Medical centers are always looking for new ways to deliver better, more affordable care. The latest studies are showing that what goes on just outside the medical exam room can make the biggest difference. If patients can learn to take on some of the management of their own health, their outcomes are better and costs are lower.
Many leading edge healthcare providers are beginning to hire “health coaches” to educate patients about their own health needs and to encourage them to take a more active role in their own care.
A labor union health center based in New York City’s garment district is tackling this challenge in an especially innovative new way. “The question is who should be doing this coaching?” says Karen Nelson, Medical Director of UNITE HERE health center.
Most medical centers have looked to registered nurses or professional health educators to fill the role of health coach. This can be very effective, but it’s also expensive. So Nelson sat down with her staff of two doctors, one nurse, and, significantly, a team of patient care assistants -- the unlicensed workers who traditionally do the bulk of support work at the Center. She had the idea that perhaps they could be trained and promoted to be the health coaches. “We talked and we decided we were going to start with our patient care assistants.”
UNITE HERE, the combination of the former Ladies Garment Workers’ Union and the Hotel Employees and Restaurant Employees’ Union, runs health programs serving almost 500,000 mostly low-wage, largely immigrant workers, their dependents and retirees. About 1,000 of these patients suffering from chronic diseases such as diabetes and heart disease are treated at the Special Care Center in New York, where Nelson started a pilot program to study her new idea.
Beginning with forty assistants, she worked with educators to come up with an on-the-job program that trained them over several months to be health coaches. They learned how to listen to patients, to communicate effectively, to work closely in teams with doctors and other medical staff, to use sophisticated electronic patient records technology and to teach chronically ill patients skills for managing their own health.
Many of the assistants came from similar backgrounds and socioeconomic groups as the patients themselves. They were also widely accessible to patients, able to give patients valuable one-on-one time in the center.
“The doctor is really only able to spend a little time with each patient,” says Kathy Morales, one of UNITE HERE’s new health coaches. But she and her colleagues have more access. “We have a lot of small increments of time with them and we even call them at home,” Morales said.
She and the other coaches work with patients to help them understand how things like diet affect their blood sugar levels. Morales, a 43 year-old mother who changed careers after being laid off as a corporate administrative assistant, says she loves her current job. “It can be so rewarding to be able to help these patients through speaking with them, to really help them reach their goals.”
Morales and others are able to form lasting relationships with patients. Patients often find it easier to talk to them and tend to deliver more pertinent information that allows for better treatment. “When these coaches run groups for patients,” says Nelson, “you can really see the lights go on in these patients, they get it!”
Within the first year, the primary indicators of health for the diabetic and heart patients improved so dramatically, they surprised Nelson. “We hoped to see 30-40% of patients with reduced numbers for these indicators,” says Nelson, “but we found 60 to 80%.”
“The real issue,” says Nelson, “ is whether the cost is worth the overall improvement in care.” They discovered that even with the sickest patients, there was a $38 percent savings. In the second year, the center was given an additional funding by the Union. ” Even though our budget went up by one million, our costs went down by two million.”
The Union is making plans to adopt this model at its health center that serves restaurant and hotel employees in Las Vegas. In the meantime, Nelson is sharing her findings with other healthcare groups.
What do you think? Patient Care Assistants (Medical Aides) are chosen for promotion and must pass a test at the end of their training. There are currently eight specially trained health coaches working at the UNITE HERE health center. They are, in turn, training others who can replace them when needed. Nelson reports that she is still experimenting with how much responsibility should the health coaches take on. Do you think health care facilities should be required to maintain a staff of trained health coaches? Post your comments below: |
