Coaching better health
LOS ANGELES — William Jones has shuttled in and out of the hospital so often that his HMO calls him a frequent flier.
A two-pack-a-day smoker who quit about a decade ago, Jones suffers from emphysema and breathes with the help of an oxygen machine.
To cut his once-a-month emergency room visits, the 79-year-old retired truck driver turned to a health care coach provided by his insurer for counseling about follow-up visits to doctors, prescription drugs and other medical needs.
Since then, Jones has only been to the ER once in the past four months.
“It’s an amazing turnaround,” said his daughter, Cindy Lopez. “Every time he’s hospitalized, he’s depleted more and more.”
Health insurers are increasingly using health coaches to help discharged hospital patients navigate the daunting transition to home care and stay out of the ER. For some people, the coaching brings more independence and improves their quality of life.
In return, health plans stand to save money if patients avoid expensive returns to the hospital.
A study by doctors at the University of Colorado found that patients who worked with health coaches were less likely to return to the emergency room in the first six months after they left the hospital.
In addition, the researchers estimated the use of coaches could reduce annual hospital costs by about $845 for every patient enrolled in the program.
“The whole idea is, let’s work with you and your family so you’re not ending up in the emergency room,” said Mohit Ghose, a spokesman for America’s Health Insurance Plans, a trade group that represents about 1,300 health insurers.
The National Center for Health Statistics reports that ER visits jumped 18 percent in the past decade to 110 million in 2004. About 13 percent of those visits led to people being hospitalized.
Most health coaches are registered nurses hired by insurers to make regular house visits or talk to patients on the telephone.
Coaches sometimes role-play with patients to teach them how to read their prescriptions or make appointments with doctors.
Post-hospital problems can be especially acute for the elderly, whose ranks will swell as the first baby boomers turn 60 this year. Patients can forget to take new medicines or fail to make critical medical appointments.
To address those issues, the federal government is experimenting with a three-year pilot coaching program that involves about 115,000 fee-for-service Medicare patients who tend to suffer from heart failure or diabetes.
Since last year, participating patients received coaching after leaving the hospital or as part of their regular care through eight health care organizations. The groups must show a 5 percent cost savings as a result of the coaching or repay the government for the cost of the service.
Results of the study won’t be available until next summer, but anecdotal evidence suggests some Medicare recipients improved their health through coaching, said Barbara Hoffman of the Centers for Medicare & Medicaid Services, the agency that administers government health insurance programs for the elderly and disabled.