Preparing the Health Care Workforce for the New Health Care Environment

While the practice of evidence-based health coaching will continue to evolve, a body of evidence from the behavioral and health care sciences already exists to guide health coaching practice. Though traditional coaching models and approaches may have some value, the Institute of Medicine has emphasized that today’s health care professionals need to master the broad set of interdisciplinary competencies that support disease prevention and chronic care improvement.14

Leaders in chronic care improvement, including Ed Wagner21 and Thomas Bodenheimer22 have emphasized that chronic care improvement is a new model of care—a model that requires a significant reorientation and redesign of usual health care services and roles. The health care workforce must be prepared to function in this new model of care. For patients with multiple or complex chronic conditions—the population associated with the highest health care costs—we know that care management services provided by health care professionals who have been trained in this new model of care deliver better results.23

In 2003, HealthSciences Institute and its partners designed an interdisciplinary competency model—based on the core competencies for the 21st century health care workforce identified by the Institute of Medicine.24 The resulting competency model incorporates population health improvement foundations and evidence-based health coaching competencies that support patient engagement, whole-person care, communications, adherence, and self-care and lifestyle management.

With funding from the Minnesota Department of Human Services, in 2004, HealthSciences Institute developed and piloted a curriculum, training and certification program—the Chronic Care Professional (CCP) certification program. The program competencies and curriculum were further validated in 2007,25 leading to the 4th edition of the program in 2008.26

The CCP program has been adopted by state health care programs in the United States, as well as Canadian provincial health care units. Additionally, the program has been selected by leading health care plans, health systems and medical home programs. One peer reviewed study found that disease management programs that combine evidence-based health management interventions, delivered by nurses who have completed the Chronic Care Professional (CCP) certification program, improved patient clinical outcomes, quality of life, and reduced costs for patients with diabetes.27

Clearly, popular health coaching approaches are valuable because they put the focus on the patient. However, to be effective, health coaching must be both patient-centered and evidence-based. Replacing traditional patient education-oriented approaches, with unvalidated or informal health coaching approaches will not deliver expected value. Just as intuitive medical practice is being supplanted by evidence-based medical care, informal health coaching approaches must evolve to deliver better results for both patient and purchaser.

Yet, competence in health coaching is not innate. At first glance, health coaching may seem intuitive and simple, but it is not easy. For most clinicians trained in directive, patient education-oriented approaches, health coaching represents a paradigm shift. Proficiency in validated approaches such as motivational interviewing takes practice to develop. Competence must be attained and improved through advanced adult learning programs, as well as performance measurement and mentoring. Finally, health coaching cannot stand alone in either traditional health care or population health improvement settings. The effectiveness of health coaching depends on it being integrated within broader chronic disease prevention and chronic care improvement efforts.

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References
1. International Coach Federation. Definition of coaching. 2009. International Coach Federation Web Site. Available at: http://www.coachfederation.org/. Accessed November 15, 2009.
2. Whitworth, et al. (2004). Co-Active Coaching: New Skills for Coaching People Toward Success in Work and Life. Mountain View, California: Davies-Black.
3. International Coach Federation. Coach competency model. 2009. International Coach Federation Web Site. Available at: http://www.coachfederation.org/research-education/icf-credentials/core-competencies/
4. Butterworth S. Influencing patient adherence to treatment guidelines. Journal of Managed Care Pharmacy. 2008;14:S21-S25.
5. Rubak S, Sandboek A, Lauritzen T, Christensen B. Motivational Interviewing: a systematic review and meta-analysis. British Journal of General Practice. 2005;55:305-312.
6. Hettema J, Steele J, Miller WR. Motivational interviewing. Annual Review of Clinical Psychology. 2005;1:91-111.
7. Linden A, Roberts N. Disease management interventions: what’s in the black box? Disease Management. 2004;7:275-291.
8. Linden A, Butterworth S, Roberts N. Disease management interventions II: what else is in the black box? Disease Management. 2006;9:73-85.
9. Miller W, Rolnick SR. Motivational Interviewing: preparing people to change. 2nd ed. New York: Guilford Press; 2002.
10. Rollnick, S, Miller, WR, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: The Guilford Press; 2008.
11. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the patient activation measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Services Research. 2004;39: 1005-1026.
12. Hibbard JH, Greene J, Tusler M. Improving the outcomes of disease management by tailoring care to the patient’s level of activation. American Journal of Managed Care. 2009;15:353-360.
13. Fisher J, Fisher W. The information-motivation-behavioral skills model. In Diclemente RJ, Cosby RA, and Kegler MC eds. Emerging Theories in Health Promotion Practice and Research. San Francisco, Jossey-Bass. 2002:40-70.
14. Andersen B, Sidorov J. Disease management applications. In DMAA. Managing Disease: A Comprehensive Guide. DMAA: Washington, DC; 2007:25-42.
15. Butterworth SW, Linden A, McClay, W. (2007). Health Coaching as an Intervention in Health Management Programs. Disease Management & Health Outcomes. 2007;15:299-307.
16. Dezii CM. Medication noncompliance: what is the problem. Managed Care (Suppl). 2000;9:S7-S12.
17. Stephenson B, et al. The rational clinical examination. Is this patient taking the treatment as prescribed? JAMA. 1993;269:2779-81.
18. Ko JY, Brown DR, Baluska DA, et al. Weight loss advice U.S. obese adults receive from health care professionals. Preventative Medicine. 2008;47:587-592.
19. Patient Centered Primary Care Collaborative. Joint principles of the patient centered medical home. Patient Centered Primary Care Collaborative Web site. 2007. Available at: http://pcpcc.net/content/joint-principles-patient-centered-medical-home. Accessed November 20, 2009.
20. Bodenheimer, T., et al. Patient self-management of chronic disease in primary care. JAMA. 2002;288:2469-2475.
21. Wagner EH, Austin BT, Von Korff M. Organizing Care for Patients with Chronic Illness. Milbank Quarterly. 1996;74:511-544.
22. Bodenheimer T, Wagner EH, Grumbach K. Improving Primary Care for Patients with Chronic Illness. JAMA. 2002;288:1775-1779.
23. Bodenheimer T, Berry-Millet R. Follow the money—controlling expenditures by improving care for patients needing costly services. New England Journal of Medicine. 2009;23:1521-1523.
24. Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington, DC: The National Academies Press; 2003.
25. HealthSciences Institute, DMAA: The Care Continuum Alliance. Population Health Improvement Professional Development Survey. Chicago, IL: HealthSciences Institute. November, 2007.
26. Chronic Care Professional (CCP) Certification Program Manual (4th ed). Chicago: HealthSciences Institute; 2008.
27. Wilhide C, Hayes JR, Farah JR. Impact of behavioral adherence on clinical improvement and functional status in a diabetes disease management program. Disease Management. 2008;11:169-175.