5 Points on Incorporating a Health Coach Into a Spine & Pain Group
When building a comprehensive integrated care program, consider using a health coach to coordinate care within your spine or pain practice adding this specialty can be very beneficial for patients who are dealing with chronic diseases or other pain conditions. This new team member is usually a licensed clinical social worker (LCSW) who partners with patients from the first visit to help set goals, establish action plans and provide guidance toward self-care management.
"A health coach, in a spine or pain practice, is a very valuable resource because the physician's time can then be focused on medical issues whereas the health coach will focus on the behavioral side of the patient's care," says Scott Anderson, COO of Prairie Spine & Pain Institute in Peoria, Ill. "When physical medicine, functional and behavioral specialists are working together in a single site, we consider that an integrated care program; we believe a health coach becomes yet another positive tool in the toolbox for patient care."
Mr. Anderson developed the program and has successfully implemented the concept within three different pain programs; he is currently building Dr. Richard Kube's spine and pain group in Peoria, Ill., "Prairie Spine & Pain Institute" on bringing it to the fourth. To download his integrated patient care visit planner, which outlines the program structure and payment codes, click here.
Mr. Anderson discusses how to build a health coach program at your pain or spine practice to optimize patient care and practice revenue.
1. Program structure. The program can be structured to assess patients and provide the necessary services for transitioning to self-care management. Mr. Anderson's program includes four assessments:
• Quality of life assessment (semi-annual)
• Functional assessment (semi-annual)
• Physiological assessment (diagnosis of chronic pain)
• Nutrition assessment (annual)
The program also includes several types of visits to keep patients on track. The visits include:
• Quality of life visits—Visits to help patients develop goals toward self-management where patients can develop action plans and discuss barriers to treatment
• Medication management visits—Quarterly visits to review adherence to medication, modify medication management plans and provide medication counseling
• Physiological visits—Semi-annual visits that include a comprehensive physical, medical plan review and plan of care development
• Nutrition visits—Quarterly visits for nutrition therapy, diet planning and nutrition management
• Interventional therapies visits—Visits where interventional therapies are used in conjunction with the integrated treatment plan as appropriate
• Functional visits—Visits where patients discuss exercise as medicine and address their ability to improve function, use exercise protocol and build a Wii Fit program for self-care management
• Patient education visits—Visits where patients are educated about their chronic pain conditions, which include group classes, activity counseling and lifestyle modification
The plan detailed by Mr. Anderson includes up to 50 total visits on an annual basis per patient. The plans are individualized for each patient's condition to achieve their goals.
"A goal might be for a patient to lose weight," says Mr. Anderson, as we know that obesity impacts pain levels. Working with a health coach the patient can work on reducing their weight through exercise or other coordinated activities. Single site integrated care programs provide the opportunity to make sure we are getting the best patient results."
2. Introduce the behavioral specialist as a "health coach." Patients have an aversion to the title "behavioral specialist" and may refuse to work with health coaches if they think the coaches will be providing psychiatric-like care.
"Patients don't want to talk to a 'shrink,'" says Mr. Anderson. "In their minds, they don't have a problem with their brain; they have a problem with their pain. When you ask them to talk to a 'behavioral specialist,' they will rebel because they think you think it's all in their head; but for them their pain is very real."
Introduce patients to their health coach as one might be introduced to a physical therapist: physical therapy is improving the patients' function while the health coach is someone who focuses on the non-functional aspects of care.
3. Measure the patient's progress. It's important to have measurable goals associated with managing chronic pain. Once the program is established, the first thing health coaches should do with patients is conduct an assessment about whether the patient has chronic depression, where their pain is and how it impacts their functional life.
"We take each answer from our health questionnaires and use them to set up realistic goals," says Mr. Anderson. "At a Weight Watchers meeting, the first thing they do is step on a scale to get a baseline measure of their weight, providing an opportunity for improvement. Then they talk to each other about what they did over the past week to make progress toward their goals. We are going through the same process to work with the patients psychologically."
After the goals are set, health coaches motivate patients to work toward self-management through regular visits and plan modifications. Measuring baseline progress is important as outlined in Mr. Anderson's program. The information can be stored in a patient registry for each chronic medical condition so outcomes can be tracked and coaches can refer to past cases when working with new patients.
4. Billing for the services. As long as the health coach is a licensed clinical social worker, the services are billable using behavioral health codes — specifically CPT 96150 through CPT 96155. The visits are typically an hour long and billed in 15 minute increments, much like billing for physical therapy.
"It will be anywhere from $30 to $50 allowable per 15 minutes, which means $120 to $200 collections per hour, for a person to coordinate care," says Mr. Anderson. "You can do really cool things for the patient and provide them with great opportunities for better care, and generate revenue at the same time."
Mr. Anderson's program also identifies how practices can bill for each different visit.
5. Fully integrating the patient's care. This model of hiring a health coach is more effective than referring patients out to behavioral specialists because everyone is available under one roof. "This way, you are proactive and involving the behavioral person side-by-side with the physician's care, and it is much more effective," says Mr. Anderson. "It's a very positive approach to helping patients improve their quality of life and function, and reducing their pain."
While Dr. Richard Kube is a spine surgeon he saw the benefit of how integrated care programs for his practice would enhance patient care opportunities and the ability to streamline patient care management. Dr. Kube also saw how offering an integrated care program at Prairie Spine & Pain Institute would generate more patient referrals from the primary care physician community, providing a larger base of patients that may be surgical candidates.
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