Siouxland Community Health Center serves individuals in Iowa and Nebraska. It has implemented health coaching as a strategy in working with their high risk patients. Dave Faldmo, a Physician’s Assistant who serves as Siouxland’s Quality and Medical Director was interviewed on November 30, 2016 regarding Siouxland’s service and its use of health coaches in their clinical setting. Following is a transcript of that conversation along with observations from 4 of Siouxland’s case managers who have experienced Clinical Health Coach training — Aimee Speck, Cherie Rasmussen, Denise Houts and Cinda Krause.
“Siouxland Community Health Center is a large Federally Qualified Community Health Center that offers dental, behavioral health and urgent care services. We provide most of the HIV care in the area and offer an in-house pharmacy. We are a comprehensive FQHC and a Level 3 Patient Centered Medical Home. We have 20 medical providers that serve around 25,000 patients providing around 100,000 visits per year.
We work to provide comprehensive team-based care for our patients. Our case managers have received training through the Clinical Health Coach—it has been invaluable. The Motivational Interviewing skills they received has been great! As a supervisor of the case managers, when we get a new case manager on board we try to get them in to the next training offered by the Clinical Health Coach and the Iowa Chronic Care Consortium. It has been a wonder training to bring our new case managers up to speed. It helps them become more than just a health educator, and provides them with additional tools to help overcome barriers that patients might be having in taking control of their health.”
“Each of our case managers have distinct roles. All are assigned to provider teams, and they also have other roles such as hospital follow-ups, reducing ER visits, and follow-up of procedures that we perform in-house. They follow patients that have complex needs. Each month they reach out to those patients (either face-to-face or by phone) that have A1Cs great than 9 to make contact with them. They are invaluable helping us care for some of these patients who need a little extra help. Each team has an RN assigned to them, but unfortunately these RNs don’t have the time it takes to spend with these patients. The case managers are allowed the time to sit down with those patients and motivate them to take control of their health and give them the knowledge and education they need to take control of their own health. When you really need to motivate a patient to make some life style changes or to overcome some social barriers or behavioral health issues, the Clinical Health Coach training has been really helpful!”
“When I think of healthcare going from volume to value—health coaching will become so important in meeting different quality measures that we are expected to meet. Right now, we get paid on how many patients we run through our doors. However, this is transitioning to providing those patients with “value” as a basis for payment. Even though most of the services provided by our case managers and health coaches are not reimbursed by insurance companies, we are ok with that, because we know how important it is to meet those quality measures and know that our main mission is to provide better care for those patients and living healthier lives.”
Case Manager #1: “Engaging your patients starts the first time you walk in the room. When you have Clinical Health Coach training, you know you are not just going in to educate a patient. You can tell somebody 15,000 times, “you need to take your medication” but unless they are motivated to do so, it isn’t going to happen. I currently have a patient that has diabetes that has been out of control for years and years. She was one that we’d kind of written off and assumed she would eventually be on dialysis. I took care of her dad who has died while on dialysis. That still didn’t motivate her. The first time I walked in the room, she crossed her arms and turned her head away—she wouldn’t speak to me. Now she tells me how everyone else that has ever tried to help her tells her, “this is what you need to do, this is what you have to do to make changes. You are the only one that comes in and listens to me.” Just last month, she has her sugars under control and she’s finally taking care of herself. She’s motivated, she’s engaged, and she calls me when she has questions. She is a completely different person. That is huge!”
Case Manager # 2: “I think coaching has influenced the patient’s experience in letting them know they have a personal bond with you. They know that they can trust you and come to you with anything and you will be there to listen. You are more than a person that comes in, hands them education and leaves. I give my patients my phone number so they can call me at any time.”
Case Manager # 3: “I think another thing with changing the behavior. Through coaching you find out a lot more about your patient. They seem to really open up to you, and often times find out about other problems they are having. Especially with social determinants of health, you find out about what other barriers they are experiencing because they have that trust in you. They know you’re not just there throwing education at them, they do open up to you a lot more. You find out a lot more about the patient and find other resources that can help them with.”
Case Manager #1: “With the patient experience, we support what the provider says so it feels like a team approach — not just one person telling them what to do. They may feel intimidated talking to their provider about something embarrassing or they feel like they did something wrong. When we come in, they feel like it’s a more team approach, they have someone to talk to and ask questions – questions they otherwise may have been afraid to ask. This enhances patient care. Providers and nurses often have very limited time, just when the patients want time. Usually it’s “get in, get out” let’s get the results and we’ll call you with what we find out. Then we walk in, have that time with the patients, and the patients feel like they’re getting value from their appointment.
Case Manager #4: “Siouxland Community Health Center is really ahead of the times right now. I think coaching is the future of health care. We are coming to a point in time where we are going to be reimbursed for how well we are taking care of the patients, versus “walking them through the system.” This approach is very ahead of the game, and other centers should focus on following.”
Case Manager #1: We came back excited because before all we did before was education. We started using the readiness ruler. How motivated are you? Why are you an eight and not a six? All of the sudden, these people when asked why they were motivated for change, they started crying and would talk about their families. We would walk out of the rooms asking each other, “How many people would you make cry today?” This is when we knew we were connecting as a partner with our patients.