Proximity is important for smooth patient flow at Union Health Center (UHC) in Manhattan. The two main corridors of this Level 3 patient-centered medical home are used as the dividing line for forming two teams of three providers and one designated health coach each. When a patient comes to the clinic, a quick walk down the corridor is all that's needed for a warm handoff between provider and coach.
Interactions with the health coach take place based on the patient's preferences. The goal of the first meeting is to reassure the patient that they now have a supportive partner in their health care who will be with them long-term. Health coaches have flexible scheduling and make it a point to be accessible, often taking appointments by phone or conducting face-to-face visits to accommodate their patients' busy lives. They have their own appointment books and any care team member with access to the electronic health record (EHR) can book patients with a health coach. Health coaches meet with a patient as often as needed for the patient to reach his or her self-management goals. This could come in the form of bi-weekly meetings for six months or monthly meetings for one year. Some patients meet one goal and move on to another, continuing to work with a coach for an extended period of time. Patients may also come back for coaching after their clinical measures fall out of range and their provider refers them again.
To track coach-patient interactions, health coaches use customized templates. These templates enable consistent and thorough documentation in the EHR and make it easy for the coaches to remember where plans were left at a patient's last visit. Providers can see the impact coaching is having on whether patients are meeting their goals, which can impact clinical measures. The templates have become valuable tools to standardize documentation of coaching sessions in the EHR.
It is essential for patients to feel they are being heard and understood for patients to get the most out of the coaching experience. The health coaches at UHC are medical assistants who share language and cultural experiences with their patients; all medical assistants are bilingual and speak Spanish, French-Creole, or Chinese in addition to English. Patients at Union Health Center often call their health coach when they are facing challenges managing their chronic condition and aren't sure if they should schedule an appointment with their provider, demonstrating the strength of the bond that develops between patients and the health coaches.
Coaches use “closing-the-loop” and “ask-tell-ask” approaches to educate patients and confirm patients' understanding of their own care plans. While training on these techniques was outsourced initially, two team members onsite can now facilitate initial training and annual booster training. The curriculum not only provides training in 12 clinical areas, including diabetes, prediabetes, hypertension, asthma, weight management, and smoking cessation, but also incorporates training on soft skills, such as communication and empathy. Role-playing is encouraged to help the coaches master techniques. This robust training program is part of UHC's commitment to medical assistant professional development.
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