Integrative Health Coaching: The Missing Link In Our Healthcare System

PBHealthcare Business Solutions LLCStrategy, Marketing, Management for Health Care®

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Background 75% of our national health costs are related to chronic

conditions that have their origin in lifestyle behaviors

In dollar terms, $1.8 trillion of $2.4 trillion spent on health care is due to unhealthy lifestyle behaviors

Most of our healthcare delivery is geared toward returning people back to unhealthy lifestyles and not toward changing unhealthy lifestyles

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The Typical Patient/Provider Experience• Average amount of time for a patient/physician visit is

5-7 minutes

• Physician determines the patient’s problem within average of 18 seconds

• Patients increasingly complain that they do not have enough time to explain things or ask questions; patient is time-pressured and forgets 90% of what was said by the physician

• Physician’s focus is on “what is your chief complaint?” rather than “what is happening in your life?”



What Is Integrative Health Coaching? A whole-person approach to healthy living that

promotes on-going engagement (as opposed to episodic interaction) between the provider and the consumer

Active planning and accountability on the part of the individual, with rigorous assistance from a highly-skilled coach/advocate



Why Integrative Health Coaching? A proven approach to changing personal behavioral

patterns that have fueled our culture of sick (and not health- promoting) care

Puts accountability in the hands of the only party that can make changes to disease-fostering health patterns: the consumer

Educates consumers to learn evidence-based treatment guidelines, and to understand treatment options/costs in order to make informed decisions about when, how, and where to utilize healthcare resources



Clinical Research Unquestionably Demonstrates The Value Of Health Coaching Cardiovascular Disease

Vale MJ et al. Coaching patients On Achieving Cardiovascular Health (COACH): a multicenter randomized trial in patients with coronary heart disease. Archives of Internal Medicine 2003 Dec 8-22;163(22):2775-83.

Edelman D et al. A multidimensional integrative medicine intervention to improve cardiovascular risk. Journal of General Internal Medicine 2006 Jul;21(7):728-34.

DiabetesWhittemore R et al. A nurse-coaching intervention for women with type 2 diabetes. The Diabetes Educator 2004 Sep-Oct;30(5):795-804.

AsthmaFisher EB et al. A randomized controlled evaluation of the effect of community health workers on hospitalization for asthma: the asthma coach. Archives of Pediatrics and Adolescent Medicine 2009 Mar;163(3):225-32.

Cancer PainOliver JW et al. Individualized patient education and coaching to improve pain control among cancer outpatients. Journal of Clinical Oncology 2001 Apr 15;19(8):2206-12.

• Weight LossTucker LA et al. Telephone-based diet and exercise coaching and a weight-loss supplement result in weight and fat loss in 120 men and women. American Journal of Health Promotion 2008 Nov-Dec;23(2):121-9. [Note: Coaching and the supplement (made by TriVita), separately and in combination, helped participants lose weight and body fat.]

Bone mineral density in adolescent girlsDeBar LL et al. Youth: a health plan-based lifestyle intervention increases bone mineral density in adolescent girls. Archives of Pediatrics and Adolescent Medicine 2006 Dec;160(12):1269-76.



Cardiovascular Clinical Research

3-year study by Duke Integrative Medicine indicated health-coached participants had twice the reduction in inpatient admissions as non-coached participants

Coached participants demonstrated positive behavior changes that reduced cardiovascular risk over a ten month period. Biggest improvements were in healthier eating, lost weight, and reduction in smoking.

(“A Multi-dimensional Integrative Medicine Intervention to Improve Cardiovascular Risk: Randomized Controlled Trial”, Duke Center For Integrative Medicine/Duke University Medical Center, 2008. Funded by the Centers for Medicare and Medicaid Services)



Difference Between Wellness Coaching and Well-Being Coaching

Traditional Wellness Programs

Case Management Orientation

Compliance Approach

Templated Health Planning

Focused On Meeting Employer’s Goals

Disease oriented: manage the symptoms

Integrative Health Coaching

Behavior Modification Orientation

Motivational Approach

Personalized Health Planning

Focused On Achieving Employer and Individual’s Goals

Lifestyle and behavior oriented: encourage self-health management



Role of the Integrative Health Coach

The integrative health coach :

Guides clients in learning about diagnostic and therapeutic modalities and alternative approaches to management of health issues

Helps clients to navigate the health system

Helps clients to make the right choices and decisions with respect to their total well-being

Operates as a “two-way” member of the medical team



How Will Contracting With PB Healthcare Business Solutions Benefit Your Clients?

Clients learn how to effectively navigate the health system, which results in increased client satisfaction

Coached clients are more committed to making improvements in their lifestyle behaviors

Improvement in the quality of the patient/provider interaction: a more engaged and informed patient and a less-stressed care provider

Sustained health improvements and the potential to reduce un-reimbursable hospital re-admissions (e.g. 30 day post-discharge)

Provides clients with continuity before, during, and after engagement with the health system; can keep clients from leaving the system due to fragmented and disjointed coordination

Strengthens loyalty of consumer to using your healthcare offerings as opposed to those offered by other providers



Different Phases Of Coaching

1. Client/Coach

Group or

individual

motivational

interviewing

Educate on CAM

resources

2. Client/Provider/Coach 3. Client/Hospital/Coach

Pre-visit

assistance in health

assessment,

preparing key

questions, internet

research

Post-visit

assistance in

preparing

personalized health

plan

Monitoring plan

adherence through

weekly, bi-weekly,

and monthly

coaching

Pre-admission

assistance in

preparing for

hospitalization

In-hospitalization

assistance

Post-

hospitalization

assistance

Weekly, bi-

weekly, and

monthly coaching

11

Pre-health system engagement Health system engagement and Post-system engagement

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Pilot Program: How Approach? Choose specialty like general internal medicine, oncology, or

cardiovascular care

Controlled trial of usual care vs. care utilizing integrative health coaching

Minimum of 6 months

Measure effectiveness on both qualitative and quantitative parameters

Client and physician satisfaction

Productivity

Gains in biometric measures e.g. cholesterol reduction, blood pressure

Adherence to personalized health plan



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Health & Medicine

Integrative Health Coaching: The Missing Link In Our Healthcare System