May 8: "Care guides'' show another face of health reform

  • Article by: MAURA LERNER , Star Tribune
  • Updated: August 16, 2013 - 10:26 AM

By offering a friendly ear – but no medical advice – they have been able to influence patients when MDs could not.


Betsy Snyder, a care guide for Allina Hospitals and Clinics, visited with a patient in her waiting room office on Thursday at Abbott Northwestern General Medicine Associates in Minneapolis.

Photo: COURTNEY PERRY • Special to the Star Tribune ,

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Dr. Richard Adair insisted that they spell it out clearly when the jobs were first posted: No experience required.

The idea was to hire people with no medical background, give them two weeks of training, and send them off to clinics to start seeing patients.

Five years later, these so-called “care guides” are fixtures at more than two dozen Allina Health clinics in the Twin Cities, and groups around the country are calling to find out how the concept works.

The guides are part of a fast-growing, and hotly debated, trend in medicine: Putting people with minimal (if any) medical expertise on the front lines — with titles like patient navigator or coach — to help improve care, and rein in the costs, of patients with chronic illnesses.

The Allina program, which began as a pilot project in 2008, may raise some eyebrows: Most of the care guides are in their early 20s, some in their first jobs out of college.

But new research, which Adair and a colleague will present this week, shows that the care guides have been able to influence patients in ways that doctors alone could not — helping people to quit smoking, get their blood sugar under control, and make other small victories in the daily battle with chronic illness.

One of the frustrations with traditional office visits, Adair said, is that the doctor’s message often evaporates when the patient gets home.

“You can just tell sometimes that you’re not getting through to the patient,” he said. “They’ll give you the old bobblehead response, but they’re not going to do it.”

For people with chronic illness, such as diabetes or heart failure, skipping a medication or ignoring their diet can be particularly dangerous.

But it happens all the time, he said. “I thought, ‘what could we do differently?’ ”

Hiring more doctors or nurses, he knew, would be prohibitively expensive.

The care guides were his answer. With a $6 million grant from the Robina Foundation in Minneapolis, Allina hired a dozen of them, at the rate of $16 an hour, and set them up in cubicles in clinic waiting rooms. Their job: Meet with struggling patients, go over their doctors’ instructions in detail, and see whether they could help them make progress.

No lab coat

Betsy Snyder, 23, never wears a white coat on the job. She wouldn’t want her patients to get the wrong idea.

“I try to explain that I’m a different type of clinic employee,” said Snyder, who’s been a care guide at the Abbott Northwestern General Medicine clinic in Minneapolis since December.

When she started, Snyder, who graduated from Macalester College last May, went through a two-week medical boot camp. That included three days of classwork (in “disease basics” and electronic medical records) and shadowing doctors, nurses and others around the clinic.

There’s even a one-page “scope of practice” that spells out what they can and can’t do.

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