Robert Sakowich's life is an ongoing calculation, a struggle to wrangle his blood sugar into the safe range. Diagnosed with type 1 diabetes in 1987, the 59-year-old former Polaroid technician makes every choice—about when and what to eat, when to exercise, how much insulin to inject, and how many glucose tablets to take—with an eye toward hitting "the magic number." If he misses? Blood sugar spikes make him irritable, and dangerous dips leave him with blurred vision, slurred speech, and the threat of a diabetic coma. Finding himself in this state in the past, the lifelong bachelor from Watertown, Mass., would quickly down some orange juice and phone a neighbor to request a callback in an hour "to make sure I'm still here." Today, Sakowich enjoys much-improved blood-sugar control, thanks to his healthcare coach, a woman named Rima whose last name he doesn't know and whom he has never met.
Rima Mathewson, one of a new breed of health professionals tasked with training and cheerleading clients into a state of wellness, is a registered nurse who works for Health Dialog, a Boston-based company that provides healthcare coaching as a benefit through companies and insurance plans to some 24 million people. Health Dialog coaches, 85 percent of whom are registered nurses, have access to insurance claims data so they know, for example, if a client has recently had open heart surgery or hasn't had a checkup lately to monitor hypertension. Mathewson first called Sakowich after he switched insurance plans in 2007, and she has proved an invaluable source, he says, of practical information and prodding. In a pinch, eight Life Savers should bring too-low blood sugar back into range, she might point out. Or she might remind him that it's time for an eye exam to check for any diabetes-induced damage. "My primary-care physician doesn't call me. Specialists? They don't call," he says. But Rima, he says, will call "as often as I like."
Some experts think this kind of healthcare coaching might go a long way toward managing the system's ills, too. Approximately 75 percent of the total U.S. healthcare expense—more than $2 trillion in 2006—is attributable to chronic disease. Yet research has shown that just over half of people with chronic conditions actually get recommended preventive care—aspirin therapy after a heart attack, say. By doing a good job of guiding people like Sakowich, "you keep people out of the hospital and reduce readmission rates," argues Ken Thorpe, a healthcare policy expert who is executive director of the Partnership to Fight Chronic Disease. As the $1 billion earmarked for prevention in February's Recovery Act is spent, Thorpe believes, all manner of programs and businesses will sprout up to help people mind their doctor, quit smoking, get active, lose weight.
There's already a considerable spectrum of offerings, from the Health Dialog model to services of solo entrepreneurs with little or no background in health. "The coaching industry is still the Wild West," says Sean Slovensky, president and CEO of Cincinnati-based Hummingbird Coaching Services. Hummingbird is hired both by companies (including Google and Adecco Group) that extend the services to employees and by individuals who search online for a weight-loss coach, for example. Such individual coaching costs about $35 to $45 per month. "We are busier now than we were when the economy was good," Slovensky says.
Hummingbird's coaching approach is based on the tenets of positive psychology, identifying personal strengths—a high capacity for self-control, resilience, or compassion, for example—and using them to help the cause. The majority of Hummingbird coaches have a master's in counseling, though some are exercise physiologists or nurses, says Slovensky. On average, Hummingbird clients interact with their coaches four or five times per month by phone, E-mail, instant messenger, or cellphone texts but not in person. Robin Hardman, a Hummingbird coach in Ontario, Canada, has tackled a range of goals, from helping pregnant women eat more healthfully to getting clients trim and fit enough to go off cholesterol or hypertension medications. The reward, she says, is in watching people reach those "ah-ha moments when they realize they have a choice."