Recently, the New England Journal of Medicine (NEJM) published an article entitled “Coaching for Better Health: Lessons from Elite Sport.” (Volpp K, Camplin-Warner A) The paper was published as a NEJM Catalyst article, which is the journal where NEJM presents innovative ideas to improve and transform health care delivery.
To understand the importance of this Health Coaching article appearing in the NEJM Catalyst, we must appreciate the standing of the NEJM as the most important medical journal in the United States and probably the world. This is not mere opinion but backed by the objective measure of Impact Factor (IF), calculated by an independent firm and based on frequency of journal citations in a given year. The IF of the NEJM for 2022 was 158.5. To put this in context, the IF for Journal of the American Medical Association (JAMA) in 2022 was 120.7. Another example is the Annals of Family Medicine (AFM) which has an IF of 5.70. AFM is a good journal, with a high IF compared to most scientific journals whose IF falls below 2.0, with less than 2% achieving IF > 10.0. The takeaway point is when the NEJM publishes an article it is a huge accomplishment – for health coaching to be recognized as an innovative and potentially transformative health care strategy in NEJM Catalyst is a very big deal for Health Coaching!
The purpose of the article was to draw a parallel between Health Coaching and the coaching of elite athletes. Given both these practices have the objective of improving (health or performance), through the achievement of goals and skill building, it is easy to see the broad foundation for this comparison. The corollary is furthered by describing the “coach” as someone who cultivates motivation, and helps the individual to learn and grow, while engaging in a supportive and caring relationship. Within this context, the article goes on to emphasize the following points about coaching:
engage the whole person – physically, mentally, and emotionally.
purpose-led, personalized goal-setting
scenario planning, change management, and resilience training
improving self-awareness, expectation management, and learning from setbacks
forming better habits and routines, and removal of obstacles that cause friction
modifying the choice environment so that defaults favor the desired behavior
leveraging technology, social support, and enhancing external accountability
focusing on the process, not only outcomes, while celebrating personal growth and progress
The authors go on to explain that the U.S. Health care system is not set up to support patients to achieve personal health care goals. Currently, patients typically have inadequate support and are seen as disengaged. Well-meaning clinicians do not have the time and likely not the training to effectively guide, or coach, their patients. The authors propose an integration of coaches in an innovative care delivery team. Coaching sessions will allow patients to genuinely feel supported by their extended medical team, encouraging them to try harder to change and improve health. Moving to this model will require a shift in mindset to a preventative, rather than simply treat or fix, strategy. Further, a change from fee-for-service to value-based care with reconsidering what success looks like needed. This new system can then emphasize improved patient choices, sustainable behaviors, and outcomes while improving the trajectory of health care costs.
Wow – this is tremendous endorsement of health coaching offered by a prestigious and influential organization. The newly approved CPT reimbursement codes for health coaching are not mentioned in the article and it is probable this paper was written well before the codes were approved. Over the coming years, these codes should be a tremendous boon to health coaching once the final protocols and utilizations are fully determined. It is also curious that the National Board of Health and Wellness Coaching or an outstanding coach training program (e.g., Wellcoaches) was not mentioned in this piece – maybe the authors were trying to remain unbiased in their endorsement of any particular coaching agency. Finally, the authors could have simply cited “The Coaching Psychology Manual 2nd Edition” for much of the information presented. This publication is an industry-standard, and fully explains most of the coaching principles presented in the NEJM Catalyst article while delving much further into techniques employed by a masterful health coach.
Health and Well-Being Coaching (HWC) is quickly rising in esteem as regarded by the medical community. This can be no better evidenced then a publication emphasizing HWC by the prestigious NEJM in their journal (i.e., Catalyst) which introduces innovative and contemporary intervention techniques. This point is further evidenced by the recent AMA and Medicare Services approvals of a temporary CPT codes for the reimbursement of coaching services. The future for HWC is bright ... and that future is now !
References
1) Volpp K, Camplin-Warner A. Coaching for Better Health: Lessons from Elite Sport. 2023. NEJM Catalyst 4:6. doi:10.1056/CAT.22.0272
2) Moore M, Jackson E, Tschannen-Moran B, Wellcoaches Corporation. 2016. Coaching Psychology Manual Second ed. Philadelphia: Wolters Kluwer.