The Cardium Health primary health coach model. At
Cardium Health, our participants are at the center of all that we do. Their success
is our success, and it’s often attained through small, positive steps taken in
the right direction.
Our primary health coach model is designed to work with people, one-on-one, to achieve
their health goals one step at a time. We understand that making healthy lifestyle changes
is often harder than accepting a diagnosis of a chronic disease. Our approach is designed
to meet people where they are in the healthcare
continuum. For participants with multiple
conditions, our multi-disciplinary clinicians work together to help individuals improve
their overall health.
Each participant in a Cardium Health program is assigned a Primary Health Coach (PHC)
based on the individual’s predominant disease condition and personal health goals.
During the initial assessment process, a Cardium Health Senior Health Management Clinician
will match each participant with a PHC best suited in terms of experience as well as
counseling style.
Cardium Health clinicians represent a broad range of disciplines such as behavioral
health specialists, cardiovascular nurses (RN), certified diabetes educators (CDE), exercise
physiologists (EP), oncology nurses (RN), registered dietitians (RD) and respiratory
nurses (RN). Depending on an individual participant’s predominant health condition
and goals, a clinician from any one of these expertise areas would be assigned. For example,
a participant in our diabetes
program would be assigned a certified diabetes educator as his or her PHC.
The PHC works with each participant to develop a customized care plan, which serves
as the foundation to provide disease-specific education, build self-awareness, and encourage
and promote self-advocacy.
Disease-specific education is aimed at helping participants understand how their conditions
develop and progress; how the controllable risk factors impact their health; signs and
symptoms of disease progression; and the role of prescribed medications. For example,
participants in the Cardium Health CAD
program learn about the importance of reducing
blood pressure and cholesterol levels, as well as how a heart healthy diet and regular
exercise can improve their condition. The PHC works with the participant to address areas
of concern, and together they develop realistic goals to improve overall health and wellbeing.
Cardium Health is dedicated to providing the highest level of expertise available to
treat the whole person, not just the disease. To this end, participants may receive
one-on-one counseling from speciality health coaches (SHC) to meet individual health
goals. All Cardium Health clinicians serve as both primary and speciality health coaches
depending upon each participant's customized care plan.
Working with the individual participant’s customized care plan, a PHC will recommend
consults with an appropriate SHC as needed. For example if a participant in the heart
failure program wants to quit smoking, the PHC will make a referral to a tobacco cessation
specialist. This process provides both the participant and the SHC with the information
they need to ensure a positive and productive relationship.
The length of the specialty consult varies depending on the participant’s goals,
motivation and progress. All calls are documented in DM
TrackSM and reviewed by the
PHC. Out-going calls are made to chart progress toward goals, assist in overcoming barriers
to change, and provide support and encouragement. Any medical concerns or issues that
arise are discussed with the PHC to determine if any additional interventions are necessary.
When the participant and SHC agree that the goals have been met, the SHC transfers the
participant back to the PHC with follow-up instructions. Additionally, the participant
receives a follow-up call from the SHC between three to six months after the initial
consult (or as requested) to review maintenance of their health goals. Throughout the
counseling process, enrolled participants are allowed unlimited inbound calls to either
their PHC or SHC.
Cardium Health Primary & Specialty Health Coaches
Getting Connected / Working Together Model [
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