Q&A: What does a health coach from an insurance company do?

Q: A health coach at my insurance company called me because I was identified as a member for outreach. What does a health coach do?

A: Health coaches are specially trained registered nurses who offer 24/7 support through an insurer to help members with chronic conditions, complex health issues, and everyday health concerns. Health coaches play a vital role in helping members achieve their health goals.

Health coaches carefully identify members after reviewing information such as abnormal lab results, new diagnoses, frequent ER visits, recent hospitalizations, or medication needs. Once a health coach contacts a member and explains the support available, members can voluntarily agree to work with their coach before moving forward. There is no cost for members to speak with a health coach, but based on the member's insurance plan, some elements of the health coaching program may not be available.

Health coaches work to develop personal relationships with members and help to identify an intervention strategy for the health problem. For example, if a diabetes patient is not receiving necessary testing for the condition, a health coach can intervene and help facilitate communication with the patient's doctor. Or, health coaches can educate members on their disease, medications, and side effects, and identify additional resources as needed, such as nutritionists.

The goal of health coaches is to help members maximize the benefits provided by their insurer.  That can mean providing emotional support through a chronic condition, collaborating with members' health care teams, or leading members to other resources, such as pharmacists and social workers.

Diana Lehman is a director of case and condition management at Independence Blue Cross in Philadelphia.