How Effective is Health Coaching in Reducing Health Services Expenditures?
Yvonne Jonk, Ph.D, assistant professor, University of North Dakota
Karen Lawson, MD, assistant professor, Center for Spirituality and Healing
Heidi O’Connor, MS, research fellow
Xuyang Tang, HSRP&A Ph.D student
Yvonne Jonk, Ph.D, Karen Lawson, MD, and Heidi O’Connor, MS, are lead authors of this research study. Xuyang Tang prepared this brief as a class assignment for PubH 8802, Health Policy Applications, taught by Lynn Blewett, Ph.D, professor, and Sarah Gollust, Ph.D, assistant professor.
As health care costs continue to rise, policymakers are paying more attention to cost minimization, quality of care, and cost-effectiveness of treatment. As high care costs are a direct result of over-utilization of medical goods and services, health coaching may be a key strategy to decrease health care cost while improving care quality by helping high-risk patients to better understand their health care needs and to more effectively communicate with health care providers.
Few studies have evaluated the effect of health coaching on health expenditure and quality in the past. Medical Care recently published a study by Yvonne Jonk, Karen Lawson, Heidi O’Connor, et al. which evaluated the effect of a health coaching intervention on enrollees of high-risk health insurance plans’ health care expenditure on prescription drugs, as well as in inpatient, outpatient and emergency room settings.1
The health coaching intervention included 5 to 6 telephone sessions within a 6-month period. The health coaches helped participants identify health goals and improvement plans to empower participants to establish a relationship with their health care providers that results in more effective communication. The language used in the sessions, intervention milestones and skill-sets were tailored to individual participants, and the frequency of the calls varied by the convenience of the participants. The coaches had experience with nursing, psychology, social work, physical activity physiology, nutrition, health education or a combination of them, and completed a customized training program prior to the intervention.
The study participants included private health insurance plan enrollees identified as high cost based on having multiple comorbidities or high adjusted clinical group risk score. Participants were enrolled in the plan during 2008 to 2011. The participants of the study were identified and recruited through claims data, health assessments, physician referrals or self-enrollment. The final participants of the intervention met five criteria: 1) were not enrolled in multiple health coaching phases in the past, 2) were not enrolled in the self-directed track which did not meet with health coaches, 3) had continuous private insurance coverage throughout the study’s time period, 4) did not contribute to the top 1% of the costs, and 5) had 6 months of claims data before the first health coaching session and 6 months of claims data after the last health coaching session. The study used claims data of 2,322 individuals, 1,161 in the intervention group and 1,161 in the control group. The participants of the intervention and control groups were matched one-to-one based on their characteristics other than health coaching participation. The analysis compared the health care expenditures pre- and post-health coaching of the intervention group with that of the control group participants in inpatient care, outpatient care, emergency room, and prescription drugs.
Health coaching was associated with reduced health care expenditures. The intervention reduced the proportion of health coaching participants who incurred inpatient health services expenditures by 8.8 percentage points, from 20.3% in the 6 months pre-health coaching to 11.5% in the 6 months post-health coaching. The difference between participants who incurred costs for emergency room visits pre- and post-health coaching was 7.4% percentage points lower. For participants who incurred costs for outpatient services, health coaching participants’ average per month cost of outpatient services decreased by $122 from pre- to post-intervention, but the average per month cost of the participants who were not in health coaching increased from $426 to $580 in the same time frame. Relative to non-health coaching participants, the total predicted cost-savings of participating in health coaching is was $412 per person per month across all four types of services.
Compared with health coaching participants who were not included in the study, the study’s health coaching participants tended to be 50 years or older and more likely to live in rural areas. Health coaching participants in the study sample were less likely to have mental health problems but more likely to have glaucoma, hypertension, osteoporosis and hyperlipidemia than participants excluded from the sample.
The current political environment encourages minimizing health care expenditures and improving health care quality. This study demonstrates that health coaching is one strategy that can be used to decrease health care expenditure. The study demonstrates that having a stronger relationship between patients and physicians reduces needless care and improves quality of care.
1 Jonk Y, Lawson K, O’Connor H, et al. How Effective is Health Coaching in Reducing Health Services Expenditures? Med Care. 2015;53(2):133-140. doi:10.1097/MLR.0000000000000287.
HPM Research Brief is a summary of recent research by faculty and staff in the Division of Health Policy and Management, School of Public Health, University of Minnesota. Our efforts help to influence policy and improve health outcomes across the globe. Visit our website at sph.umn.edu/hpm.