Health Coaching in Primary Care: Considerations for Collaborative Practice

Health coaching can transform the patient experience—and the clinical outcomes--in a primary care practice. A well-developed collaboration between a skilled physician and a well-trained coach can support lasting behavior change and have profound positive impact on patients’ health and wellbeing.

But standards for health coaches are still evolving, and not all receive the same degree of training. The differences between the many coaching programs may be considerable, yet nearly all graduates from these programs call themselves “health coaches.”

How do you distinguish a qualified coach? And once you find someone who is a good fit for your practice, how do you set up a collaborative practice model that works well for you, for the coach, and ultimately for your patients?

Here are some important factors to consider when finding, hiring, and integrating a health coach into your practice.

What’s the Role of a Health Coach?

Simply put, health coaches facilitate change. Working with individual patients or groups, they use motivational strategies, behavior change healthcoach headertheory, and communication techniques to help patients create sustainable behavior changes that lead to better health. They bridge the gap between what patients know they need to do to be healthy, and the intrinsic motivation that patients need to actually make and sustain those changes.

It all starts with a practitioner’s care plan, which guides the formulation of the patient’s wellness goals. Together, patient and coach create a plan to work toward these goals, addressing any challenges or roadblocks that arise and that impede incorporation of the practitioner’s recommendations.

In a good collaborative practice, the coach will feed back to the physician as the patient makes diet and lifestyle changes, simultaneously incorporating input and further guidance from the physician.

Generally speaking, health coaches working within their defined scope of practice do not get involved in making medical diagnoses or prescribing medical treatments. But depending on their training, they can often provide considerable insight and intelligence on how to adapt and implement dietary and exercise plans for people struggling with specific disorders.

Practically speaking, health coaches help medical practices become more “high-touch,” by providing the ongoing day-to-day support and guidance for which most physicians have neither the time nor the training. Coaching can free up a clinician’s time to do what he or she does best, while closing care gaps, and providing ongoing contact with patients who are transitioning to healthier lifestyles.

Setting Standards

The field of health coaching is still in an early stage of its evolution. Currently, there are two professional organizations that have emerged as global leaders in creating professional standards for coaches: the International Coaching Federation (ICF) and the International Consortium for Health and Wellness Coaching (ICHWC).

ICF is the world’s largest organization of professionally trained coaches. However, ICF’s oversight covers coaches from a range of disciplines and is not specific to the field of health coaching. Though health coaching does utilize some core principles, practices, and techniques used by coaches in other fields, it also has a unique knowledge base and skill set that will be needed for work in a clinical setting.

The ICHWC is focused solely on health and wellness coaching, having pioneered science-based training, research, and education of health coaches over the past two decades.

ICHWC developed a Scope of Practiceand Code of Ethics for the field, outlining the parameters for what health coaches are trained to do—and also what they are not trained to do. Since this scope of practice does not include diagnosis or treatment per se, many coaches apply their expertise in behavior change techniques to care plans developed by physicians, nurses, or other licensed medical practitioners.

Recently, ICHWC launched the first-ever board-certifying exam for health coaches, which establishes a new credential, the National Board Certified Health & Wellness Coach (NBC-HWC).The exam assesses coaches on competencies like health and wellness knowledge, communication techniques, process for behavior change, and ethics.

This new “gold standard” national credential is definitely something to look for when considering a coach for your practice. However, keep in mind that many good coaches have yet to earn this new credential, and there are several other criteria you can use to identify the right coach for your patients.

Evaluating a Coach’s Training

There are many coach training programs out there, and they vary greatly in length and thoroughness. So when you’re evaluating a potential coach, start by looking to see if the program he or she attended is approved by ICHWC. A list of approved programs can be found on the ICHWC website.

FMCA logo 2016 top header2Program length and number of interactive training hours are important considerations, as these are often indicative of the amount of material covered and the time students spend developing their skills. The more rigorous coaching programs require coaches to undergo supervised practical skills assessments before earning their certification.

The rise of online programs is another factor. These can be just as academically rigorous as on-site education, and may have the added bonus of diversity of graduates due to the accessibility and flexibility of online learning. Graduates of online programs are typically self-motivated and possess strong ability to learn independently. They’re also likely to be comfortable with virtual tele-coaching—an increasingly important aspect of healthcare in our digital era.

Coach training may also align with certain specialties that could benefit your practice, such as Functional Medicine, nutrition, or mind-body medicine. The Functional Medicine Coaching Academy, developed in collaboration with the Institute for Functional Medicine and based on core functional medicine principles, is a leading example of this.

Some training programs also emphasize different settings for coaching, such as corporate wellness, partnership with a physician’s office, or independent practice. These factors may indicate whether your practice’s needs match a candidate’s education and experience.

Hiring The Right Coach

When determining who is the right coach for your practice, start with the needs of your patient population. Coaches may have experience working with certain groups or focus areas, such as chronic disease, women’s or men’s health, psychology of eating, pain, pediatrics, or eldercare.

Some coaches hold additional licenses that may be supportive to your practice, like registered nurses, occupational therapists, or registered dietitians. However, experience shows that one need not have prior training in another healthcare discipline in order to be a good coach. The mark of an excellent coach is the ability to fully listen to patients, and offer hope, compassion, and support.

Coaching style is important, as it influences the dynamics between the coach, the patient and the overseeing clinician. In an interview, look for someone engaging and inspirational who can discuss how concepts such as mindfulness, values, intrinsic motivation, or character strengths factor into patient interactions. Listen for verbal cues like “individualized,” “supportive,” and “patient-centered” to help gauge whether a candidate will be a good fit for you and your patients.

Another consideration is coaching modality: on-site or virtual, group or individual.

Virtual coaching skills are a big plus if you serve patients with limited mobility or transportation challenges, or if the ideal coach isn’t located Healthcoach 2near your clinic.

On the other hand, if a significant proportion of your patient population lacks comfort with technology or prefers in-person, face-to-face connection, then the tele-coaching skills matter less, and you’ll want to find someone who prefers to work onsite and in-person.

Individual coaching provides one-on-one attention, and can be more easily tailored to each patient’s scheduling needs. Many patients love the direct attention. That said, group coaching offers benefits like lower costs, a sense of community, and efficiency. The group option works well if you have a number of patients dealing with a similar health issue, such as metabolic syndrome and diabetes or weight issues.

Choosing A Financial Model

Most practices that have health coaches use one of three payment models:

  • Coach as a salaried employee;
  • Independent contractor, or
  • Outside referral

In the first two models, the medical practice pays the coach directly. In the third set-up, the patient pays the coach directly.

While all three are viable options, patient engagement and participation tends to be better when the coach is more directly connected to the clinic, and the coaching services are included as part of a package through the practice.

Patient follow-through tends to increase when coaching is framed as a critical step in implementing a plan of care, rather than an additional out-of-pocket expense.

A benefit of working with a coach as an independent contractor or referring to an external coach—as opposed to hiring a coach as an employee-- is that both you and the coach have an opportunity to test out the relationship prior to making a deeper commitment.

It is also a good option if your practice is growing and cannot yet support a full-time coach.

A salaried position, on the other hand, may enable a coach to engage more deeply with the mission of your practice and the lives of your patients. Plus, a full-time on-site coach can support your practice in other ways, such as community outreach or increased communications with the entire collaborative care team.

Legal Considerations

There are a few legal considerations that you’ll want to include in your decision-making process. Consider:

  • How bringing a health coach onto your team will affect your malpractice insurance. You’ll want to ask your malpractice insurance carrier about this.
  • A coach requires the same oversight as any employee who has access to or interacts with your patients, and you’ll need to be in compliance with any and all federal and state regulations pertaining to this.
  • What consent forms you will need in order to clearly outline to your patients what your coach will and will not offer.
  • That a coach cannot and should not diagnose disease, prescribe, or in any way act as a surrogate for a doctor, nurse, or other licensed medical professional. This must be clear to the coach and to all patients.
  • Telemedicine regulations differ state-by-state. This is an important consideration if you plan to offer virtual coaching and your coach or your patients are out-of-state.
  • As a member of your practice, your coach will be subject to any and all patient privacy concerns and HIPAA regulations that would apply to any other member of your clinic’s staff.

Close collaboration between a primary care physician and a health coach is a recipe for success in holistic medicine. Not only will patients benefit from more hands-on support from a warm professional trained in behavior change, but practitioners may find themselves with more time to focus on the “detective work” that they love and that patients expect.

Finding the right coach is simpler than it sounds. By examining a coach’s credentials, approach, and style, and making a few financial and legal decisions, your clinic can find, hire, and integrate a competent coach. The addition of a professional who is passionate about helping your patients improve their health and well-being can promote the improved outcomes and patient satisfaction that are the hallmark of all good healthcare practices.

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Sandra Scheinbaum, PhD, is a practitioner, speaker, author, teacher, and entrepreneur. She holds a PhD in clinical psychology, specializing in positive psychology, cognitive behavior therapy, and mind-body medicine. Dr. Scheinbaum was the first psychologist to become an Institute for Functional Medicine Certified Practitioner, and is the founder of The Functional Medicine Coaching Academy.

 
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