"There were concerns from doctors about sharing responsibility, and it took a while to earn trust, build relationships, and define roles and build team based care," he says. "Doctors learned quickly that health coaching skills are around patient engagement. It's time consuming to visit with patient to find out what they're motivated to work on. Once docs saw patients were benefitting, it was an easy sell."
At the outset of the pilot in Nebraska, Hoover says there were only two health coaches, but requests from physicians increased that to well over two dozen across Nebraska and parts of Iowa. Hoover reasons that investing in health coaches is the right thing to do because patient engagement is going to be a primary driver of successfully transitioning into a healthcare system that values wellness over illness.
The Value of Coaches
"Physicians manage about 20% of a patient's health, the rest is really determined by a patient's lifestyle," he says, adding coaches are trained to get patients to claim more ownership over their health. He points out that as a doctor, he can tell a patient to "lose 30 pounds," but knows that advice may be taken to heart only for the duration of the visit. A health coach has a different approach, an admittedly better one.
"A true skill set of health coaches is motivational interviewing," he says. "Let's say you have a patient who is 30 pounds overweight, smokes, and leads a sedentary lifestyle. What health coaches are skilled at doing is saying, 'Which of these areas would you like to approach now? It's identifying where the patient is motivated to do something now. They feel like it's a collaborative relationship."