Health coaching as a care management strategy in the clinical setting is relatively new. During the past decade a few exploring and pioneering practices began utilizing coaching as a defined element in care management. The drivers: 1) a growing conviction that the patient is the great under utilized resource in healthcare; 2) a widespread recognition that the most healthcare takes place outside the provider’s office guided by the patient’s behaviors; and, 3) a clear understanding that most care, especially for those with chronic conditions, is self-care. Stepping beyond mere engagement, leading practices recognize that activating patient behaviors in partnership with physician led care teams achieves significant patient outcomes.
The Clinical Health Coach training was constructed in a clinic setting built upon these driving principles. It focuses upon building performance skills as a behavior change specialist and a care management facilitator. This unique skill-set combination is essential to make coaching effective in clinical settings. Clinical Health Coach training continues to evolve based upon evidence from published reports and authenticated findings from care management/practice transformation initiatives funded through the Affordable Care Act and other sources.
Healthcare organizations committed to researching the efficacy of health coaching in the clinical setting are invited to review key references here. In addition, the following sampling of annotated references provide helpful, accessible information.
Butterworth, Linden and McClay. “Health Coaching as an Intervention in Health Management Programs.” Journal of Disease Management & Health Outcomes. 2007.
Authors provide robust references supporting how moving lifestyle behaviors can influence the onset of chronic conditions and aid in the management of existing conditions. They address how health coaching interventions have worked with disease management, health management and smoking cessation, and observe that motivational interviewing is the only technique to be fully described and consistently demonstrated as being causally and independently associated with positive behavioral outcomes.
Thom, David, et al. “The Impact of Health Coaching on Medication Adherence in Patients With Poorly Controlled Diabetes, Hypertension, and/or Hyperlipidemia: A Randomized Controlled Trial.” February 2015. Journal of American Board of Family Medicine (JABFM).
“Health coaching by medical assistants significantly increases medication concordance and adherence.” There was a 10% increase in the number of patients that took their medication to completion in the right amount of days that received the health coaching compared to the group that had the usual care. And overall, the group that worked with the health coaches had a greater mean of adherent days that than control group.
Swieskowski, David. “Office-Based Health Coaches: Creating Healthier Communities.” Mercy Clinics. Group Practice Journal. February 2008.
Author highlights on the successes of an office-based health coach in both the financial and physical health states of the clinic. Health coaching in this setting included a “culture of data collection and continuous improvement” and being proactive as a clinic rather than reactive. In terms of financial gain, it was reported that the office gained $4 for every dollar spent on health coaches and their programs, showing not just drawn even with more testing success, but validating the worth of a health coach in terms of revenue. “The biggest payoff is the creation of healthier communities.” Article affirms the effectiveness of the health coaching through lowered cost for the clinic, improved outcomes for the patients through the improved testing, and a better patient experience in the clinic as the program became well accepted by the individuals receiving care.
Roberts, Shirley. “Health Coaching in the Medical Home: Report on Experience of Leading Clinics and Health Systems.” Roberts Health Solutions. March 2015.
This survey captured data from 10 leading clinics and health systems across the U.S. regarding their experience in utilizing health coaching in the medical home setting. Responses indicate that leading clinics and health systems are increasingly adopting health coaching to build patient self-care skills, improve health behaviors and inspire a new level of accountability. It provides respondent observations on coaching and its impact on patient experience, clinical outcomes and cost. In addition there is analysis related to how care coordinators, care managers and other healthcare professionals with health coaching skills are activating patients to fashion a patient centric medical home. Finally, the report highlights particular skills and training that have been found to be most useful for healthcare teams committing to a health coaching strategy.
Willard-Grace, Rachel, et al. “Health Coaching by Medical Assistants to Improve Control of Diabetes, Hypertension, and Hyperlipidemia in Low-Income Patients: A Randomized Controlled Trial.” 2015. Annals of Family Medicine.
In a 12-month study with 441 patients at two different clinics in San Francisco, the goal of the was to attain a composite measure of being at or below the stated goal for each patient related to Hemoglobin Ab1c, systolic blood pressure, low-density lipoproteins (LDL), and cholesterol. A secondary goal was to achieve administration of all appropriate tests for the patients, and coaching patients on their individual goals. Researchers confirmed that the health coaching arm group was more likely to attain both the primary goals (46% vs 34% respectively for the group working with the coaching and the one without), and the secondary goals at a rate of 34% for the health coaching arm versus 24% for the non-coaching group. Of most drastic difference in the two groups was that the coaching arm part of the study doubled their percentages when it came to the Hemoglobin Ab1c test compared to the non-coaching arm.
Huffman, Melinda. “Health Coaching: A New and Exciting Technique to Enhance Self-Management and Improve Outcomes.” April 2007. Clinician’s Forum.
This article discusses the outlook of health coaching on a general level, specifically the improvements that can happen in self-care outside of the physician’s office. “Providing care in the patient’s place of residence affords the home health provider opportunities that other providers do not have.” This quote gives breadth to the prospects of health coaching in many different settings and opportunities.
Jonk, Yvonne, et al. “How Effective is Health Coaching in Reducing Health Services Expenditures?” February 2015. Journal of Medical Care Section, American Public Health Association.
Over one-thousand participants in a study completed four weeks of health coaching. With this work a significant decrease in incurring costs for outpatient and overall costs reached $286 and $412 per patient, per month, respectively. These outcomes show the importance of health coaching on a physiological level as well as the financial level, benefitting both the clinic and patient in this situation. These findings were for high-risk patients that had been dealing with chronic diseases and the financial burden that comes with that.
Appelgate, Hereford, Kunath and Vohs. “Health Coaching: Transforming Conversations and Care Practices.” September 2013. Iowa Chronic Care Consortium.
There is unparalleled experimentation with new approaches to managing chronic disease in this country. Still, there is mostly an anecdotal understanding of the adoption of health coaching in the clinical setting for patient engagement, activation and care management. This survey of practicing healthcare professionals recently trained in Clinical Health Coaching provides a practical view “from the balcony” of this evolving field. The results suggest that professionals trained in Clinical Health Coaching are passionate about the potential for this approach to care management. And, based upon self-reported data, these coaches in clinical settings are experiencing progress in communication with patients and self-management promotion. Good background references are provided
Shinn, Marta, et al. “Coaching to Decrease Childhood Obesity.” Institute of Coaching, Child Guidance Center, and Dr. Riba’s Health Club.
Pediatric obesity is a very overwhelming problem throughout the United States with significant money being diverted to it in the process. This study aimed to help families with the initiation of at home lifestyle changes to improve the health of the youth needing a change in weight. The “Family Mealtime Coaching” program included real-time coaching techniques to ‘reduce maladaptive parenting practices and poor child eating habits during meals’, while also giving examples of positive influences and examples for the child to see. They used integrative research-based positive psychology to develop these healthier outcomes for the children and their families. The results of the study showed an increase in family-style serving, intuitive eating, and the usage of table talk for all of the families. Over the coaching period, weight gain slowed or stopped for children participating in the Family Mealtime Coaching program.
McGonagle, Beatty and Joffe. “Coaching for Workers with Chronic Illness: Evaluating the Intervention.” Journal of Occupational Health Psychology. 2014.
Over a 12-week period, six sessions took place for the participants that were all telephone-based health coaching hoping to help workers manage the challenges of dealing with chronic illnesses and their effects on work and other stressors. The results confirm that the workers who were a part of this study had improved work ability and decreased their exhaustion. Coinciding with these very positive effects, were improvements in mental resources, resiliency, and how they evaluated themselves after the twelve weeks were completed. Overall, the improvements of personal well-being as an individual may be navigating challenges of working a long work-week without suffering from mental or emotional sickness due to their physiological chronic illnesses.
Huffman, Melissa. “Health Coaching: A Fresh, New Approach to Improve Quality Outcomes and Compliance for Patients with Chronic Conditions.” September 2009. Home Healthcare Now.
In a study of what health coaching is and how it can affect home care for patients now and in the future, this article highlights not only the efficacy of health coaching but also the sheer necessity for it. This shows how clinicians can improve the outcomes for patients to understand self-management and what it takes to make effective health changes.The goal was keeping patients in their home (instead of a nursing home or other retirement community) and understand how to care for themselves on a day-to-day basis.
William K. Appelgate, PhD, CPC
Founder and President
Clinical Health Coach