William Appelgate, PhD, is the cofounder of not one, but two organizations dedicated to population health.
He helped found the Iowa Chronic Care Consortium, a population health non-profit, in 2002 and its spin-off training organization, Clinical Health Coach, in 2008.
Dr. Appelgate has served as executive director of the Iowa Chronic Care Consortium since 2002. Previously, he served as a faculty member and vice president of planning and external relations at Des Moines (Iowa) University. Dr. Appelgate spent the first 25 years of his career serving as president and CEO of two healthcare systems in the Midwest.
He earned a master's degree in curriculum systems from Loyola University in Chicago and a doctorate degree in higher education and public policy from Southern Illinois University in Cardondale.
Dr. Appelgate recently spoke with Becker' s Hospital Review about the Iowa Chronic Care Consortium, Clinical Health Coach and his hopes for the future of population health.
Responses have been lightly edited for length and clarity.
Q: Can you share the story behind founding ICCC and Clinical Health Coach?
WA: The presidents of Iowa Health System, Mercy Health Network, Iowa United Auto workers, Iowa Farm Bureau and Des Moines University, along with myself, founded the ICCC in 2002 to reduce the burden of chronic disease in Iowa. Through ICCC, we developed population health projects for health systems in Iowa, before eventually moving to other states.
Most projects were fairly sophisticated in design and used match control groups, so we could assess the positive effects of the projects over a long period of time. We found excellent results. At one health system, we reduced readmissions of heart failure patients from 30 percent to 8 percent in eight months.
In 2008, we had a clinic system come to us and say, "Hey can you help us create a training program that reflects what you're doing?" The consortium had always done the coaching, so it wasn't beyond our grasp to develop such a program. Once other systems started asking for training, we created Clinical Health Coach as a formal training program from the ground up.
Q: What does Clinical Health Coach training entail?
WA: The program is very performance oriented. We're preparing and developing skills in a variety of healthcare professionals. A lot of people who go through the training are individuals in the healthcare system who do patient-facing work, like care coordinators, quality managers and some case managers. About 60 percent of the people going through our training are nurses, registered nurses, advanced nurse practitioners, etc. In the balance are individual members of healthcare teams, like physicians, physician assistants and dieticians.
We see "clinical health coach" more as a skill set than a position. You go through training, but you are not health coaches. About 60 percent of the training is focused on preparing you as a behavior change specialist, and about 40 percent is improving your skills as a care management facilitator.
We focus on coaching people on three things: health behaviors, self-care skills and inspiring accountability. While we don't bring any dramatic clinical interventions to hospitals, we've found behavioral changes create really positive results on the clinical value compass, clinical outcomes, value outcomes, patient experience outcomes and costs.
Q: What is the biggest challenge with population health today?
WA: Dr. Toby Cosgrove [CEO of Cleveland Clinic] was on "Meet the Press" recently and at the end of his presentation he was asked, "What' s the one big breakthrough opportunity we have in healthcare today that would make a difference and change the nature of healthcare in the U.S.?" He didn' t talk about legislation and funding. Instead, he said the biggest challenge — and opportunity — in healthcare is getting people to take greater responsibility for their healthcare.
I always say 90 to 95 percent of healthcare happens in bathrooms, bedrooms, etc. If we can't change behaviors relating to self care, we won't be as successful as we need to be. For 20 years, we've had evidence-based guidelines for the management of diabetes. Last year, the U.S. spent $176 billion on direct healthcare costs for the disease — not because a lot of healthcare providers didn't know what to do, but because Americans have poor self-behavior and self-care.
To lower costs, boost patient responsibility and create a healthier country, we need to inspire people through coaching and a one-on-one basis. Healthcare professionals have been taught to teach and tell. We' ve found that doesn't work well. Instead, we need to teach healthcare professionals to ask, listen and inspire.
Q: Where do you see population health moving in the future? What sort of trends do you predict?
WA: One trend is how healthcare views patients. When Dr. Farzad Mostashari — the former national coordinator for HIT who got the U.S. involved in technology and medical records — was leaving office, he said the greatest opportunity in healthcare is using our underutilized resources. There's no question that patients, and their families, are the greatest underutilized resource in healthcare.
Right now, healthcare relies a lot on quick binary fixes. We prescribe a pill because it's quicker and easier than other means. However, patients are more likely to take control of their own health when they feel their opinion is valued. We must view patients as a resource, not just a challenge. If they take on more responsibility, then we take on less risk. That's where the opportunity lies.
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