Coaching Boomers to Better Health
By William Appelgate, PhD
“Given that the healthcare system is overburdened and clinician time is limited, some experts regard patient self-management as the only arena where there is available capacity within the U.S. healthcare system for improving quality of care and reducing cost.”
Healthcare is at a profound inflection point. Virtually all healthcare professionals are contending with an industry in the midst of truly tectonic shifts in the healthcare landscape. These forces include the inexorable transition from ‘volume to value’ and all that entails, including new organizational structures (e.g. ACOs and PCHMs) and reimbursement models. New strategies in the effective delivery of care are critical, and will focus more on holistic and proactive care versus episodic “sick care”. Fundamental to that objective is activating the patient as an often untapped resource in their care, especially when chronic conditions are at play in their lives. This issue of Case in Point, dedicated to the impact that the Baby Boomer generation will have on the healthcare system, is especially timely. The demographics and psychology of this group and their outsized demand threaten to overwhelm and burden the current healthcare system.
The first Boomers started turning 65 as of January 2011, but the consequences of that birthday are only beginning to factor into the healthcare equation. That will change. Boomers now account for more than 35% of adult Americans, while their appetite for services, and especially healthcare services, will far outpace their population. Stanford economist John Shoven may have accurately calculated that today’s 65 year old has the same mortality and health as a 54 year old had in 1947, but it is hard to reconcile that statistic against the tidal wave of impending chronic disease heading toward us.
The numbers are staggering. Six out of ten Boomers will have a chronic disease, one in four will be burdened with diabetes, one in three with obesity and more than half diagnosed with high blood pressure. Add to that the fact that more than 35 million will have comorbid chronic conditions and the scale of the problem comes sharply into focus.
The case for keeping the ‘well’ Baby Boomers on a path toward health is another challenge upon which the healthcare system has seldom focused, but must now exploit as a golden opportunity. How do we mitigate the predictable trend toward increasing health risks and decreasing health status as Baby Boomers age?
One answer is utilizing an approach focusing on factors that support human health and well-being, rather than on factors that cause disease. Quite the opposite of pathogenesis, this approach termed ‘salutogenesis’ considers each individual more or less healthy while being more or less ill, along a continuum. Our health behaviors and environment shape major portions of our health risks and health status. If we can maintain (zero trend) health or build it in the Baby Boomer population, dramatic cost containment and savings will result along with the resulting higher order well-being that is desired by all.
So what is the role of the care manager, case manager, nurse, primary care physician and home care specialist in this new dynamic? The opportunity to collaborate with and engage the patient to become accountable for their health becomes a fundamental component of the care plan. The focus on coaching and communicating is equal in value to prescribing and educating. Succinctly summarized by Carla Stebbins, PhD of Des Moines University, “you can be the most clinically-gifted person on the planet, but if you don’t know how to communicate that to a person – where they can own it and base change on it – then you’re not going to be as effective.”
Statistics back this up. Independent studies have found that:
- 30 – 50% of patients leave their provider visits without understanding their treatment plan.
- hospitalized patients retain only 10% of their discharge teaching instructions.
- On average, a patient has 23 seconds to describe their concerns before they are interrupted by the healthcare provider.
A recent AHRQ study estimated that 95% of all diabetes care is self-care. The Iowa Chronic Care Consortium has been on the forefront of population health initiatives and our experience shows that this self-care percentage holds true across the spectrum of chronic conditions. In order to effectively reach in to build patient self-care skills, health coaching becomes a critical and powerful component for empowering the patient as an expert in their own health.
Specific to Baby Boomers, the data shows that this population is more educated and more affluent. While they may have more chronic conditions, they nonetheless define themselves as healthy and physically active. Boomers have an increased likelihood of simultaneously caring for both children and aging parents, and the CDC reports that they have an increased frequency of major life events (e.g. death, marriage, change in job). While they are highly adept at using the internet to research health information and understand their conditions, the challenge of inspiring genuine accountability and building self-management skills remains. The key is partnering with Boomers by emphasizing their role in terms of empowerment and control.
Health coaching is a fundamental approach to delivering patient-centered care. While this can be deceptively challenging for the care team, there are fundamental health coach practices that should complement the care team’s clinical expertise.
Engaging with the patient through multiple techniques –Health coaching combined with motivational interviewing and other coaching sciences is a primary engagement skill, and one that requires training, ongoing practice and reinforcement.
Making compassionate, patient-centered care a priority – The emphasis and attention needs to remain on the patient, their holistic needs, and not simply focused on the chronic condition.
Making the patient central to the any therapy plan and goal setting – Successfully prompting health behavior change and patient empowerment requires the provider to recognize the patient as a capable and resourceful part of the plan.
Customized education and skills training – Boomers are particularly receptive to rich, detailed information, but be aware of cultural, socio-economic and health literacy variation.
Team-based care – Expands the support for the patient and family, and facilitates the care manager exploring options in using different team members for comprehensive care, including registered dietitians, social workers, pharmacists, behavioral health professionals and others.
Consistent, responsive follow-up – Effective patient engagement pivots on driving accountability to the patient level, attentive reinforcement from the patient care team, along with workflow systems and practices to support efficient follow-up.
Physicians, dietitians, nurses and care managers have been carefully trained to “do, teach and tell” with the noble goal being to “fix” the patient. Many of these professionals are exceptionally talented in this approach of delivering healthcare. However, a profound challenge exists, and the impending chronic health needs of the Boomer generation will only magnify this challenge. When we, as health care professionals, see the end of our work as teaching or telling a patient the best steps to care, we may have fallen short of the critical target—growing the patient’s ability and confidence in long lasting behavior change. The labeled “non-compliant” patient is often someone who needs further exploration in discovering their own motivation for change.
The bigger truth centers on more on truly activating the patient. The health coach, whether in the role of care manager, nurse or home health specialist, must engage and activate the best in patient health behaviors. The application of health coach skills, combined with clinical expertise, is the surest way to address the dual challenges of an evolving accountable patient-centric healthcare industry and the impending impact of the boomer generation and their chronic disease burden. The future of our nation’s economic health depends on it.
“To Live a long and Healthy life, develop a chronic disease and learn how to take good care of it.” – Sir William Osler
Dr. Appelgate is the Executive Director of Iowa Chronic Care Consortium, an entrepreneurial non-profit organization focused on population health, clinical health coaching, and health and wellness promotion. Under his leadership, ICCC has led the Iowa Medicaid Enterprise and health care systems in deploying large scale population health programs in heart failure, diabetes, and health improvement. He is also actively involved in the development of chronic health care cost reduction strategies within recently enacted health care reform legislation.
Centers for Disease Control, National Health and Nutrition Examination Survey (NHANES), 2010
Centers for Disease Control, Summary Health Statistics for U.S. Adults: National Health
Interview Survey, 2008
Stanford Report, July 10, 2012; ‘Q&A: Stanford economist John Shoven on Social Security’; http://news.stanford.edu/news/2012/july/social-security-qanda-071012.html
Wikipedia, May 20, 2013; http://en.wikipedia.org/wiki/Salutogenesis
American Hospital Association, May 2007; ‘When I’m 64: How Boomers Will Change Healthcare’
BusinessWeek, February 7, 2013; ‘Scary Health-Care Statistics on the Broken-Down Boomer Generation’; http://www.businessweek.com/articles/2013-02-07/scary-health-care-statistics-on-the-broken-down-boomer-generation#r=lr-fst