Purchasers See Value in Evidence-Based DM & Health Coaching

Public and employer purchasers continue to look to their health plan and wellness, disease management and case management vendors for continuous improvement in member engagement, member impact and cost offset. However, while accreditation organizations such as URAC and NCQA, have defined population health improvement program standards, wide variance remains with regard to the actual services being delivered during member encounters, as well as the preparation and readiness of professionals delivering these services. Given the imperative for evidence-based care in today’s health care environment, these factors are considered prime opportunities for improving member service, impact, and program return on investment (ROI).

In a number of health care settings, patient and cost outcomes have been improved through formal preparation of staff in the systematic application of evidence-based disease management and health coaching approaches and interventions. However, many nurses and other professional staff in population health improvement settings may not be aware of or routinely apply these approaches. And, organizations including the Institute of Medicine and the World Health Organization have concluded that chronic disease prevention and chronic care improvement require new professional competencies that are qualitatively different than the traditional acute care-oriented approaches that are taught in most health care professional training and continuing education programs. Yet, most health care professionals have not been formally trained in these new core competencies.

In late 2007, DMAA and HealthSciences Institute conducted a professional development survey of health plans and disease management organizations. At that time, the two certifications most often required or recommended by these organizations were the Certified Case Manager (CCM) and Chronic Care Professional (CCP) certifications. And while many organizations used various training and mentoring programs for new and existing staff, most were focused primarily on internal offerings, software, evidence-based guidelines, and patient education. While others reported using some type of internal or external health coaching, change readiness, patient education, or motivational interviewing training for their staff, there was little uniformity in the content or standards for these programs—making it difficult for purchasers to objectively evaluate staff competence.

Of late, providers and population health improvement organizations have been looking to health coaching training or certification programs to fill workforce competency gaps. However, concern has been raised about the quality and evidence-based foundations of popular health coaching programs. Many health coaching programs have been simply adapted from untested “life coaching” models—or are based more on “pop psychology” than evidence. Dr. Susan Butterworth, recipient of two NIH grants to study the efficacy and impact of health management interventions, and HealthSciences Institute Advisory Board Member, recently cited "With few exceptions, the health coaching training programs and certifications that we have seen are not based on behavior change science. The models and interventions that they advocate have not been objectively evaluated, particularly for use with people with chronic health conditions or for use in health care encounters. We believe health coaching should be an evidence-based practice, utilizing approaches that have been demonstrated to produce outcomes and validated in peer-reviewed studies for this population."

HealthSciences has been working nationally with health care buyer groups and purchasers to better define expectations for population health improvement practice and staff readiness. As HealthSciences Institute President & CEO, Dr. Blake Andersen, recently noted at one purchaser session "We believe that it is in the best interests of consumers, purchasers, as well as the organizations delivering these services, to support evidence-based disease management and health coaching services. We agree with the Institute of Medicine and the World Health Organization that this work requires formal preparation in population health improvement practice, including evidence-based medical care, as well as evidence-based strategies for engaging consumers, supporting disease self-management, and building motivation for lifestyle change. Moreover, staff readiness should be assessed, and the impact of disease management and health coaching services on patient engagement and activation measured.”

Increasingly, purchasers are addressing vendor staff training and credentialing in requests for proposals (RFPs) and contracts. And HealthSciences Institute has been working its partners to develop a preliminary checklist that can be included in RFPs or vendor contracts to evaluate staff readiness and capacity to deliver evidence-based health coaching, disease management and care coordination services:

• What are the disease management, case management or health coaching training and experience requirements for new hires?

• What certifications, including Chronic Care Professional (CCP) certification, must staff obtain prior to employment or within the first year of employment? For current staff, are tuition fees funded directly by employer or via tuition reimbursement?
  
  
• Have any health coaching staff training or certification programs in use been appropriately vetted and evaluated? Are health coaching programs grounded in peer-reviewed research for populations at risk of or affected by chronic conditions?
  
  
• Have competency models been developed for staff in key program roles?
  
  
• Are internal new hire and staff development programs competency-based? Do they address the foundations of population health improvement including evidence-based medical care guidelines, shared communications, disease self-management support and adherence, cultural competence, and formal health coaching practice?
  
  
• How many hours are devoted to topics addressed in new hire and staff development programs? Which learning modalities are used? What are the backgrounds of the training instructors or faculty? How is participant learning measured?

• Are program staff supporting client lifestyle change by applying evidence-based national guidelines for diet, physical activity and weight loss and management?
  
  
• Do internal training and development programs reflect the science and best practices of adult learning and workforce development to support learning transfer?
  
  
• Is staff competence periodically assessed using standardized rating scales? Are strategies in place to assess individual and team competency gaps?
  
  
• Is member engagement measured using industry-standard strategies and methodologies?
  
  
• Are member-level outcomes such receipt of evidence-based care, adherence, clinical values, and patient activation measured using standardized tools and methods to ensure member impact?

As the field of population health improvement evolves, with new programs and professionals entering the field from employer, community and medical home settings, purchasers will continue to look for documentation that these programs are delivering evidence-based services, adequately preparing program staff, and evaluating member and cost impact. Not only will these steps support the value of population health improvement solutions, but will assist purchasers in evaluating program quality and facilitating continuous performance improvement.