Steve Finn, PT, DPT, OCS
Director of Rehab Services
Myrtue Medical Center
Harlan, Iowa
| Kathy: | Steve, thank you for taking time to talk with me about an innovative model that you and your team have developed since your involvement with Clinical Health Coach Training last April.
Can you share a little bit about your setting… where you are located and something about your community? |
| Steve: | We are in Harlan, Iowa. A town of 5,000. County population of 13,000. Very rural and an older population. Our hospital would be considered a critical access hospital. Usually what that means is its 25 beds or less. We’ve got a wonderful medical staff to go along with that. Our Rehab Department is staffed with several PT’s, OT’s and speech therapists. We have a 47,000 square-foot Wellness Center that we are attached to. |
| Kathy: | Kathy: What would you say is one thing that has most excited you about the value of health coaching? |
| Steve: | As a physical therapist, it definitely provides us with a working model of how to effectively manage a patient that has one (or frequently) many chronic diseases. Obviously, that’s a challenging patient for any discipline, but as a physical therapist we believe we are very well positioned to be a critical component in their health management. It provides us knowledge and skills to move from that episodic care that we have done year after year to more of a population health model. |
| Kathy: | In terms of the types of patients you see as a physical therapist, what kinds of chronic conditions do you encounter most frequently? |
| Steve: | Many of them have a diagnosis of obesity and are diabetic or pre-diabetic. But, we also see lots of patients with chronic pain. And, again, this model fits in very well managing these patients because you are working on changing behaviors verses a specific program. |
| Kathy: | Does insurance restrict in the amount of time or number of visits that you can work with your patients in a traditional setting? |
| Steve: | Yes, it wouldn’t be unusual for us to see patients for 8-12 visits. In years’ past, you may see that patient 2-3 times a week for 3 to 4 weeks, which is a really short time duration to note significant change. So, now we’ve gone more toward seeing a patient once a week. It may still total 8-12 visits, but span a three-month time period. By then, we are starting to see changes in what that patient has been dealing with whether its chronic low back pain or just not being able to start a wellness program for several years. So, we have gotten some traction from that. Hopefully, after therapy we try to transition them to what we call our “Live Well Program”. We have a wellness center attached to our therapy department. We have two exercise science people who have gone through Clinical Health Coach training and they can continue to follow up with them and hopefully turn it into more of a lifestyle change and long term commitment. |
| Kathy: | Now, I’d like to transition to your program model, because your model is really interesting. As a physical therapist, your work begins as a standardized referral process, and you are working toward physical health improvement. But at Myrtue Medical Center, you have built a great relationship with the clinic’s Wellness Center. Tell us more about your model. |
| Steve: | In our clinic it’s call The Live Well Program. But, it’s been happening in physical therapy circles throughout the United States for the past several years. So, I just want to emphasize that none of this is our original thought, but we have taken that information and made it our own program. So now the entire conversation and treatment plan changes for us. For example, I may have a patient that has had low back pain for the last 15 years. But, also they could be 100 lbs overweight and have multiple other chronic problems. In the past, we would have been asking “What can I do to help this patient in the next two to 4 weeks?” Now, the conversation changes to looking holistically at the patient, and trying to drive positive behaviors that they themselves would like to change, which leads them down the path of being a healthier individual. Telling the patient, “Wait, I don’t expect you to be better in 3 weeks from now. I would hope for you to start getting a little bit better three months from now.” That way they may take some ownership, with goals being set in more bite sized segments. It’s more feasible to see changes in a three month period. Then, we can follow up with them in a 6 month, 12 month process. Chronic pain is a huge problem for the entire medical community so it definitely takes some education and buy in from the patient. It’s not for everyone, but even those patients that haven’t been successful with this approach, some have come back a year later and say now they are ready to try again. There is no such thing as a silver bullet. If there were, there would be no one in chronic pain right now. It’s a lifestyle and behavioral change but it should be a long-term approach. |
| Kathy: | I heard two things. You’re changing the landscape of expectations. I also heard this is open-ended. You’re willing to let people try on their own, but you’re really open to have them come back to get guidance. |
| Steve: | Yes, then you have a captured audience and have a great chance to be successful with that patient. But, it takes time and persistence. Even though we really like this program, we tell them it’s not easy to do this. |
| Kathy: | Who makes up your program implementation team? |
| Steve: | It’s our entire rehab staff that has implemented this process. It’s very important to have a warm hand-off. We have two very great clinical health coaches with exercise science degrees (in the Wellness Center) that we can hand these patients off to and they can follow the patients long term. That is really important in terms of our programs’ success. We also have big buy in from our medical staff. Because, there’s not too many medical staff who aren’t looking for a better way to take care of the morbidly obese patients or the chronic pain patient or the one with other chronic conditions. They accepted this program with open arms and have really bought into the whole process. |
| Kathy: | Do they refer to the physical therapy services or the Living Well Program? |
| Steve: | Some of both, but even if patients are referred through a traditional path or diagnosis, we are stepping back and taking a look at the whole patient. We are still going to address the diagnosis, but we are going to turn it into a long- term solution. |
| Kathy: | As a starting point, you can bill for services through physical therapy because you are providing traditional physical therapy services |
| Steve: | Yes, and we are hoping that in the future we won’t need that diagnosis. Maybe they will just be referred to us for obesity or diabetes or another chronic health problem. That is the format we follow right now and it’s very workable. The Clinical Health Coach Model doesn’t have to take a long time. We can really break that up effectively in 10 or 15 minute segments throughout therapy sessions. When we are willing to be disciplined in this process, we see more changes long term with patients. |
| Kathy: | So, it doesn’t have to interrupt and take longer time for you. You can build this into your services. |
| Steve: | Yes. |
| Kathy: | How does the referral process to the Wellness Center work? |
| Steve: | The patients that take that next step, (which is about 70 percent of them), make a two-month commitment. They work with our clinical health coaches and go to the wellness center at least 3 times per week. They won’t be with a health coach all those times. Our coaches meet with them on average 7 visits in a 2 month time period. Going from therapy, where you have a lot of people looking just like you, this is a different environment. Many patients have never set foot in a wellness center so we do some hand holding at first, until they become more comfortable. We just love wellness centers as a whole because they are such a positive place and very cheerful place a lot of good things happen on a daily basis. |
| Kathy: | So they form sort of a support group. Do you see them helping each other? |
| Steve: | Absolutely. Frequently, after these people have worked out, they sit out at tables and visit and drink coffee or have a glass of water. You see the social impact as well as the physical. |
| Kathy: | What is the fee to join the Wellness Center? |
| Steve: | For us, it’s just a small fee. I think its $50 for the first two months which allows them to have access to the Wellness Center after they have been introduced to everything by our clinical health coaches. After two months it’s up to them whether they are going to join the Wellness Center for long term. We understand if people do not choose to join. They can be successful on their own. We really do like the “tribe” mentality, when you have that extra support build in for the exercise. We have about a 47% join rate for people that go through the 60 day Living Well Program. That’s pretty high. |
| Kathy: | Is the Wellness Center at the medical facility? |
| Steve: | It was built by our hospital so obviously, we have had tremendous backing from our administration to back the importance of wellness for our entire surrounding population. The Rehab Department is attached to the Wellness Center. |
| Kathy: | The community can come in and use the Wellness Center? |
| Steve: | Yes, it was huge expenditure when they first built the Wellness Center, so it took a lot of courage on their part. They really believed in the mission of wellness and I think that’s what led them down that path. |
| Kathy: | How many patients enroll in the Live Well Program per month? |
| Steve: | We average 4-6 patients each month that transition to the Live Well Program. There are 50-70 patients at any given time using the Wellness Center as part of the Live Well Program. |
| Kathy: | Do you have a success story that you could share? |
| Steve: | We have had several. It has been very refreshing. We all know, as medical professionals, about the high burn-out rate when you are working with patients with chronic conditions. This provides an entirely different approach. It is much more patient- centered. We see an increase in compliance with home exercise programs and have just started collecting data to see how many patients are members of the wellness center after their 2nd year, 3rd year, and 4th year. |
| Kathy: | We are very impressed on how you have been able to grow this model. Even if it was developed somewhere else, it becomes local and clearly it has become very local to your community. Is there anything else you would like to share? |
| Steve: | I would like to let people know that this can be successfully integrated anywhere throughout a rural area. Lot of times we feel like rural areas are isolated and we don’t have the opportunities to implement those programs. But if you can get buy in from your administration, it makes sense for everyone to have some similar program in place. |
| Kathy: | Are there businesses that will be willing to support the Living Well Program for someone who cannot afford the $50 two- month commitment? |
| Steve: | We offer a scholarship opportunity and also there are a fair number of patients involved that are beneficiaries in the Iowa Medicaid program. |
| Kathy: | This has been very insightful and motivating. We appreciate your time and applaud you for the work that you are doing. |
| Steve: | We really appreciated your time too and we love the program. I can’t speak for everybody, but definitely for physical and occupational therapist, it fits so well with what we are trying to accomplish. It really should be a standard of practice in the upcoming years. |