Can health coaches help fix our healthcare system?

Simply put, habits are hard to break and bad habits like smoking, drinking, sedentary lifestyle and overeating are making our population sick. Who in the healthcare system can tackle these issues before they manifest into chronic disease?

Doctors are trained to diagnose and treat, but they aren’t trained to help people change their behavior, nor should they be since most physicians, particularly general practitioners, are already severely overloaded. Nurses provide support and information but their assistance is limited to office visits or hospitalizations. Until recently, there has been an unmet need in the healthcare system for a provider who works with patients in the days and weeks between appointments. But now there is a new breed of healthcare professionals, called health and wellness coaches who are filling that gap.

Health coaches are trained to help people change their lifestyles using a tailored approach and the tools of compassion, motivation and self-efficacy building. One does not have to be trained in medicine to be a coach. Margaret Moore, Co-Director of the Harvard Institute of Coaching, stresses that it takes a large skill set to be effective, and for people transitioning from other medical disciplines it requires a deprogramming from the role of expert advisor to that of health facilitator. While physicians serve as advisors, defining agendas, and treating disease, health coaches serve as partners, eliciting patient’s agendas and co-discovering solutions. One is helpful for treating illness, the other for changing habits.

There are numerous examples in the literature of health coaching programs achieving good outcomes in programs for smoking cessation, weight loss and diabetes management. Corporate America is also catching on, with some of the nations biggest employers such as Johnson & Johnson hiring health coaches for their workforce to cut down on medical expenses and lost productivity.

Despite these gains, the practice hasn’t quite hit the mainstream and in most cases it is not covered by health insurance. One reason for this is that field is still highly fragmented in terms of certification and education. Unlike seeing a board certified physician, when you work with a health coach you don’t always know what you are going to get. Educational programs differ in intensity, some are the equivalent of a master’s degree and others just a scant two-week certification course.

In order to standardize the emerging field of health coaching, Dr. Karen Lawson, Program Director for the Health Coaching track at the University of Minnesota, has partnered with Margaret Moore to lead the charge. In 2010 they convened a team of colleagues at a summit to develop national standards. A number of issues were identified such as the need for uniform educational standards, core competencies and more research demonstrating cost savings.

“There is a huge lack of understanding from within most conventional healthcare clinicians as to what health coaching is and how it is different from case management, disease management, nurse education and health navigators. Part of the need is for us to come up with a cohesive definition and clarification of credentials to be able to hold our own in this ground where there is a lot of confusion,” commented Dr. Lawson regarding the immersion of health coaching into mainstream medicine.

When asked if health coaching was an outsider movement, Margaret Moore asserted that in the future health coaching will have a place in the conventional primary care system, especially if there is an overhaul of the pay per service reimbursement model.

Who will fix healthcare? The answer to this is still unclear, but health coaches are certainly priming themselves to be an important part of the solution.

Monique Brouillette is a medical writer who writes a regular column in the Boston Examiner.

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