Health Coaches To Guide  Chronically Ill Medicare Patients

PITTSBURGH (AP) — A new pilot program will provide chronically ill Medicare patients with access to health coaches, who will advise them on medical choices and preventive care and help calm any fears.

The three-year program, dubbed Medicare Health Support, will neither cost participants anything nor alter their benefits. It will offer customized care plans and 24-hour hot lines to help and counsel patients on issues ranging from treatment to living wills.

Coaches could also tell patients what questions they should ask doctors, even rehearsing asking such questions. But they aren’t substitutes for physicians and won’t try to be, said Tamara Hall, senior vice president of innovation at Boston-based Health Dialog Services Corp, which will implement the program in western Pennsylvania.

Instead, they will try to help reduce patients’ confusion when “they’re are fearful of something, they don’t understand what’s going on,’’ said Hall, a registered nurse who also serves as a health coach. “We help them digest what’s going on. Just like with a personal trainer, if you teach the right technique, you get better.’’

The Centers for Medicare and Medicaid Services, the federal agency that administers Medicare and Medicaid, this month launched the program to give 180,000 chronically ill fee-for-service Medicare recipients nationwide access to health coaches. Medicare is the federal health care insurance program for people 65 or older and for the disabled. Federal officials hope the new program saves money while improving the health of Medicare recipients.

The federal agency estimates that Medicare this year will spend $333 billion in benefits, of which about $280 billion will be fee-for-service payments, under which patients are allowed to see doctors of their choice and bill Medicare for services, said Sandy Foote, a senior adviser with the agency.

Medicare Health Support began in Oklahoma, Maryland, and Washington, D.C., this month. Preliminary information has been sent to participants in western Pennsylvania. The program will soon launch in Mississippi; Florida, from Tampa to Naples; greater Chicago; northern Georgia; Queens and Brooklyn in New York; and 35 counties in Tennessee.

Foote said each provider will be paid per participant per month, depending on the geographic area, and the agency would not make public the exact fee. The program targets 20,000 people chronically ill with diabetes and/or congestive heart failure in each area. Another 10,000 in each area will be in control groups so their medical costs and quality can be measured against the other group.

The number of coaches in each area will vary. Most will be in the regions they serve but others will travel to visit patients who need personal assistance.

If the companies do not show at least a five percent savings between the two groups, they will have to give back their fees, Health Dialog Chief Executive Officer George Bennett said. He said he expects the western Pennsylvania program to be expanded to the eastern part of the state next year.