Study on chronically ill patients: "Coaching can save money"

Interview with Günter van Aalst, Director of the TK North Rhine-Westphalia Regional Division

Patients, who become chronically ill, usually learn to live with their disease after a short time. Taking medication or daily insulin injections becomes routine – and that's a good thing, because nobody should feel like the disease is constantly breathing down their neck. On the other hand, a sense of having the disease "under control" can lead to mistakes.


Photo: Older man with glasses and suit - Günter von Aalst

Günter van Aalst, Director of the TK North Rhine-Westphalia Regional Division; ©Techniker Krankenkasse

Diabetics for instance sometimes forget their resolutions and eat too much or heart patients start smoking again. In the worst-case scenario, with poor disease management you can end up in the hospital. Yet before things get that far, appropriate measures should be taken. This is why the German Technician Health Insurance (German: Techniker Krankenkasse) conducted a study on the Topic "Phone Coaching Helps Seriously Ill Patients and Saves Money". We spoke with Günter van Aalst about the interesting findings.

Mr. van Aalst, which patients were included in the study?

Günter van Aalst:
The project was aimed at insured persons with chronic diseases, particularly diabetes, hypertension and heart conditions, who are so sick that without assistance they would have had to be admitted to the hospital in the near future. More than 35,000 patients participated in the phone coaching. The youngest participant was 33, the oldest 79 years old.

How is phone coaching conducted?

van Aalst:
In phone coaching, participants talk with their personal coach on the phone for half an hour every two weeks. The primary objective of these phone calls is to motivate patients to engage in health-conscious behavior. Together with their coach, patients define their personal and individually attainable goals and agree on the steps to get there. Aside from self-management, inherent in these conversations are therefore exercise and diet, taking medications, drinking behavior and also smoking. The coaching is divided into three stages: the introductory phone calls to get to know each other, intense coaching conversations during the main phase, which should achieve a change in personal behavior and finally there are the phone calls to prevent relapse.

What qualifications did the coaches have?

van Aalst:
The coaches were recruited from the medical care professions as well as sports and nutrition sciences. In addition to their main qualifications, all coaches received internal training. Expanding language skills during phone conversations, but also relaying paralinguistic cues such as voice pitch, tone, volume and active listening were a major focus in this training.

By their own account, participants felt “significantly better“ after taking part in the study. To what extent did possible social isolation of participants play a role?

van Aalst:
This effect may have been exhibited in individual cases. However, it was not detectable in the study design.

Did the different patient groups yield different results?

van Aalst:
We were able to achieve an overall positive outcome with this project. The accompanying project evaluation showed that coaching causes an improvement in subjective health across all diagnostic groups. Especially patients with chronic heart disease benefitted from coaching. In these cases, physical impairments also reduced significantly based on their own accounts.
Photo: Older woman speaks at the phone

The study participants were called at regular intervals by trained coaches; © goodluz

What costs was the insurance company able to save by using the coaches?

van Aalst:
Within the scope of the scientific evaluation, we compared the cost trend of the participants with a control group. The results are clear-cut: regardless of the diagnosis, the development of overall costs for the coached patients was more favorable than with the patients of the control group, who didn’t receive coaching. In terms of hospital expenses for instance, savings of approximately 180 Euros per participant became apparent. Coaching can therefore actually save money, if it manages to prevent escalation of the respective course of disease.

Where else are the health coaches being used?

van Aalst:
The TK has already been offering its insured members free online coaching services for many years. The spectrum ranges from diet and fitness coaching to stress management coaching all the way to programs to quit smoking and motivational training. All programs are conducted by qualified trainers.
Photo: Simone Ernst; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Simone Ernst and translated by Elena O'Meara.