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Physicians are leaders in addressing the root causes of chronic diseases in primary care and establishing reimbursed Health and Well-being Coaching Services. Physicians who are trained as coaches are pioneers who will shape the future of healthcare. Why become a Physician Coach? Improve your own well-being. Learning about, and applying, key coaching concepts like self-compassion, growth-mindset, and wellness visioning will inevitably have a positive impact on your own life. Increase patient satisfaction and engagement. Your patients will experience you as a more empathetic listener who delivers patient-centered care. Change the culture of your organization. Gain valuable skills for communicating with colleagues and building trusting, collaborative relationships. Where are our Physician Coaches? Wellcoaches has trained and supported hundreds of physicians as coaches through Massachusetts General Hospital, Brigham & Women’s Hospital, Columbia University, Johns Hopkins, Stanford University Hospital, Emory University Hospital, Beth Israel Hospital, and members of the American College of Lifestyle Medicine community. Curious about your own well-being? Wellcoaches has developed a validated inventory to support you in reflecting upon your own well-being in the areas of life, work, body, and mind. Take the Inventory or share it with a patient! Additional Resources on Physician Coaching The American Medical Association's Coaching in Medical Education  (contributions by Wellcoaches CEO Margaret Moore) Foundations in Lifestyle Medicine Board Review Course  (contributions by Wellcoaches Chief Coaching Officer Erika Jackson) Two Randomized Controlled studies of Wellcoaches coaching for physician burnout show robust efficacy Coaching for primary care physician well-being: A randomized trial and follow-up analysis .  Journal of Occupational Health Psychology, 2020 Physician Coaching by Professionally Trained Peers for Burnout and Well-Being: A Randomized Clinical Trial , JAMA Network Open, 2024 AAFP Lifestyle Medicine Course (coaching content developed by Chief Coaching Officer Erika Jackson and presented by Faculty Member Charles Inniss) Mayo Clinic Proceeding study defining physician coaching competencies (contributions by Wellcoaches CEO Margaret Moore "I am incredibly proud to shared that I am now a certified Health and Well-being Coach thanks to the fantastic  Wellcoaches  certification program. I started this journey in December 2023 and admittedly took my time to soak in everything I was learning. Margaret Moore and her team have created the gold standard for understanding personal motivation and the coaching relationship! I highly recommend this to all other family physicians who want to encourage their patients in lifestyle based preventative care." - Jill Haltigan, Family Physician

The Journal of Integrative and Complementary Medicine recently published “ Compendium of Health and Wellness Coaching: Addendum 2023 .”   This is the eagerly anticipated third installment of the Compendium, and it brings us a comprehensive look at the recently published health and well-being coaching (HWC) research literature. This article adds to the original compendium  publication and the 2019 Addendum . This collection of three review papers that we call the Compendium of HWC Literature covers research from 2000-2023, and provides an evidence-based anchor for the profession.  Wellcoaches supported the recent compendium effort as Margaret Moore (CEO) and Gary Sforzo (Research Advisor) were co-authors on the team publishing the paper.  Gary led the first two installments, which were supported by Wellcoaches and our vision to properly track the entirety of the HWC literature. Looking at the Compendium publication numbers (see the table) it becomes clear that HWC is a growing field with new research adding depth of knowledge while also expanding the HWC scope of practice. Many articles for using HWC intervention were added to the well-established diabetes (42 new papers) and obesity (46 new papers) categories.  Just as remarkable, 18 articles were added to the newly emerging categories of Respiratory Disease and Chronic Pain.  It was also impressive that the number of Compendium studies on patients with cancer more than doubled (from 10 to 27) after counting the 2023 Addendum articles.  In all, the 2023 Addendum provided 204 (186 + 18 in new categories) new HWC research papers to the Compendium.  It is also noteworthy that in more than 20 years of researching HWC, the rigorous randomized controlled trial (RCT) was used in the design of more than half of these studies.  Table.  HWC Compendium Research Totals Across the Years                  Year 2017 2019 2023 Condition RCT/Total RCT/Total RCT/Total RCT/Total Cancer 7/9 1/1 6/17 14/27 Cholesterol 9/14 2/5 0/3 11/22 Diabetes 14/32 4/12 28/42 46/86 Heart Disease 7/12 6/7 11/12 24/31 Hypertension 7/14 2/7 7/14 16/35 Obesity 13/31 10/27 24/46 47/104 Wellness 15/38 6/13 12/21 33/72 Miscellaneous NA 5/9 20/31 25/40 Pain and Respiratory (new) NA NA 5/18 5/18                   Total 72/150 36/81 113/204 221/435 RCT = randomized controlled trial  As important as the sheer quantity of information provided in the 2023 Addendum, the quality was also excellent.  The summarized knowledge from the new research again strongly supports the benefits of HWC when working with patients managing diabetes, obesity, cancer, hypertension, or heart disease.  These benefits include patient-centered outcomes (e.g., self-efficacy, quality of life) and health biomarkers (e.g., blood pressure, cholesterol, glucose, body weight).  Healthy habits, such as performing more physical activity and eating more plant-based foods, were also enhanced by HWC.  By and large, “ HWC was found to be an acceptable, feasible, and effective intervention for improving clinical, surrogate, self-care outcomes, and quality of life outcomes. ”  The 2023 Addendum to the HWC Compendium also identified newly established areas of HWC research. Emerging as important areas of study, working with patients having chronic obstructive pulmonary disease (COPD), and working with those living with chronic pain.  Generally, patients with COPD benefited from HWC intervention by showing better self-management, including medication adherence.  Improved quality of life and mental health (e.g., depression scores) were also consistently observed in these patients after a coaching intervention.  HWC also helped patients with chronic pain who showed improved functional ability, reduced pain severity, and quality of life improvements.   These initial results are promising, but the Compendium authors added that further research is needed to better define the role of HWC in treating these patients.  The authors of the 2023 Addendum dutifully noted the impact of the COVID pandemic on HWC research efforts during the period under study.  While being a general impediment, the pandemic did not shut down research efforts.  In fact, this challenging period of time revealed, and possibly forced, a shift toward greater use of technology and telehealth methods.  Initial findings showed promising results for using digital technologies and platforms in combination with HWC.  Generally, HWC effectiveness was maintained and not impaired while employing remote applications.  Moreover, there was evidence found for HWC assisting with stress management and resilience, while fighting job burn-out during the COVID times of heightened societal stressors.  It is wonderful to observe an ability for HWC interventions to be flexibly administered and adapting to crisis, while still effectively helping patients. The authors indicated that this third installment of the Compendium will be the last in the current form.  We should not expect to see another addendum published in the future.  HWC is seen as a maturing field with numerous subtopic reviews being published yearly.  These are expected to inform HWC professionals well enough with no further need for a compendium-like collection to be maintained.  There is also the hope that advanced, AI-driven search engines will be able to maintain a living database of HWC literature.  Such a database, if periodically updated and housed on a prominent HWC web site, would well inform, serve, and carry the profession into the future.  The Compendium of HWC Literature, in its three installments (2917, 2019, 2023), provides a strong research evidence base for the HWC field.  HWC coaches and researchers alike should feel comfortable using this powerful source of knowledge to inform their efforts.  Bringing such information to practice will strengthen and enhance the HWC profession.

Wellcoaches and INTERVENT form Strategic Partnership to Provide an Unmatched Coaching Solution for Medical Practices Wellesley, MA (May 7th, 2025)  - Wellcoaches Corporation and INTERVENT International have formed a strategic partnership in order to deliver a turnkey, highly effective and profitable coaching solution for medical practices. Combining the Wellcoaches network of skilled health and well-being coaches with the AI-powered, medical grade, proven INTERVENT coaching platform, brings to physician practices the top coaches and the top software available at scale to support patients in developing and sustaining change in mindset and behavior, and in engaging fully in the power of lifestyle medicine. Having trained more than 16,000 professionals as coaches in 50 countries, Wellcoaches Corporation is renowned for excellence in coaching science, education, training, mentoring, and supporting skilled health and well-being coaches throughout their work span. INTERVENT's AI-powered, comprehensive lifestyle management and behavior change coaching programs are evidence-based and transform expert clinical guidelines into personalized patient care plans. They are widely deployed as chronic care management services for patients in more than 140 medical centers, including clinical trials funded by the NIH and the PCORI. Notes Neil Gordon, MD, CEO of INTERVENT, "By addressing the root lifestyle causes of chronic diseases and their associated complications, Wellcoaches and INTERVENT will help countless patients improve their health and physician practices improve their clinical outcomes in ways they can all sustain." Margaret Moore, CEO of Wellcoaches adds: "As the most respected and innovative industry leaders (coaching in healthcare), the combination of Wellcoaches coaches and INTERVENT software, methodology and published outcomes is unmatched in scaling skilled coaches on healthcare teams." Wellcoaches is marketing the Wellcoaches INTERVENT platform to its healthcare clients and Wellcoaches-certified coaches working in healthcare across the US. Medical practices can readily integrate coaches and coaching services in a scalable, turnkey, profitable manner while producing publishable patient outcomes data. Physician teams can employ their own coaches mentored by Wellcoaches, have their team members trained by Wellcoaches, or access Wellcoaches-employed coaches, or a combination thereof. The INTERVENT platform provides compliant support to enable physician practices to successfully bill and collect for appropriate services, including chronic care management and other CPT codes. About Wellcoaches Founded in 2000, Wellcoaches has forged the path for professional coaches working in health and well-being, in collaboration with the American College of Sports Medicine and the American College of Lifestyle Medicine. Wellcoaches has trained 16,000 coaches in 50 countries, of which more than1,500 are dual Wellcoaches and NBHWC-certified. The Wellcoaches training curriculum is based on the Wellcoaches Coaching Psychology Manual, a bestselling textbook having sold 54,000 copies. The Wellcoaches protocol laid out in the manual has been studied in 23 published scientific studies, including two randomized controlled trials of coaching to improve physician well-being. All studies have shown statistically significant benefits to clients and patients with diverse needs in diverse settings, from smoking cessation to obesity, diabetes, cancer, and burnout. About INTERVENT Founded in 1997, INTERVENT International is a physician-led, behavior change and population health management company. INTERVENT develops, licenses and provides evidence-based, AI-enabled, data-driven programs for the prevention and management of multiple chronic diseases and cost-drivers. INTERVENT's programs have been proven effective for widely diverse groups of individuals in more than 120 published scientific abstracts and manuscripts, demonstrating significant and positive clinical outcomes across lifestyle-related chronic diseases including prediabetes, diabetes, obesity, hypertension, stroke and heart disease. More than two million individuals have participated in INTERVENT's programs, including patients from over 140 medical centers as part of current landmark multi-center chronic disease prevention/management-related clinical trials. For more information, please visit www.wellcoaches.com and  www.interventhealth.com .

“The Well-being Coaching Inventory (WCI): Questionnaire Development and Validation” was published on Feb 20, 2025 in The American Journal of Lifestyle Medicine (AJLM).   This paper has important practical significance as it presents a health and well-being coaching (HWC) instrument that can be used by HWC coaches and researchers alike.  As with our recent blog on GLP-1 meds , this new article was also authored by members of the Wellcoaches family: co-authors Margaret Moore, Erika Jackson, Rosie Hunter, and Gary Sforzo are all part of the Wellcoaches team who worked on the WCI.  This team was led by Sebastian Harenberg, Ph.D., who is an expert in questionnaire development and validation processes.  The WCI was created to support coaching the whole person connecting both work and personal life.  Our expert team did the in-depth analysis of established well-being measures to develop 49 concise questions with high relevance to HWC.  The inventory is sub-divided into four critical dimensions:  Mind Body Work  Life  The Life sub-dimension represents personal life away from work, but the inventory thoroughly emphasizes work well-being.  The 49 questions capture responses for psychometric and evidence-based constructs, including but not limited to mindfulness, self-compassion, autonomy, creativity, satisfaction, burnout, vitality, flourishing, work-life balance, self-actualization, and gratitude.    After developing the questions, an extensive statistical process was undertaken to establish WCI reliability and validity.  Three rounds of sampling on over 800 participants yielded rewarding and valuable results.  After the analyses were complete, the WCI was found to be both reliable and valid.  It was determined that a shorter 20-item version should be applied for quantifiable or numerical data.  Alternatively, the 49-item version, which requires 15-20 min to complete, is ideal for use as a coaching intake tool.   The 20-item WCI yields total score for well-being and a sub-score for each of the four dimensions. This shorter version can and should be used in repeated fashion over time to document changes in these scores.  This can be done for an individual, or a group (e.g., if a coach wanted to check their own WCI scores across all their clients).   If an individual WCI item is of interest for a client, then either version of the WCI can be used to investigate change over time in that item.  Using the WCI at regular intervals (e.g., every 3 months) can help a coach assess progress on well-being issues important to their client. The 20-item version of the WCI also provides a handy HWC research tool.  It takes only 5-10 minutes to complete and can be administered remotely to large numbers of participants in a study.  Researchers have long awaited a validated HWC core outcome measure and the WCI provides just that.  Now, in addition to examining population specific biometric measures such as body weight or blood pressure, the WCI is an outcome measure that delves specifically into the coaching process for any group of clients.   When studying patients with diabetes we measure A1C to examine glucose control, but the WCI provides a measure to determine HWC impact on specific coaching-relevant results.  The WCI is a core coaching outcome measure that can be applied across all HWC research and will help us to better understand the general well-being impact of HWC processes. Both the WCI article and the actual WCI inventory are freely available  for your use. As a coach, you can send clients to the Wellcoaches WCI web home.  They enter a return email, and after answering all the questions, the results are sent back to them in only a minute or two.  The coach can ask the client to share their WCI results leading to an abundance of potential topics to be addressed.  As a coach, you may applaud and emphasize excellence demonstrated by high scores on items such as gratitude, nutrition, and autonomy. Then you might suggest exploring items potentially presenting opportunities for improvement, such as self-compassion, sleep, job satisfaction, or time in nature.  Each client will present a unique and individual WCI profile for the coach to address in a client-centered manner.  Furthermore, you can track scores for the WCI core 20 items over time and document well-being progress for your client.   Watch for a new class:  Wellcoaches is developing a WCI course to help coaches fully harness the power and apply this valuable HWC instrument. In summary, the research highlighted here provides psychometric validity for an exciting new HWC tool.  The WCI investigates many HWC-relevant items that can be totaled for a well-being score ……or examined as individual coaching topics.  The coach can recommend the WCI be completed by clients and then use it to structure and optimize coaching conversations – it is a powerful coaching tool.  Researchers can use the WCI as a core HWC outcome measure to show improvements in well-being over time in groups of coaching clients.  The WCI is made available, as a gift from Wellcoaches , for use by coaches and clients, and researchers, everywhere. Reference: Harenberg S, Sforzo G, Hunter R, Jackson E, Moore M. The Well-Being Coaching Inventory (WCI): Questionnaire Development and Validation. Am J Lifestyle Med. 2025 Feb 20:15598276251320573. doi: 10.1177/15598276251320573.

Coaches understand the value of autonomy. They thrive on the freedom to chart their own path, enjoying the flexibility to work when and where they choose, and the ability to work with clients of their own choosing. Coach with confidence When you use our coaching tools, you can be assured that they work!  The Wellcoaches Protocol of health/well-being coaching is the most thoroughly tested coaching protocol in the healthcare and well-being domains, resulting in positive, statistically significant outcomes in all 22 peer-reviewed studies. 194 coaches, 30,984 patients/clients, 128,076 coaching sessions What you will learn The keys to improving patient well-being (and your own) How to differentiate the coach approach from the educational approach How to establish growth-promoting relationships Ways to display deep coaching presence Expressing compassion through empathy The value of building positive emotions for resilience Strategies for eliciting motivation The process for building self-efficacy The stages of readiness to change The protocol for building powerful visions Inquiries for crafting designs for behavior experiments What it takes to create generative (ah-ha!) moments Meet a Few of our Successful Entrepreneur Coaches Kim Acedo , MSc Kim runs a virtual health and well-being coaching practice specializing in supporting professional women in midlife and beyond. With over a decade of experience coaching leaders and professionals across industries, she helps women prioritize their health and well-being—because when women take better care of themselves, they don’t just thrive personally, they create a ripple effect that challenges gender norms, strengthens leadership pipelines, and advances gender equity—values that are central to her mission. Cathy Dunford , PCC, NBC-HWC   Her expertise in leadership development and lifestyle medicine has been honed by collaborating with professionals across various industries, helping them navigate the challenges of high-stakes environments. Dr. D. Ivan Young , MCC, NBC-HWC, CPDC For over a decade, Dr. D. Ivan Young has been dedicated to helping people create a positive, lasting change in their lives. He is a TEDx speaker with over 4.9 million views, an ICF Master Certified Coach and Master Neuro-Linguistic Programmer, a Wellcoaches Certified Health and Well-being Coach, a Certified Diversity Coach through the Coach Diversity Institute, and a credentialed Master MBTI Practitioner with a Ph.D. in Holistic Life Coaching. Dr. Young is also a Fellow at the renowned The Institute of Coaching McLean, a Harvard Medical School affiliate.  John Marshall , PCC, NBC-HWC As the Founder of Humessence and a Conscious Leadership & Executive Coach, John is dedicated to helping leaders achieve outstanding results and cultivate thriving team cultures without compromising their values or well-being.⁣ With a robust background in Sales and Business Development, including significant experience at ExxonMobil, John understands the demands and challenges of operating within a global enterprise. His approach to coaching is deeply rooted in mindfulness, self-awareness, and emotional intelligence, enabling leaders to navigate complexity with clarity, resilience, and their authentic leadership style.⁣ Ellen Goldman , M.Ed., NBC-HWC, PCC Business professionals may put their work responsibilities before self-care, and end up exhausted, burnt out, out of shape, overweight, or all of the above. But Ellen makes it easy to tweak everyday habits and fit new healthier ones into your workday, so you end up with more energy and focus, leading to greater productivity, improved health and happiness.  Rebecca Schubert, MS, RDN, NBC-HWC Registered Dietitian Nutritionist and National Board Certified Health and Wellness Coach with twenty years of experience helping people who are defeated, frustrated and confused from constantly being on diets end their war with food and their bodies, teaching them how to eat in a way that finally allows them to feel confident, proud, and happy-while loving what they see in the mirror. Tiff Cagle, MD , NBC-HWC is a family physician, writer, musician, and coach who helps physicians take control of their life and find their purpose so they can do the work they love. Through navigating her own non-traditional path in medicine, Tiff discovered an epidemic of physician burnout and developed a passion for helping her colleagues find balance and fulfillment. She founded EmpoweredMD to provide resources and holistic coaching to physicians facing burnout, and she considers it her calling to create something she believes is essential for everyone: a place where you can think for yourself. Emily Wheldon , JD As a coach, I enjoy helping career-driven people who have ADHD, chronic illness, or a family member with chronic illness to build the life they want, despite the challenges they face. My mission is to empower my clients to achieve their personal and professional goals, while embracing their neurodiversity and coping with their health conditions. I am passionate about neurodiversity in the law, helping destigmatize ADHD, and expanding access to coaching. I use evidence-based strategies, compassionate communication, and tailored support to create a positive and transformative coaching experience.

For students enrolled in cohorts beginning April 2025.

On November 19, 2024 the American Journal of Lifestyle Medicine (AJLM) published “Health and Well-Being Coaching Adjuvant to GLP-1 Induced Weight Loss.”   This article hits close to home because it was written by four members of the extended Wellcoaches family:  Margaret Moore, Pam Peeke, Neil Gordon, and Gary Sforzo.  It is a very timely piece, given how quickly and recently these medications have turned the medical world upside down.   The article reminds all readers that the FDA approved these highly effective medications with the recommendation that they be taken alongside proper diet and exercise. The article also presents the shortcomings of GLP-1 prescription, recommended lifestyle changes, and health and well-being coaching (HWC) as a potential key to sustainable treatment success.   Glucagon-like peptide-1 receptor agonists (GLP-1s) have very high biological activity across many organs. More to the point, GLP-1s are anti-obesity medications that can lead to weight loss of 20-25% in a very high percentage of compliant patients undergoing 1-2 years of treatment. The primary reasons for weight loss are greater satiety and appetite suppression.  Initially prescribed to treat diabetes, these meds are becoming recognized as a miracle drug that might help with an array of ailments from heart failure to mental health to alcohol abuse.  More benefits are being proclaimed almost daily!  The BIG downside is the medications only work while you are on them.  Meaning that if you stop taking the drug, many of the benefits, if not all, will be lost over a short time.  GLP-1s are currently very expensive, may be hard to access, and can be difficult to tolerate in the long term for many patients.  Examples of side effects seen with GLP-1s are: Gastro-intestinal ( most common) Constipation, diarrhea, vomiting Headaches, fatigue  Mood disturbance Loss of muscle, bone density, strength, and balance #Kidney, vision, allergic reactions (#less common) More side effects are being proclaimed almost daily!  Given these issues associated with GLP-1 use, it is not surprising that over 50% of prescriptions are terminated within the first three months.  Sadly, weight regain is common once the meds are stopped!   The solution, as the FDA recommends, is to combine lifestyle change with GLP-1 prescription.  Though lifestyle change is the solution, we know how difficult it is for the average person to begin and successfully maintain healthy behavior changes such as proper diet and exercise habits. This is when the AJLM article strongly delves into the documented benefits of HWC and how coaches can work with and help obese patients using GLP-1s.  HWC is documented to help with healthy lifestyle change and to improve medication adherence.  Specifically, HWC can assist the weight loss process.  The article elaborates that successful HWC treatment in obese patients is based on building a trusting relationship in a client-centered process.  Using many effective and familiar coaching tools such as mindfulness, active listening, reflections, and positivity while being genuine and curious will augment success. The point is to build self-esteem, confidence, and autonomy in patients so they create daily habits that will sustain them during use and after stopping GLP-1 medication.  Further details are provided in the article.  Any coach reading this, and working with an obese patient using GLP-1s, is urged to check out the full AJLM article for greater detail.  In summary, there is a great new treatment available to help patients suffering with obesity.  The number of patients taking GLP-1s is growing exponentially and we will all soon know someone using these meds, if you don’t already.  GLP-1s can literally be lifesaving but………… In the long-term…….GLP-1s with successful behavior change fortified by a well-trained and effective coach is the likely the best plan to treat obesity.   If you are a coach who wants to, or is working with patients prescribed GLP-1s, then watch for the upcoming Wellcoaches course offering on Obesity and GLP-1 use.  The course is expected to launch in the Spring 2025 and will be delivered by highly qualified, subject-matter experts.   In conclusion, obesity and the highly related incidence of diabetes are tremendous societal health problems that are preventable and treatable.  GLP-1s are FDA-approved medications that are very effective in giving patients a huge boost in fighting these life-altering and threatening diseases……. BUT, GLP-1s need help to be an effective treatment.  Knowledgeable coaches who can promote appropriate behavior change and medication adherence can be essential to long-term success for these patients. All this in combination with new opportunity for reimbursement ( see previous blog ) make it a great time to be a coach.   If you are a health and well-being coach, you can be a vital part of this monumental health change process!! For more details see this Reference: Sforzo GA, Gordon NF, Peeke PM, Moore M.  Health and Well-Being Coaching Adjuvant to GLP-1 Induced Weight Loss.  Am J Lifestyle Med.  2024 Nov 19:15598276241302273. doi: 10.1177/15598276241302273. Epub ahead of print.

NOTE: We will provide an attendance certificate for Module 1 once we have confirmed the completion of all requirements. To maintain our high-quality standards, this is a manual review and may take up to 5 business days following the completion of all components. At that point you will be granted access to Module 2, if you have paid for Module 2. NOTE: We will provide an attendance certificate for Module 2 once we have confirmed the completion of all requirements. To maintain our high-quality standards, this is a manual review and may take up to 5 business days following the completion of all components. At that point you will be granted access to Module 3, if you have paid for Module 3.

By Simon Matthews, FASLM, MHlthSc, DipIBLM, MAPS, PCC, NBC-HWC, CPHWC Firstly, thanks to Gary Sforzo for distilling and illuminating some key elements of this paper. And thanks also to my co-authors! This was a true trans-disciplinary effort in which the whole became greater than the sum of the parts and the specific contributions of each part of the system merged into that whole. I’d love to explore a little more deeply one specific part of the behavioral change puzzle – sustaining change. Gary has named “permissive flexibility,” in particular as a likely contributor to sustained change. I want to explain why and how that might be the case, and also suggest a useful working idea for how we might think about “sustainable” in clinical practice. Let’s start with a useful idea of sustainable and I think this will draw us towards understanding why the principle of permissive flexibility  has value. As we explored in the paper, there is no universal definition of sustainable. If a person is able to maintain a change into the medium or long term, or some other defined period of time, we could call that sustainable. If the manner of supporting change in the healthcare system leads to cost reductions, or improvements in vocational satisfaction for the agents of behavioral change (physicians, dietitians, EPs and so on), we could also call that sustainable. The concept you use to define sustainability will affect the metrics used to assess it. So, is there a “best” candidate? I think there is. The healthcare system has multiple actors including the patient, physicians, allied health clinicians, healthcare organizations, government policy actors, economic policy actors and more. However, the system is (or should be!) designed to serve the needs of the patient, and not vice versa! Therefore, the most useful idea of sustainable in healthcare, in my opinion, is one which is focused on patient needs and patient priorities. In effect – sustainable  needs to be understood in whatever way supports the patient to engage meaningfully and vitally in their own life, and their family, community and national life. If we separate this idea from the patient, we risk setting an arbitrary (and likely external, system focused) standard of “sustainable” and losing the focus on patient priorities. Given that, how might we go about supporting sustainable change? The notion of permissive flexibility encourages us to work with the client to create pathways for change that allow for variability. It also means recognising that different physical and psychological environments are likely to cue different behaviors in the client. This concept was made clear by the German American psychologist Kurt Lewin (1890 – 1947) who developed the field theory of behavior, leading to the famous formula B= ∫ (P,E)  – behavior is a function of the person and their environment. Therefore, if we focus behavioral change efforts only on asking someone to do a behavior differently, we’re ignoring the critical influence of variable psychological and physical environments. If we instead approach this by inviting the client to be curious about those environments and to question how they come to behave differently in different environments, we’re starting to move towards the idea of third order change  in which the coach is supporting the client to become their own “diagnostician”, their own decision maker and their own expert in implementing particular strategies at particular times. This third order of change  idea has been explored deeply by Donella Meadows (1941-2001) in her paper Leverage Points – Places to intervene in a system . She shows very clearly that intervening at the “parameter” level of a system rarely leads to long term behavioral change. In health care an example of this type of intervention could be instructing or encouraging a person to eat 6 servings of vegetables rather than 2, or exercise for 30 minutes daily rather than 10, or sleep for 7.5 hours per day rather than 5. The patient may briefly change behavior but because nothing else has changed in the values, beliefs, attitudes, fears, hopes, dreams and capacities of the person, the new behavior will likely extinguish quickly. Meadows argues powerfully that the most effective leverage point for change is the “ power to transcend paradigms ”. This calls us all to remain flexible; to realise that there is no one correct or best way of approaching change and difference; to recognise that every situation will provide facilitators and inhibitors of change. In health behavior change contexts we can harness this power through inquiry, listening and reflection to support the patient to understand their own capacity to consider themselves in new and different ways. Examples of the types of inquiry that might prompt this type of self-reflection could be: How did you come to form that view of yourself? When have you noticed that this perspective has not  helped you? What other ways might there be of considering this? What else could be different when this changes? What will it mean to you, to be able to adapt in this way? What can you do to develop more trust in your own plans? What benefits could arise from changing your approaches at different times? How could disruptions to your routine and plans help you? What could be the best outcome of experiencing a failure? Third order changes are not easy to implement – the entire system must adapt, rather than simply performing one limited behavior differently; however, intervention at this level also provides the most likely pathway to sustainable and constantly evolving behavioral change. Further reading Leverage points – Donella Meadows 1st order, 2nd order and 3rd order change Lewin, K. (1951). Field Theory in Social Science. New York: Harper

Mayo Clinic Proceedings recently published an article entitled “ Supporting Sustainable Health Behavior Change: The Whole is Greater than the Sum of Its Parts. ”  Simon Matthews, Wellcoaches Faculty member, was a co-author on this informative piece describing behavior change through health and well-being coaching (HWC). The Purpose  of the article is to equip clinicians with tools and related evidence allowing them to encourage behavior change in their patients.  The authors focused on key health-promoting behaviors including: Eating a well-balanced diet Increasing physical activity Managing stress well Improving sleep Avoiding/mitigating risky substance and unnecessary medication use Nourishing social connections HWC is described in this paper as an effective behavior change intervention.  The “coach approach” was clearly elaborated and summarized as a patient-centered, concordant communication style that encouraged provision of autonomy and permissive flexibility  – key personal attributes for supporting long-term healthy behavior change.  A takeaway here is that health and well-being coaches should always be keen on promoting client or patient autonomy and permissive flexibility. The power of autonomy is featured in this paper as the essence of patient-centered coaching.  Autonomy is a psychological need emphasizing freedom from external control and acting from personal motivation.  Autonomy is recognized as a key component of the Self Determination Theory (SDT).  SDT is a foundational theory of HWC and much of the intervention’s success relies on promoting autonomy.  Relatedness and Competence are also components of SDT that can also be advanced by HWC. Permissive flexibility (PF) appears to be an important determinant of healthy behavior maintenance.  PF allows an individual to adapt to changing demands, resources, perspectives, desires, and emotions while connecting to personal values.  Higher PF allows a person to more likely be successful at maintaining weight loss or adhering to a physical activity program.  To the extent that HWC can increase PF, it should increase the likelihood of intervention success. Another theme of this paper is behavior change sustainability.  The authors made it clear more research was needed in this area, especially beyond six-months after HWC intervention.  It seems critical to understand the HWC dose and strategies that best ensure long-term patient success.  However, the authors do offer an “expanded” view on sustainability saying that we should consider it a worthwhile outcome if HWC supports a patient for only a limited period of time in managing chronic disease.  This is particularly true when health care providers also benefit from this process, leading to a mitigation of potential feelings of burnout.  We may come to find HWC effects do not persist for long after the coaching process is halted.  This is not unlike what happens with prescription of medication, exercise, or diet – meaning that, if the intervention is stopped the beneficial effects will fade over days, weeks, or months.  It is very possible we come to find that, HWC is a lifelong process.  Maybe the successful client requires lower levels of intervention later in the treatment process – e.g., a “booster” HWC session every three months.  There are important research questions around this topic of sustaining healthy behavior change through HWC that need to be more fully explored. The point of adding a qualified health and well-being coach as a member of the patient care team was made more than once in this article.   Articles like this one are providing a roadmap for health and well-being coaches to chart their future.  As a coach, now is the time to consider partnering with a clinical team and providing support for both patients and the healthcare team.  A good coach can help on both ends of this relationship, promoting healthy patient behavior change while reducing clinician burden and potential for burnout.  Also remember that, in the right clinical settings, HWC services may be eligible for insurance reimbursement – this was addressed in our last Wellcoaches Newsletter blog.  Time to take advantage of these opportunities! REFERENCES Matthews JA, Matthews S, Faries MD, Wolever RQ. Supporting Sustainable Health Behavior Change: The Whole is Greater Than the Sum of Its Parts. Mayo Clin Proc Innov Qual Outcomes. 2024 May 18;8(3):263-275. doi: 10.1016/j.mayocpiqo.2023.10.002.

In July 2024, The American Journal of Lifestyle Medicine published an article entitled “Health and Wellness Coaching Services: Making the Case for Reimbursement.”  Our very own, Wellcoaches Founder and CEO, Margaret Moore was the senior author.  The Purpose  of this article was to describe the path to reimbursement for Health and Well-being Coaching (HWC) forged by collaborators over the last five years.  Led by the National Board for Health and Wellness Coaching (NBHWC) this group included the Veterans Health Administration (VHA) and more than 70 other concerned and involved organizations.  This collaborative targeted and petitioned the American Medical Association’s Current Procedural Terminology (CPT) Panel and the Centers for Medicare and Medicaid Services (CMS).  Ultimately, these oversight bodies determine the fate of reimbursement for health services. In more detail, the first few paragraphs of the article describe our societal epidemic of lifestyle diseases and the need for an effective treatment promoting healthy behaviors.  HWC is described as a patient-centered approach emphasizing behavior change while focusing on areas such as physical activity, nutrition, stress reduction, and sleep.  The case is made for HWC as a credentialed, rapidly growing, and effective intervention to guide clients toward better health by preventing and managing lifestyle diseases. HWC is said to align as part of a healthcare team.  Physicians will refer patients to HWC services for personalized planning to support them in engaging their health care goals.  Diverse healthcare and clinical models, where HWC is effectively integrated into patient care, includes sites such as VHA, Mayo Clinic, Massachusetts General Hospital, and University of California, San Diego.     The case for HWC reimbursement is made by providing four critical reasons: Improving care quality Supporting other healthcare professionals to reduce loads and potential for burnout Empower patients in a cost-effective, socially and culturally sensitive manner Directly support partners and stakeholders who are crucial to healthcare delivery  The Path to Reimbursement In 2019, the VHA recognized the need for coding and tracking coaching services that was not possible with then-existing CPT codes. The VHA, with support from NBHWC, applied for and was successful in having approved Category III CPT codes for HWC.  These codes are in effect until 2029 and they allow the VHA to continue using and evaluating HWC as an integral part of caring for the complex health needs of Veterans. While Category III codes work well for the VHA, they are generally not reimbursed by public and private payers.  Accordingly, the collaborative led by the NBHWC, sought to further petition the AMA and CMS for Category I CPT billing codes.  This request required further documentation establishing the effectiveness and maturity of HWC as a viable healthcare profession.  This information included: Evidence of HWC as effective for managing chronic disease – randomized and controlled (RCT) studies affirming HWC being used to effectively prevent and manage diabetes, hypertension, heart disease, obesity, stroke, chronic pain, and cancer in a variety of healthcare setting with a diversity of coaches. Evidence for an effective dose of coaching – research review information to establish guidelines for HWC session duration, frequency, program length, and total dose.  The CPT codes adopted these guidelines providing for a 60-minute introductory session and follow-up sessions of 30 minutes with up to 15 coaching sessions over 7-9 months.  About 60% of the studies cited to establish this dosing framework were delivered remotely – aka – via telehealth.   Establishing coaches as qualified health professionals –evidence that NBHWC, with the National Board of Medical Examiners (NBME), established a credible national HWC certification based on approved national education and training standards.  This process has resulted in over 10,000 certified coaches from a diversity of licensed and non-licensed practitioners.   Providing HWC Utilization data in the US - information from 72 organizations on use of coaching services.  Since 2015 over 4 million coaching sessions were recorded.  The VHA alone accounted for nearly 150,000 reported sessions delivered by certified coaches. As a result of these more recent efforts for establishing CPT codes, the CMS announced in November 2023 that HWC were included on the 2024 Medicare Telehealth Services List.  This action was taken on a temporary basis – now through 2027 - with the expectation that positive clinical outcomes will be documented using these new coaching CPT codes before permanent approval would be considered.  CMS expects verifiable, peer-reviewed evidence to be provided to support the movement of HWC services to a permanent reimbursement code.  There are several pathways to use the temporary CPT codes for reimbursement of HWC services.  Medical practices can directly bill patients or use monthly value-based care allowances to finance coaching services.  Medical practices can bill Medicare for eligible beneficiaries who are using HWC services under physician supervision. Medical practices may also use the CPT codes to engage in negotiations for billing other third-party payers (e.g., Medicare Advantage plans or private insurance).   Finally, Health Savings and Flexible Spending Accounts may reimburse HWC services when prescribed by a physician as medically necessary.  The Future for HWC Going forward the HWC profession must ensure standardized HWC training and credentialing.  Furthermore, clinical and financial outcomes for HWC must be tracked using standardized outcomes and the new temporary CPT codes. There also needs to be a substantial amount of work reported in underrepresented populations.  The HWC field must also continue to document and identify important factors that contribute to positive outcomes such as consideration of patient readiness, coach experience, and technological advances.  Recognizing and implementing these positive factors can help make a stronger case for HWC reimbursement to insurance providers.  Finally, the HWC field must provide published clinical effectiveness evidence for HWC using the established, but temporary, telehealth services CPT codes.   The paper concludes by describing the tremendous development of the HWC profession over the last decade. Approval of CPT codes for HWC is evidence of this development!  The future requires extensive use of these codes and documentation of such.  These efforts will encourage development of the profession and reinforce the value of HWC by optimizing patient-centered resource use and coordinated care.   This blog does not do justice to the detail provided in the full-length paper.  To capture and appreciate these details, the reader is directed to the complete article.   REFERENCES Abu Dabrh AM, Reddy K, Beech BM, Moore M. Health & Wellness Coaching Services: Making the Case for Reimbursement.  American Journal of Lifestyle Medicine . 2024;0(0). doi: 10.1177/15598276241266784

A paper entitled “Competencies of Coaches that Predict Client Behavior Change” was recently published in the Journal of Applied Behavioral Science. The Purpose of this study was to determine which coaching competencies were most important to promoting client behavior change.  Competencies were defined as being related to Emotional and Social Intelligence (ESI). To name a few, competencies such as empathy, positive outlook, and emotional self-control were considered.  The authors focused on coaching as a strategy to improve employee behavior and performance, i.e., career or executive coaching.  Nonetheless, the results of this work can inform the practice of health and well-being coaching (HWC) as these coaching models are more alike than different.  Furthermore, the hope is that findings may guide training and certification programs by identifying important coaching competencies. The Methods of this study involved pairing and defining the interactions of 240 coach-client dyads.  These pairings were trained physician coaches working with medical students over the course of a two-year period.  Peer-assessments were made of ESI coach competencies and client behaviors at baseline and 24 months later were measures to assess behavior change. Results indicated that general mental ability did not distinguish between coaches, but 6 of 12 ESI coach competencies studied significantly influenced client behavior.  The most impactful coaching competency, Achievement Orientation (AO), was defined as “striving to improve or meet a standard of excellence.”  When using AO, a coach was seen as helping a client juggle competing tasks and setting priorities. In addition to AO, Emotional Self Control, Adaptability, Empathy, Influence, and Organizational Assessment.  It was surprising that Emotional Self-Awareness (ESA) was not revealed as a significant competency. The authors discussed ESA as possibly essential to coach training and development but maybe not as critical during actual coaching.  Each of these coaching competencies is more fully defined in the paper cited below which is freely available (open access) at the publisher’s website. While informative, there are also Limitations in how those practicing HWC should interpret the results of this study.  Medical students (trying to excel in classes) have high intelligence but limited age-range and practical experience.  They are not the same as at-risk patients trying to improve their health or even the same as executives (workers) trying to improve job performance.  While these differences are very real, they do not fully preclude us from carefully making a few generalizations and recommendations from these results. Coaches effectiveness for encouraging client behavior change may be rooted in key skills or competencies. Achievement orientation (e.g., asking questions to help a client prioritize competing demands) may be an essential coach skill, especially when working with clients who express time constraints. Emotional Self-Control allows a coach to hold back personal reactions during a coaching conversation.  This skill focusses the coaching session on only the client’s needs while not confusing the coach’s emotions as part of the issue at hand. Adaptability, or being able to shift the coaching approach or line of questions, may be a critical coaching skill. Empathy, carefully listening to a client and having them know they are heard, is a valuable coaching skill. A coach can encourage desired behavior change in clients by modeling behavior informed by emotional and social intelligence competencies. While some readers may want to adapt more of the findings from this study to all coach settings, it seems prudent to first consider these above as reasonable for generalizing to HWC. As a side note, the authors of this article claim that current coach training techniques and certifications are not based on research or established theory but instead on opinions of experts or clients indicating which coach competencies are valuable.  It is easy to take exception to this statement.  NBHWC standards are based on well-established foundational theories and techniques such as goal-setting, motivational interviewing, self-determination, and stages of change.  Each of these has an extensive database, which has proven useful in helping clients change their behavior.  Furthermore, the Wellcoaches Approach is thoroughly studied in numerous research articles showing a beneficial effect for HWC clients of all types – as a trip to this website readily shows … Boyatzis et al. have initiated an interesting and valuable line of research.  ESI competencies, such as achievement orientation and emotional self-control, appear to be important coaching competencies – at least in certain situations.  Moreover, it seems that behavior of the coach, and specifically role modeling during a coaching session, may be a critical component of successful coaching.  While there are limitations to this study, such research can help us better understand our work as coaches. This study also helps us realize there is a need for much more investigation examining how to optimize coaching.  Specifically, we need to see HWC studies attempting to figure out what works best in a session – regarding both coach competencies and coaching strategies.  We can learn how to best and most effectively coach from work like this.  Hopefully, we will soon see more research focused on HWC to further inform our practice. REFERENCES Boyatzis, R., Liu, H., Smith, A., Zwygart, K., & Quinn, J. (2023). Competencies of Coaches that Predict Client Behavior Change. The Journal of Applied Behavioral Science, 0(0). https://doi.org/10.1177/00218863231204050