Health Coaches: Patient Selection and Effectiveness
Ellen Beckjord, PhD, MPH
Associate Vice President, Population Health and Clinical Transformation
UPMC Health Plan
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What is Health Coaching?
Health coaching is the use of evidence-based
skillful conversation, clinical interventions and
strategies to support client/patients to
achieve their health and wellness goals
through lifestyle and behavior modification.
A health coach partners with individuals
through the process of behavior change. This
is done through support in setting goals,
unearthing values, strengths, and motivations,
and encouraging the development of
sustainable healthy behaviors and attitudes.
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Health Coach Scope of Practice
“Health and Wellness Coaches partner with clients seeking self-directed, lasting
changes, aligned with their values, which promote health and wellness and, thereby,
enhance well-being.”
The National Consortium for Credentialing Health and Wellness Coaches (NCCHWC) (2019)
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Responsibilities of a Coach
Apply effective communication skills to help a client increase
motivation and ownership to making a change
Help clients develop and exploit their strengths to support
successful behavioral change
Help clients develop achievable and measurable goals to
monitor success and motivate ongoing behavioral change
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Using Coaching Theory and Framework
Transtheoretic
al Model
Mindfulness
Motivational
Interviewing
Social
Cognitive
Theory
Self
Determination
Self-Efficacy
Theory
Patient
Activation
Health Belief
Model
Positive
Psychology
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Coaches Focus on Client Needs
Motivation
Commitment
Accountability
Feedback
Reinforcemen
t
Knowledge
Social
Support
Self
Awareness
Resource
Awareness
Self-Efficacy
Health Coach Academy by UPMC
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Health Coach Training & Board Certification
• The National Board for Health and
Wellness Coaching is a consensus-building
collaboration of leaders representing many
health and wellness coach training and
education programs in the United States.
• Have worked diligently as to attain a vision
of creating a National Certification for
health and wellness coaches, built upon
best practices.
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Health Coach Academy by UPMC
51 UPMC Health Plan
lifestyle health
coaches passed board
certification to date
1 of 9 health coach
training programs
approved by National
Board for Health &
Wellness Coaching
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Health Coach Academy by UPMC
Health Coach Training & Skill Development
• Coaches are trained using a curriculum approved by the National Board for Health &
Wellness Coaching (NBHWC). This includes 3-day Motivational Interviewing training ,
health coaching competencies, lifestyle knowledge, UPMC program delivery skills,
practical skill evaluation (80 hour curriculum).
Quality Assurance Review (QAR) & Mentoring
• Coaches receive regular QAR and mentoring to support coaches in their use of the
Motivational Interviewing and coach approach for engaging, activating, and
supporting behavior change.
Skills Building/ Mentoring
• These bi-monthly sessions are a skills-based workshop focusing on a variety of topics
and include lecture, demonstration, practice, and review of real member/ clinician
interactions.
Why Motivational Interviewing?
Over 1400clinical trials
completed or in progress using MI
There are 4meta-analyses
demonstrating efficacy of MI
in health care
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Years MI has been
applied and studied
#1
MI is the only health
coaching approach that
is standardized and
associated with multiple
published outcomes
MI has 4phases which
provide the clinician
structure even in brief
sessions:
1 2 3 4
Engaging FocusingEvoking Planning
MI is the only health coaching
approach supported by
standardized & validated
assessment tools
6+
Tools being used today to
measure fidelity to MI
approach in coaching
Services
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Health Coaching and Care Management
Services for Members
Clinical Navigation
• Triage
• Assessment
• Referral
• Prescription for Wellness
• New member clinical
stratification
Lifestyle Coaching
• Weight Management*
• Nutrition Basics*
• Stress Management*
• Physical Activity*
• Tobacco Cessation*
• Healthy Families**
• Sleep**
• Diabetes**
Behavioral Health Coaching
• Anxiety*
• Depression*
• Substance Use
• Pain Management
• Grief
• ADHD
Behavioral Health Case
Management
• Care Coordination
• Establishing treatment
• Complex Care Needs
• Follow up care
• General BH Case mgt
*Digital available
**Digital in development
***Video sessions available
Physical Health
Condition
Management***
• Cardiac
• Respiratory
• Diabetes
• Rare and Chronic
Disease
• Oncology
• Low Back Pain
• Shared Decision
Making
• Kidney Health
Case Management***
• Care Coordination
• Complex Care
Needs
• Social Work
Pediatrics
• Condition
Management***
• Case Management
• NICU case
management
Maternity***
• Prenatal
• Postnatal
• Interconception Care
Pharmacy
• Medication
adherence
• Reconciliation
• Quality
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Results
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UPMC MyHealth – Lifestyle Programs with
Impact! (2010-2015)
78%
Reduced
stress
80%
Lost
Weight
*
65.2%
Improved
healthy
eating
71%
Increased
physical
activity
*
7%
Quit rate
65.2%
clinical
success
at 180
Days
44.2%
clinical
success
at 180
Days
77.1%
clinical
success
at 180
Days
50.5%
clinical
success
at 180
Days
7.1%
clinical
success
at 180
Days
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March 1, 2021-August 17, 2021
Weight Management
Enrolled in Weight Management Coaching
Enrolled in other Lifestyle Coaching (excluding weight management)
Scale of 1-10 Rating
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March 1, 2021-August 17, 2021
Physical Activity
Improvement in physical activity for members participating in other lifestyle coaching
Enrolled in Physical Activity Coaching
Improvements from pre to post on a
1-10 scale. Self ratings by members.
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March 1, 2021-August 17, 2021
Nutrition
Improvements in nutrition
Scale of 1-10 self-rating
Improvements from pre to post on a
1-10 scale. Self ratings by members.
For members enrolled in the nutrition coaching program
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Complimenting and Extending Your Care
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What is UPMC Prescription for Wellness?
An innovative physician-prescribed coaching program
that connects patients to evidence-based health
interventions and Board-Certified Health Coaches from
UPMC Health Plan.
Available to all UPMC Health Plan members at no cost.
Physicians can enter orders directly through EpicCare
or the Health Plan’s secure Provider OnLine Portal.
Modeled after best practice guiding principles:
• Physician initiates prescription for behavior change
• Use of EMR and technology integration for
streamlined notification
• Link to Health Plan health coaches for follow-up
support
• Leverage role of office staff for reinforcement and
updates
• Minimize patient barriers (no cost, widely available,
remote options and flexible hours)
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UPMC Prescription for Wellness
Provider-prescribed, member support platform to access all Health Plan resources
Lifestyle
Improvement
Behavioral Health
Support
Clinical Decision Support
& Care Navigation
Chronic Condition
Management
Individual Group Telephonic Chat Face to Face Telehealth Asynchronous Digital
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Prescription for Wellness Benefits ~ Improved Engagement and Patient Satisfaction
UPMC Health Plan’s “Impact of Physician Referral” Publication
Wins Paper of the Year Award from American Journal of
Health Promotion
An outcomes study comparison of 8,000 physician-
prescribed engagements vs 30,000 "usual care" health
plan outreach intervention demonstrated a 300%
increase in participation, enrollment and graduation from
lifestyle programs (with significant risk shifts shown to be
associated with better health and lower costs) when the
physician prescribes coaching and engagement.
• Extends physician’s expertise and care management
plan beyond the limited time of an in-office visit.
• Positions lifestyle medicine (treating the root cause of
most chronic disease) as a primary part of treatment.
• Language in the patient’s printed order serves as a
prescription for health and care support engagement
which directs patient activation.
• Health coaches leverage the voice of the physician
when engaging with patients as this reinforces both
patient accountability and the working relationship
between the physician and health coach.
• Improves patient engagement in healthy behaviors
and self-management of chronic disease.
• Improves provider-patient relationship, which patients
reflect in their assessments.
* Referrals from 7/1/14- 12/31/2019
** Passive referrals for All LOB
including incentivized from CY16
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UPMC Prescription for Wellness
People, Process & Technology
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Entering a Prescription for Wellness in the Provider OnLine Portal
Provider OnLine Main Page Prescription for Wellness Page
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Entering a Prescription for Wellness in the Provider OnLine Portal
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Returned in Approximately 30 Days
“Prescription Progress Note”
• Health Coaches outreach to patient within 48 hours of prescription.
• Provider receives feedback in approximately 30 days of prescription
• Note back to practice from health coach will indicate one of following:
• Reached
• Unable to be Reached
*Will include few sentences with more information on the outcome.
• Note back to the practice will include patient’s health coach name as well as their
direct line.
• Contact this health coach for questions regarding the specific patient
Goal: Continue to promote patient engagement, behavior change, and care adherence
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Prescription for Wellness Provider Feedback Notes
Now Accessible by Patient
• Health Coaches
return feedback note
on patient
engagement and
plan electronically to
prescribing provider
30 days from date of
prescription.
• Effective 3/31/21,
feedback notes are
visible to members
via MyUPMC.
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Physician and Office Team: Keys to Success
• Identify champions to spread
the word
• Optimize the interdisciplinary
team – equip, empower,
support.
• Develop office systems and
practice to support desired care
• Measure processes and
outcomes – provide feedback to
your team
It’s a team effort – from check-in to exit!
Every staff member plays a role
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Provider/Office Staff Materials
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Patient Materials
Poster
Brochures
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Giveaways
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Prescription for Wellness Questions
Contact Information:
Jamie Delu – Director
Christine Sheffey – Program Manager
Christian Gabarda – Program Manager
Service Email Account: RxforW[email protected]
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Prestigious award honors best health papers and those who bring outstanding humanity to fields of medicine
UPMC Health Plan’s “Impact of Physician Referral” Outcomes Study
American Journal of Health Promotion 2020 Paper of Year Award
• Compared 8,000 physician-
prescribed engagements vs
30,000 "usual care" health plan
outreach intervention.
• 300% increase in participation,
enrollment and graduation from
lifestyle programs (with
significant risk shifts shown to
be associated with better health
and lower costs) when the
physician prescribes coaching
and engagement.
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Take Homes
• Optimize utilization of Prescription for Wellness in your clinic specialty/hospital
• Verbalize prescription during visit and state expectation to be “filled” asap
• Review your patient’s progress and reinforce health coach in feedback note
• Contact the program office (Jamie Delu) for additional support onsite including
presentation(s) to colleagues and office staff
• Utilize full spectrum of health plan support services for patients through Prescription for
Wellness (EpicCare, Provider On-Line) and RXWell app (Xealth)
• Healthy behaviors
• Disease and case management
• Shared decision-making support
• Patient/family coaching and support
• Advanced care planning and determinants of health
• Review practice- and provider-level reports and share how to improve with us!
Closing
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There’s Something for Everyone in Health Coaching!
• UPMC Health Plan wants to support, compliment, and extend your care through our health
coaching services!
• Send your patients who are our members our way and we will ensure they get the support
they need to achieve the highest level of health and wellbeing available to them.
• We would love to connect with you to learn more about how health coaching can support
your practice:
• Dr. Ellen Beckjord, AVP, Population Health and Clinical Transformation (beckjorde@upmc.edu)
• Tish Rohan, Director, Health Coaching Services (r[email protected])
• Jamie Delu, Director, Prescription for Wellness (willi[email protected])
• Dr. Amanda Gabarda, Senior Director, Clinical Training and Education (gabar[email protected])
With gratitude to this team who provided today’s content
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Thank You
