amid the rush to big data, despite advances in technology application, with acknowledgement of new
wonder drugs – effective population health still confronts indelible realities:

  • most healthcare actually takes place outside the provider setting
  • most care, especially for those with chronic conditions, is self-care
  • personal behaviors drive up to 50 percent of healthcare outcomes

Bending the trend toward better health, improved healthcare and lower cost is both worthy and achievable. The informed, activated patient has become a widely accepted goal in patient centered healthcare. The trick is getting there, especially among attributed populations of patients. What does it take? Well, it demands a new provider logic – patient partnered care.

Patient partnered care plays forward the role of the case manager as knowledgeable navigator as well as one who also inspires accountability in patient partners. Telling patients what to do and expecting them to do it is an efficient concept; evidence of its effectiveness is, at best, elusive.

The delivery of medicine has long been considered a “guild skill” practiced by healthcare professionals. It treats the sick, mends the broken and cures the ill. It is part science and part art. As healthcare migrates to value-based care, the focus on prevention and health maintenance is not only pivotal, it is also essential. Healthcare is expected to steward health status and mitigate health risk among patients. At the practice level, beating the value/cost curve is measured by a decrease in the number of patients who present themselves with exacerbations toward an increase in the number with whom we connect for prevention and maintenance.

The Transformations Most Needed

Practice transformation has been given increasing attention through CMS initiatives such as Accountable Care Organizations (ACOs), the Practice Transformation Network (PTN) program, MIPPS and the Chronic Care Management (CCM) codes. Aimed at preparing practices for value-based care, emphasis upon population prevention and maintenance is authenticated through reporting of quality and performance measures. For participating practices, there is the promise of bonus payments and transformation readiness. Current care processes, patient flows and team approaches are being redesigned and improved. Patient experience has been given increasing attention.

Pivotal in such population health transformations is patient engagement. Connecting with both the easy and hard to reach, drawing them into screening, prevention and assessment encounters is essential. Engaging and activating positive patient healthcare behaviors is the critical next step. This underscores the practical challenge of true practice transformation – building vital patient relationships.

Healthcare providers have universally acknowledged the importance of developing a “therapeutic relationship” with their patients. It is valuable to providers and beneficial to patients. This therapeutic relationship often develops between physician and patient. Increasingly, with the advent of team-based care, it develops between other healthcare professionals and patients within the provider setting. Its value derives from elements of shared trust, mutual expectation of capability and effective communication. Ironically, when one of the elements breaks down or is challenged, other elements provide a foundation to help correct or restore the therapeutic relationship.

Provider demands and requirements have intensified dramatically in recent years. However, as Peter Diamandis, Founder of the X Prize, recently observed. Patients are quite the way they have always been.

“While technology has developed and evolved dramatically, individuals still have worries, fears, hopes, desires and ambitions. They want to be moved, validated, cared for, respected and seen as capable. It doesn’t matter the technology, platform or medium through which you reach them – people are still people. Humans haven’t had a software update in 200,000 years.”

In summary, the practice transformation end game is clear – its object is achieving improved individual and population health outcomes. The path is also clear. It is a combination of transforming the conversation between providers and patients as well as transforming the care processes.

The Coaching Solution

Transforming the conversation with patients and care processes into an effective population health
strategy is a daunting task, even for the most ambitious. And, how does one accomplish that and
concurrently address the following harsh realities with a sense of opportunity?

  • How can hospital and clinics reach into and influence the 98% of healthcare that takes place outside the healthcare setting?
  • How can practitioners build patient self-care skills, especially for those with chronic conditions, whose costs are highest?
  • How can providers and their teams inspire patient accountability for their own health future? Hundreds of organizations across the country have charted a course to opportunity. And, they have begun answering these questions by adopting an evidence based coaching strategy in their clinical settings.

Coaching is built around a powerful pivotal promise – patients can and will act on their own ideas and plans especially when they are viewed as capable. In its best sense, provider teams trained in coaching seek to build positive relationships with patients – relationships characterized by trust, communication, and non-judgmental mutual respect.

Clinical Health Coach® training teaches a very particular set of performance skills. These skills, learned and practiced, enable healthcare professionals to create a positive relationship with patients, help patients build self-care skills, prompt improved health behaviors, and inspire accountability.

The Promise

Clinical health coaching, integrated into care management and case management, is a fundamental strategy for transforming healthcare. It builds upon the value of positive therapeutic relationship between provider teams and patients. It recognizes the patient as the greatest underutilized resource in healthcare. It builds upon the patient’s own motivations for getting and staying healthy. It holds promise for aligning best practice care with patient centered resources. It delivers outcomes for patients and the healthcare organizations providing their care.

We invite your questions. We look forward to exploring how coaching in your healthcare organization may be the next story of success. Call us at 515-419-6433. Visit our website at www.clinicalhealthcoach.com. Drop me an email at william.appelgate@iowaccc.com.