Proactive Health Coaching – person centred care to reduce A&E attendances and non-elective admissions (#2873)

Idea Description
Supplementary Information
Innovation 'Elevator Pitch':
We work to reduce unplanned hospital admissions. Proactive Health Coaching helps patients to better control their health and thus reducing non-elective care. Engaged patients seek care at the right place, helping the NHS use its resources efficiently
Overview of Innovation:
Health Navigator is dedicated to improving patients’ lives through digitally supported health coaching at scale which is underpinned by robust scientific evidence.

Our forward strategy includes delivering an effortless patient experience and a focus on the development of a range of digitised services. To enable this, we are transforming the ways in which we deliver our services.

One of our services is Proactive Health Coaching (PHC). PHC is a telephone-based health management service that improves patient health and quality of life, while ensuring that healthcare resources are spent as efficiently as possible.

PHC provides non-medical patient support to help patients understand their chronic conditions, plan their care and navigate an often-complex healthcare system.

By identifying those likely to see future avoidable unplanned care, a coach is able to proactively support the patient. Support including helping to stabilise their condition, feel more confident in managing their conditions and navigating the often-complex health care system, thus reducing the risk of unplanned care.

Our model is evidence-based and grounded in scientific research, supported by several successful randomised trials. In summary PHC uses a patented combined approach of:

1) a complex risk predicting algorithm to forward predict on a daily basis, patients which are at high risk of a non-elective admissions
2) to then provide a programme of individualised care to those at high risk using our nurse led case management programme.

The unique combination of the two provides the outcomes summarised below.

The end goals are:

1) To improve patient outcomes and reduce healthcare utilisation
2) To deliver operational efficiencies across the whole health system by reducing demand and avoidable admissions
3) To deliver a significant cost saving

Our company has successfully delivered this service to over 33000 patients in Sweden where we also conducted a randomised control trial with 12000 patients which statistically showed a reduction in healthcare utilisation by 30-50%. These results were published in the EJEM in 2013 and 2015.

We are now conducting another RCT in the UK with The Nuffield Trust as the principal investigator to replicate the Swedish results. We have over 7 CCGS already working with us and two years’ worth of data is showing statistically significant reductions of 30% in non-elective admissions and 36% in A&E attendances in the intervention groups.

Stage of Development:
Market ready and adopted - Fully proven, commercially deployable, market ready and already adopted in some areas (in a different region or sector)
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NB 72 yrs female  in UK well documented but left in limbo ?!! The above is good but as a patient why not listen,plan following NHS Constitution  re those with multi conditions & disabilities ignored because regarded as low priority .Put all problems symptons altogether & am having Cardiac arrest [ 13 yrs ago] ?still the negligence & wasting time continues as relates to chronic utis acute 3 weekly when researched 1969 - spina bifida  [ low priority - disregarded - underlying  possible MID [ alzheimers late Mother had severely affecting function & movement  & antibiotic targetted assistance NB Must Campaign Prof Malone Lee Urodynamics Dept  uch /whittington hospital London uk ]

I believe there is a strong Microvasscular connection as have PAH [ Dr Coghlan Royal free ] & Lipo-lymphoedema stage 2 [ cellulitus  from birth]Prof Mortimer St Georges  i was  one of first on penicillin at birth  & pill .Am now in Gloucestershire Dr Challenor has agreed to liase as still attending London once a year with spasms [ abnormal EEG A fib  [ Late Mother TIAS /MID?] - SPINAL kyphosis  relieved by targetted antibiotics & utis [ Prof Malone Lee] & possibly PRP/ analaguous stem cells would like to propose instead or  as well the steroid ones ? Also have consciousnes spasms [ sleep pattern disturbance [ & retention [ neurogenic bladder  ] one ureter too many  & poor flow [ Late father pharmnacist ]prostrate & skin cancers caught early .Believe if  managed maybe able stop heart failure symptons re function worsening also MID risk -   as happened to Late mother with MID on polmyalgia rheumatica & vere severe cognitive deterioration.Her sister had diabetic twins [ insulin dependent ] has parkinsons dementia obesity & thyroid [women]   
Maybe a tool that links family history risk   to Tests could give strategic guidance to treatment & further research - possibly stem cells to identify those who could benefit & need integtrated coordinated research base assistance? could be devised ?.

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