Health Coaching Roles and Proficiency

Professionals who serve individuals at risk of, or affected by, chronic conditions—in employer, health plan, population health improvement, direct health care and community settings—need to be proficient in core or advanced population health and evidence-based health coaching techniques.

Naturally, the level of proficiency will depend on the professional’s role and the populations that they typically serve. While it might be ideal for everyone on the interdisciplinary care team to be highly proficient in health coaching, this may not be feasible or practical. Effective chronic disease prevention and care improvement require delegation. Yet, at the same time, all members of the health care and health support team can apply evidence-based health coaching principles and techniques that will lead to better patient outcomes, as well as more coordinated and effective care—across disciplines and care settings.

Designated health coaches in health plan, population health improvement and primary care settings need to be most proficient in population health improvement and health coaching interventions. These professionals are often tasked with serving higher risk, more challenging patients—individuals who are dealing with the most difficult adherence or self-care challenges, long-standing unhealthy behaviors, or the consequences of a lifetime of inactivity, unhealthy diet or obesity.

Greater health coaching proficiency is also required because these professionals typically serve patients with whom they have no prior, ongoing relationship. These patients also often have less choice in the selection of the health coach, or the time or setting of the encounter. The first introduction to health coaching services may be a mailing or a phone call. Not surprisingly, professionals involved in such health coaching frequently cite poor patient engagement as a major barrier to success. Evidence-based health coaching approaches such as motivational interviewing are ideally suited for these encounters.

Physicians, advanced practice nurses, and nurses who serve patients at risk of, or affected by, chronic conditions in primary care and other usual health care settings should be proficient in basic evidence-based health coaching approaches. While they may not be designated health coaches, they often have an ongoing relationship with patients; and patients naturally look to them for guidance and support. At a minimum, these clinicians should be familiar with formal patient-centered partnering and communication approaches to better engage and activate patients. They must also be prepared to elicit patient goals, and to design and support individualized treatment and self-care plans that are aligned with the individual’s needs, goals and preferences. They can help by setting the stage for contacts by formal health coaches.

These clinicians can also use evidence-based health coaching approaches to support treatment adherence, which today is estimated at 50 to 60%.16 In usual care, physicians demonstrate no better than chance odds in predicting which of their patients will adhere to a regime and which will not.17 And given the fact that only 39% of obese adults receive any advice to lose weight from health care professionals during office visits,18 health coaching approaches are ideally suited to help address the epidemic of overweight and obesity responsible for many chronic conditions such as diabetes.

Patient-Centered Interdisciplinary Medical Home Teams

The patient-centered medical home is a promising new primary care model for improving chronic disease prevention and care. The medical home aims for care that is more “patient-centered”, “interdisciplinary,” and more focused on the needs of the “whole person.”19 While there are a number of important medical home process redesign steps and technologies, the readiness and capacity of primary care providers to support patient adherence and self-care will largely influence the success of the medical home.

Most primary care providers assume that they are “patient-centered,” without truly appreciating what that means. True patient-centered care is a new orientation and approach, qualitatively different than the patient education-oriented approaches routinely used in today’s health care settings.19 In usual care, for example, it has been estimated that patients participate in medical decisions with their doctors less than 10% of the time.20 The full promise of new models such as the medical home cannot be realized unless health care professionals are engaged with and prepared for this new model of care. To deliver measurable results, patient-centered care must be more than an aspiration—it must be implemented thorough routine practice that incorporates evidence-based health coaching methods.

Evidence-based, patient-centered approaches also offer a shared vision and common platform for interdisciplinary care.

Pharmacists can use motivational interviewing-based approaches to help them design individualized medication education, support medication management and medication adherence, and encourage patient disclosure of—and joint problem-solving—regarding medication side-effects or concerns that are frequently unspoken, yet which often underlie poor adherence.

Physical therapists could use evidence-based health coaching approaches to design more individualized physical activity “prescriptions,” or to better target the disease-related functional limitations that are of most concern to patients.

Behavioral health providers could use these approaches to elicit important individual life goals or barriers, and address psychosocial issues or mental health issues that may specifically contribute to disease risk, or impede self-care or lifestyle management.

Nutritionists could use these approaches to design dietary or weight management plans that fit the personal goals or cultural preferences of the patient.

In short, by working in unison, using a systematic and structured platform, the interdisciplinary care team can support care that is truly patient-centered and most effective.

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