Peer Benchmarking and Norm-Based Scoring to Improve Telephonic Health Coaching Quality

Abstract

Studies evaluating telephonic coaching to improve population health have focused on outcomes, but measurement of consistency of coaching quality is also needed. The aim of this study was to describe how one multistate health plan developed, scored, and implemented a Coach Case Quality Assessment (CCQA) for quality improvement. The nine-item CCQA is a checklist of elements selected by quality improvement teams for peer benchmarking to improve telephonic coaching. The health plan fielded the CCQA to 470 clinical coaches in 2016. Quality reviewers rated coaches' call quality on each item (1 = learning; 2 = progressing; 3 = succeeding) and planned training around composite scores in relation to team norms. A total of 470 coaches completed CCQAs with a norm-based mean score of 50.0 (standard deviation [SD] ± 10.0); 54.0% of coaches had scores within ±1 SD of the mean ("norm"), with 20.9% of coaches scoring below that range, and 25.1% scoring above it. Ninety-six percent (451/470) of coaches completed a nine-month follow-up. The mean norm-based score improved to 56.2 (SD ± 9.3), with 8.2% performing below, 42.4% at, and 49.4% above the peer norm. Scores represent significant mean and proportional changes over time, reflecting improvement on the part of whole teams. This study demonstrates norm-based scoring as an effective strategy for measuring and improving coaching quality in a telephonic behavioral change program. Health plans can implement case quality review with norm-based scoring and peer benchmarking to aid coaches in continuous quality improvement.