Experience with Health Coach-Mediated Physician Referral in an Employed Insured Population
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Given increasing interest in helping consumers choose high-performing (higher quality, lower cost) physicians, one approach chosen by several large employers is to provide assistance in the form of a telephonic “health coach” — a registered nurse who assists with identifying appropriate and available providers.
To evaluate the health coach’s influence on provider choice and the quality of the user experience in the early introduction of this service.
Cross-sectional survey of 3490 employees and covered dependents of a large national firm that offered health coach services to all employees and covered dependents. The survey began in September 2007 with proportionate stratified sampling of 1750 employees and covered dependents who used the services between October 2007 and February 2008, and 1740 non-users.
Insured adults (ages 21–64) employed by a large national firm or covered dependents of employees.
Awareness of the service, reason for using service, visits to providers recommended by service, use of health advice provided by service, user satisfaction.
The primary reason for using the service was to obtain provider referrals (73%). Fifty-two percent of users sought a specialist referral, 33% a PCP referral and 9% a hospital referral. Eighty-nine percent of users seeking a provider referral were referred in-network; 81% of those referred visited the referred provider. Measures of satisfaction with both the service and the care delivered by recommended providers were over 70%.
Customers largely follow the provider recommendation of the health coach. Users express general satisfaction with existing health coach services, but differences in performance between vendors highlight the need for the services to be well implemented.
KEY WORDShealth coach physician referral physician performance data employee assistance program survey
The authors acknowledge with gratitude the contributions of David Blumenthal MD, MPP (formerly of Massachusetts General Hospital), Angela Cafferillo, Margaret Damiano and Ginny Proestakes (General Electric), Roy Crowdis and Diane Downs (Medstat), Michael Chernew (Harvard Medical School) and Amy Schoenfeld (formerly at MGH).
This research was funded in its entirety by General Electric through a contract with the Massachusetts General Hospital and the MGH Institute for Health Policy.
One of our authors, Robert Galvin, MD, is employed by General Electric, a sponsor of this research. No other author has any conflict of interest to disclose.
Some data from this research project was presented at the Annual Research Meeting of AcademyHealth, Chicago, IL, June 28–30, 2009.
- 1.Cherry DK, Hing E, Woodwell DA, Rechtseiner EA. National ambulatory medical care survey: 2006 summary. National Center for Health Statistics: National Health Statistics Report 6 Aug 2008; 3 (Table 7).Google Scholar
- 3.Kaiser Family Foundation. A National Survey: Americans as Health Care Consumers: The Role of Quality Information. Kaiser Family Foundation and The Agency for Health Care Policy and Research Oct 1996. Available from: http://www.kff.org/insurance/upload/Americans-as-Health-Care-Consumers-The-Role-of-Quality-Information-Toplines-Survey.pdf [Accessed 27 May 2010].
- 4.Hibbard JH, Peters E, Slovic P, Finucane ML, Tusler M. Making health care quality reports easier to use. Joint Comm J Qual Patient Saf. 2001;27:591–604.Google Scholar
- 10.Abraham J. Employee awareness of provider quality information: the BHCAG experience. Research Practice; 2005.Google Scholar
- 13.Kaiser Family Foundation. 2008 Update on consumers’ views of patient safety and quality information. Kaiser Family Foundation Oct 2008, Available from: http://www.kff.org/kaiserpolls/upload/7819.pdf [accessed 27 May 2010].
- 15.The Midwest Business Group on Health. Finding doctors in Chicago: a project to improve online physician directories. The Commonwealth Fund; Mar 2005.Google Scholar
- 17.California HealthCare Foundation. Snapshot - just looking: consumer use of the internet to manage care. 2008. Available from: http://www.chcf.org/publications/2008/05/just-looking-consumer-use-of-the-internet-to-manage-care [accessed 27 May 2010].
- 18.Medicare Payment Advisory Committee. Chapter 5: Access to care in the Medicare program, in A Data Book: Health Care Spending and the Medicare Program; Jun 2008. Available from: http://www.medpac.gov/documents/Jun08DataBook_Entire_report.pdf [accessed 27 May 2010].
- 19.Shute N. Can’t find a doctor? Available from: http://health.usnews.com/articles/health/living-well-usn/2008/03/19/cant-find-a-doctor-youre-not-alone.html [accessed 27 May 2010].
- 20.Brown K. Mass. health care reform reveals doctor shortage. National Public Radio. Available from: http://www.npr.org/templates/story/story.php?storyId=97620520 [accessed 27 May 2010].
- 21.Rubenstein S. Medicare patients struggle to find primary care docs. Wall Street Journal. Available from: http://blogs.wsj.com/health/2008/12/09/medicare-patients-struggle-to-find-primary-care-docs/ [accessed 27 May 2010].
- 22.Rosen M, Liebowitz A. Health advocacy: saving time and money for employers and employees. Employee Benefits, Society of Financial Service Professionals; Aug 2004: 6–7.Google Scholar
- 23.Fronstin P, Collins SR. Findings from the 2007 EBRI/Commonwealth Fund consumerism in health survey. The Employee Benefit Research Institute and The Commonwealth Fund, March 2008.Google Scholar
- 26.Freeman HP. A model patient navigation program. Oncology Issues Sep–Oct 2004: 44–46.Google Scholar
- 28.SAS Institute. SAS OnlineDoc 9.1.3. Cary, NC: SAS Institute, 2002–2005. Available from: http://support.sas.com/onlinedoc/913/docMainpage.jsp [Accessed 27 May 2010].
- 29.Research Triangle Institute. SUDAAN language manual, release 9.0.3. Research Triangle Park, NC: Research Triangle Institute, 2004. Available from: http://www.rti.org/sudaan/pdf_files/SUDAAN_Language_Manual_Addendum_903.pdf [Accessed 27 May 2010].
- 30.Agency for Health Care Research and Quality. The CAHPS Benchmarking Database. Available from: https://www.cahps.ahrq.gov/CAHPSIDB/Public/QuexList.aspx [accessed 27 May 2010].