Experience with health coach-mediated physician referral in an employed insured population

Abstract

Background: 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.

Objective: To evaluate the health coach's influence on provider choice and the quality of the user experience in the early introduction of this service.

Design: 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.

Participants: Insured adults (ages 21-64) employed by a large national firm or covered dependents of employees.

Measurements: Awareness of the service, reason for using service, visits to providers recommended by service, use of health advice provided by service, user satisfaction.

Main results: 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%.

Conclusions: 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.

Figure 1

User satisfaction with the health coach: assistance with health information and provider referrals (adjusted % derived from multivariate logistic regression modeling). Note: Users responding include people who acknowledged use of health coach, requested and received services and used them.

Figure 2

User satisfaction with the health coach-recommended providers (unadjusted % ). Notes: Users responding include people who acknowledged use of health coach, requested and received services and used them.