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

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.

In 2006, Wellcoaches was a five-year-old school. That year, Margaret Moore, aka Coach Meg, presented wellness coaching to fitness professionals at the IDEA event. Wellcoaches has evolved and grown tremendously since then. However, as you watch this two-hour training, you’ll recognize the foundational elements that remain today: Mount Lasting Change, the intuitive dance of coaching (generative moment), helping clients craft a wellness vision, making actionable goals from a vision, and how to overcome obstacles.

Earlier this year, the Journal of American Medical Association (JAMA) published an article entitled “Effect of Personalized Risk-Reduction Strategies on Cognition and Dementia Risk Profile Among Older Adults." (Yaffe et al. 2024) The purpose of the study in this prestigious medical journal, was to determine if a multi-pronged program featuring health coaching might reduce dementia risk in group of at-risk adults averaging nearly 76 years of age.  In the ever-growing body of research defining health and well-being coaching (HWC), this is one of the first studies to directly address dementia – a debilitating and feared condition associated with old age.  The design of this study was unique in that it targeted a personalized approach to risk reduction and used HWC to deliver the intervention.  Here are some of the details of this important and applicable work. WHO:  Participants in this study were dementia-free but had two or more dementia risk factors which include: 1) physical inactivity, 2) uncontrolled hypertension, 3) poor sleep, 4) prescription meds affecting cognition, 5) high depressive symptoms, 6) uncontrolled diabetes, 7) social isolation, and 8) currently smoking.  These were all independently living older adults who were part of the Kaiser-Permanente Health Care System.  Participants (N = 172) were randomized into the intervention or control group for this two-year randomized and controlled trial (RCT). HOW:  The study was conducted before and during the COVID pandemic making much of the intervention remotely delivery.  Dementia risk was assessed for each participant and health coaches helped them prioritize related goals and then work toward achieving those goals.  Sessions were initially about 45 minutes long every 4-6 weeks, and after three months, were reduced to about 20 minutes every six weeks for the next 15 months.   A nurse was also part of the primary care team meeting every three months with those participants who had uncontrolled diabetes, hypertension, or risky meds. MEASURED: The primary outcome was a neuropsychological test battery measuring attention, memory, language, and global cognition. The authors also measured physical activity using a written scale and a waist-worn accelerometer. Blood pressure and A1C (diabetes indicator) were measured along with quality of life, sleep quality, social isolation, depression, and smoking.  These measures were made every six months. FINDINGS:  When the composite cognitive outcome measure was assessed, the HWC group improved substantially more than the control group.  The intervention participants also had a significantly better dementia risk profile at the end of the study than the control group.  In general, most other outcome measures (quality of life, sleep, social satisfaction, depression) showed the HWC participants to be better off than the control participants who did not receive HWC.  Finally, those who received HWC expressed greater satisfaction with the study protocol than the controls, who were given relevant health education materials to read and apply. WOW:  This study demonstrated that an intervention featuring HWC could very possibly alter the trajectory for the development of dementia in older adults. Alzheimer's and other related dementia diseases are some of the most feared and dreaded conditions associated with aging.  When asked, most people would rather not live than to go on with severe cognitive decline.  This is not the first study to show that risk factor reduction can improve cognition.  What makes this RCT unique is the personalized, or client-centered approach, ……AND the extensive of use of health coaches to deliver the intervention.  According to the authors, this approach appears to be more effective than what is seen in other studies that emphasize a general and directed risk reduction for all participants. The authors go on to say that COVID may have affected some of their outcome measures (e.g., social isolations) and the delivery of the intervention (remote rather than in-person sessions).  BUT …..they guess the HWC treatment effects might have been better if not for this interruption in their protocol. WRAP-UP: The application of HWC continues to grow.  Prolonging a lifespan with effective cognitive function is the hope of just about every aging person.  Doing this without extensive medication and medical intervention is a further goal that may be considered icing on the cake.  This JAMA-published study asks if HWC can be part of the solution to this pressing problem.  What we see is that It appears HWC has the potential to be of great help to older adults, especially those with greater risk for cognitive decline.  This is just another great example of how applying HWC can successfully assist with prevention of a life-threatening medical condition (see diabetes, heart disease, obesity) through lifestyle modification.  As the client base for HWC expands, it becomes clear how important this strategy may be as a global healthcare intervention. References Yaffe K, Vittinghoff E, Dublin S, Peltz CB, Fleckenstein LE, Rosenberg DE, Barnes DE, Balderson BH, Larson EB. Effect of Personalized Risk-Reduction Strategies on Cognition and Dementia Risk Profile Among Older Adults: The SMARRT Randomized Clinical Trial. JAMA Intern Med. 2024 Jan 1;184(1):54-62. doi: 10.1001/jamainternmed.2023.6279.

Let’s chat for a sec about authenticity, Merriam-Webster's word of the year. It makes sense that authenticity is in demand as we’ve had to work harder and harder to separate genuineness from falsity in the news, in marketing, and in technology. And, amidst the noise of pundits, influencers, and conflicting data, many of us grapple with having a clear point of view about life and about ourself. The value of living authentically is that it yields personal freedom and power. Practically speaking, when we live and lead authentically, we communicate and relate more easily, make decisions with less turbulence, and fall asleep more quickly because there’s less mental buzz of conflicting thoughts and stress. And while the pursuit of authenticity is a mainstay for spiritual seekers and personal growth devotees, leaders and the world at large are increasingly focused on authenticity because deceit and confusion has become perfected and machine-driven, and followers take solace in having authentic leaders. I've been exploring what it means to live and lead authentically for close to 40 years, and want to share just one important aspect to make your efforts in this path more fruitful. I've found that typical education and cultural notions about being authentic and finding our authentic self, range from naïve to misleading to bamboozling. At the heart of this mess is a collective agreement – a mistaken assumption – that hidden somewhere deep within us is an authentic self. Typical pursuit of authenticity implicitly assumes that we have a static and stable (read, authentic) Self that, with enough effort and skill, can be chiseled out and released. Unfortunately, this isn’t helpful as it flies in the face of science, philosophy, and spirituality. All of our wisdom fields  agree that everything in life fluxes and changes. From galaxies to molecules, and from markets to moods, everything is impermanent – constantly shifting and changing. Impermanence is a universal fact that touches every aspect of life, including authenticity. It is not possible, therefore, to locate a static and unchanging self, is it? We, too, are subject to change and flux. So, to clean up this limiting idea, embrace the fact of impermanence. Then you can replace your search for an “authentic self” with a notion of “authentic expression.” An expression is dynamic. An expression honors change and flux. An expression grasps that from our birth to our (hopefully) ripe old age, we continuously unfold and grow in a myriad of domains—mental, emotional, physical, interpersonal, and spiritual. An expression acknowledges that there’s no end to learning and evolving; we are constantly unfolding. It’s natural. When we embrace our authentic expression, we honor our past selves, and welcome our emerging self. We accept that changing our mind and values is a feature of evolving and maturing. We can gracefully let go of the versions of self that were sculpted by others, and make room for our unique expression of creativity and care. We bow deeply to the Universal inevitability of impermanence. When we embrace authentic expression, we attune our awareness to an unfolding self-expression. Why not do the work of authenticity in 2024? It is personally gratifying, and it is a leadership magnet to other people of depth and substance. Clarify your values. Identify child-aged beliefs and let them go. Set boundaries with people. Share your creativity and perspective more often. And as you do all this, be deeply curious about what’s emerging. This isn’t the kind of work that just end – there’s no certificate that declares that you are complete. Your authentic expression is a flow, not a pool. This work is good for your team and for your company. This work is good for your loved ones and community. And this work is ancient spiritual practice. Wishing you an amazing 2024. Happy New Year. Eric

The journal Patient Education and Counseling recently published an exciting study entitled “The Impact of Health and Wellness Coaching (HWC) on Patient-Important Outcomes in Chronic Illness: A Systematic Review and Meta-Analysis." The study was conducted by a Mayo Clinic team. Meta-analysis allows for statistically combining results of many unifocal (e.g., HWC) experimental studies to provide broad conclusions and recommendations. Meta-analysis is often the most trusted form of evidence in policy decision-making and is typically considered the pinnacle of scientific topic review. WHAT and HOW: The study’s purpose was to determine the effects of HWC programs on quality of life (QoL), self-efficacy (SE), depression, and anxiety in chronically ill patients. Chronically ill was defined as any condition limiting self-care for more than 12 months. The authors only used randomized and controlled trials (RCTs), which are considered the most rigorous and powerfully designed experimental studies. Keep in mind, to be included in this review, a study had to be an HWC RCT in chronically ill patients measuring QoL, SE, depression, and/or anxiety. In the end, they selected and analyzed 30 RCTs from the 1337 HWC articles returned by their electronic search of the literature from 2005 – 2023. The 30 retained studies had over 8600 participants that were included in the meta-analysis. FINDINGS: The meta-analyses revealed that HWC had a beneficial impact on QoL, SE, and depression. Each outcome improved at a different time point (e.g., at 3, 6, or 12 months) relative to starting a coaching intervention. Only anxiety was not found to improve after coaching. QoL, SE, and depression were measured in 14, 13, and 15 studies, respectively, while anxiety was measured in only 7 studies. MAIN POINTS: HWC intervention is beneficial for chronically ill patients and can likely improve QoL, SE, and depressive symptoms. It was difficult to determine how long the HWC effects persisted and whether booster sessions were needed because reviewed studies generally did not have adequate follow-up measures after HWC sessions stopped. Successful coaching programs attended to aspects of the Theory of Patient Capacity (TPC). Typically, three TPC constructs were addressed in HWC studies that reported beneficial findings – more on TPC below. CONCLUDING CONSIDERATIONS: The authors cited many limitations in the literature they reviewed. They called for stronger study designs, standardization of outcome measures, and longer follow-up periods. OUR COMMENTARY: Given the design of this review and meta-analysis, it is difficult to say anything about the sustainability of HWC intervention. This study specifically used papers that measured QoL, SE, depression, and anxiety but did not seek to find papers that emphasized long-term follow-up outcome measures. If you are interested in the potential long-term effects of coaching, then check out a study that was designed to address this question (Ahmann 2023). We recently reviewed Ahmann et al. 2 in this column and concluded there are sustained beneficial effects of HWC beyond the coaching period. An interesting concept discussed by authors of this study involved framing HWC treatments in terms of the TPC constructs (Biography, Resources, Environment, Work, and Social Functioning – BREWS). According to this theory, patients draw on these capacities they may possess to deal with the challenges of their treatment. It may be beneficial to plan HWC programs to address these capacities. The figure below provides a graphic of patient capacities. If you want to learn more about the TPC, then start with the reference cited below3. CONCLUSIONS: We now have further evidence of a beneficial effect of HWC on psychometric outcomes such as life quality and self-efficacy in a patient population. These are such important self-reported constructs. Consider, now, that we can be comfortable saying that participation in several months of coaching can positively impact the quality of one’s life – a strong statement even when taken in isolation from the other beneficial HWC effects reported here. The meta-analysis described here also verifies the effectiveness of HWC for addressing depressive symptoms, though, surprisingly, the papers analyzed did not support a similar impact on anxiety. A concept like the Theory of Patient Capacity might inform your coaching. Consider looking into it, especially if you work with patients with self-treatment limitations. REFERENCES Boehmer KR, Álvarez-Villalobos NA, Barakat S, de Leon-Gutierrez H, Ruiz-Hernandez FG, Elizondo-Omaña GG, Vaquera-Alfaro H, Ahn S, Spencer-Bonilla G, Gionfriddo MR, Millan-Alanis JM, Abdelrahim M, Prokop LJ, Murad MH, Wang Z. The impact of health and wellness coaching on patient-important outcomes in chronic illness care: A systematic review and meta-analysis. Patient Educ Couns. 2023 Sep 15;117:107975. doi: 10.1016/j.pec.2023.107975. Ahmann E, Saviet M, Conboy L, Smith K, Iachini B, DeMartin R. Health and Wellness Coaching and Sustained Gains: A Rapid Systematic Review. American Journal of Lifestyle Medicine. 2023;0(0). Boehmer, K.R., Gionfriddo, M.R., Rodriguez-Gutierrez, R. et al. Patient capacity and constraints in the experience of chronic disease: a qualitative systematic review and thematic synthesis. BMC Fam Pract 17, 127 (2016). https://doi.org/10.1186/s12875-016-0525-9

On November 2, the US Centers for Medicare and Medicaid Services (CMS) announced that Health & Well-being Coaching (HWC) Services will be added to the Medicare Telehealth List in 2024 in a temporary phase to study outcomes. Let's share an abundance of gratitude for everyone's amazing contributions. First, the pioneering souls who co-founded the national standards as early board members of what became the National Board for Health & Wellness Coaching: Richard Cotton, ACSM - enabled the HWC job task analysis Cindy Schultz - the first NBHWC Chair, led the project for CDC DPP group coaching standards Karen Lawson, MD - secured funding for the 2010 retreat, which enabled NBHWC formation Linda Bark PhD, RN, MCC, NC-BC, NBC-HWC - first integrative health coach, brought nurse coaches together with NBHWC Leigh-Ann Webster, NBC-HWC - built operational and marketing foundation Meg Jordan, PhD, RN, NBC-HWC - developed coaching skills standards Ruth Q. Wolever, PhD - first HWC researcher, led a systematic review that defined HWC Michael Arloski, PhD - first wellness coach, coaching standards leader Tim Cline, PhD - built a group coaching curriculum for the CDC DPP program and NBHWC Francis "Frank" Ardito, EdD - developed the NBHWC program approval system Linda Smith, PA - coaching standards leader Pamela Peeke, MD – steering board and advocacy Margaret Moore, MBA – co-leader of national standards, certification development, NBHWC formation Second, NBME leaders who believed in our co-founders' passion: David Eisenberg, MD, introduced NBME to co-founders Donald Melnick, MD, NBME past President Peter Katsufrakis, MD, NBME CEO Agata Butler - enabled HWC certification examination Craig Mills - negotiating lead of NBME/NBHWC agreement Jack Hinke - helped NBHWC establish a viable financial path Lisa Rawding - helped NBHWC establish a viable strategic path Third - Dr. Kavitha Reddy, Veteran’s Health Administration, who led the 2019 approval of CPT codes for health and well-being coaching services with our help at NBHWC. Fourth, our team who met with CMS twice in 2019 to discuss HWC services in Medicare: Brian Carey, JD, Foley Hoag Ross Margulies, JD, Foley Hoag Linda Lysoby, NCHEC Francis "Frank" Ardito, NBHWC Thomas Rebbecchi, M.D., NBME Ben Crocker, MD, MGH George Guthrie, MD, ACLM Fifth, our team that prepared and advocated for the HWC codes at the AMA CPT Panel in May 2023 and the CMS decision in November 2023: Kavitha Reddy, MD, VHA Moain Abu Dabrh, MBBCh, MS, NBC-HWC, Mayo Clinic Janet Clark, MD, VHA Melissa Opp, NCHEC Beth Frates, MD FACLM DipABLM, ACLM Michael Parkinson, MD, MPH, FACPM, ACPM Angela Fitch MD, FACP, FOMA, Dipl. ABOM, OMA Jacob Mirsky, MD, MA, DipABLM, MGH Monte Ward, ACSM Karen Avino EdD, RN, AHN-BC, HWNC-BC, SGAHN, AHNCC Leigh-Ann Webster, NBC-HWC, NBHWC Jessica Matthews, DBH, MS, NBC-HWC, DipACLM, FACLM, UCSD database Gene Kallenberg, MD, UCSD Scott Morcott, MD, NBHWC Jennifer Lundman, LCSW, NBHWC Steven Stranne, MD, JD, Foley Hoag John McInnes, MD, JD, Consultant Katy Goodell, Outreach and utilization data management Gary Sforzo, PhD, Evidence review Bettina Beech, Dr.P.H., CPT submission Jocelyn Weiss, PhD, Evidence review Margaret Moore, MBA, Team Lead What a transformational accomplishment, a milestone we will long celebrate. After 14 intense years (starting in late 2009) and 10,000 volunteer hours, I resigned from my NBHWC board and policy leadership roles in October 2023. In our next phase, I am focused on fully supporting the Wellcoaches community on our collaborative journey together. Onward & upward! Here’s to our next big milestone. Coach Meg

the decline of moments of being well While looking for an image to express the concept of well-being, I came across this photo of Japanese snow monkeys relaxing in a hot spring on a winter's day. I don't know about you, but it makes me pause, exhale, feel the warmth, and appreciate the good. In case it doesn't do that for you, consider it a warm invitation to find something that does. In pandemic time, most of us need more human warmth, more long exhalations, and more appreciation of what is good. Moments of being well, of well-being, are elusive today. A 2021 survey using a respected measure of flourishing shows that around 60% of non-boomer adults (under age 58) are NOT flourishing. The level of burnout, a terrible crisis of ill-being - mental, emotional, physical, and spiritual depletion - is at an all-time high in healthcare and other industries devastated by the pandemic. Many things that had nourished our well-being, or kept ill-being at bay, keep appearing and disappearing, like unreliable magic tricks. We are not yet skilled hunters and gatherers of the moments of well-being that make up a life well-lived, particularly for young people. well-being models As you would guess, the concept of well-being, like many human endeavors, is complicated and multi-faceted. Along with the flourishing model, we have an abundance of science-based well-being models to choose from - positive psychology, PERMA, positivity, Gallup, Self-Determination Theory, Maslow's model of Self-Actualization, CDC, and lifestyle medicine - to name some respected models. Focused since 2000 on understanding and fostering wellness and well-being through coaching, our Wellcoaches contributions include: designing coaching as a science-based well-being intervention in its own right, even when coaching isn't explicitly focused on health and well-being goals organizing and integrating well-being elements into our natural multiplicity - the mind has multiple parts, each with its own well-being formula Models of work well-being have arrived (Gallup, job crafting, research handbook, for example), along with our enlightened discovery that individual well-being, leading well, and organizational well-being are profoundly interdependent. Work is a vital source of well-being. Well-being enables great work. None too soon, well-being has become a leadership priority, not just a line item in the HR budget. well-being vs wellness With all of the scientific attention, the cool factor of well-being has overtaken the fading construct of wellness, which now seems out of fashion. While the APA defines wellness as a dynamic state of well-being, others have relegated wellness to the corner of physical health, despite an abundance of well-constructed, whole-person wheels of wellness that convey the deep interconnections of mind, body, life, and work wellness or well-being. In 2019, when our NBHWC and VA team worked with the American Medical Association (AMA) to establish healthcare billing codes for coaching services, the AMA decided on "health and well-being" rather than health and wellness. Thank goodness - at last there is a healthcare profession focused on well-being, something most agree is good for physical health, even if wellness got demoted in the process. suffer well Another thing most everyone agrees on is that we need to get better at navigating our negative emotions and experiences. In particular, we need to suffer well by turning the near-universal pandemic trauma of a severely disrupted present and future into post-traumatic growth - more appreciation, meaning, strength, possibilities, creative acts, and richer relationships. Not just bouncing back with resilience, but fully experiencing the losses and fears so they carry us forward to a better place, better able to thrive during the next tough times. a life well lived - together Whether we are enjoying moments of well-being, or experiencing and turning difficult moments into good - strength, growth, and new opportunities, we are living work and life well. Reaching out to help others, helps us feel better. Asking others for help, looking to people who are thriving or flourishing, does them a favor. They feel even better (social well-being!). We are in a well-being reboot. We are in this together. Coach Meg www.coachmeg.com More resources: Everyday Health: Mental Health Stigma Wellcoaches: A New Duet

Featuring Dr. Sonal Ullman A Beautiful Story of Coaching and Collaboration Wellcoaches & Beth Israel Deaconess Hospital In 2018, I led a grand rounds session on coaching skills for physicians at Beth Israel Deaconess Needham Hospital. Among the participants was GI physician leader Sonal Ullman, who now leads the hospital’s physician group. That auspicious session spawned a close collaboration of Wellcoaches and the hospital’s administrative, physician, and nurse leaders, giving life to a variety of initiatives: since 2019, an ongoing senior leadership/coaching program for around 50 leaders, including an annual retreat 2020-2021 - an intense burnout group coaching program at the height of the pandemic of 15+ early morning group sessions 2020-2021 - private burnout coaching of 30+ physicians by nine Wellcoaches coaches Along with four other hospital leaders, Dr. Ullman went on to complete the Wellcoaches certification and become a physician coach In early 2022, one of Dr. Ullman’s patients, Dana Martin, died of gastric cancer. In deep gratitude for her services, Dana donated $100,000 to the hospital for a project of Dr. Ullman’s direction. Her story of working with Dana is a beautiful one of deep service and impact. She published the story in a Stanford Medicine newsletter. Dr. Ullman used the donation for an internal professional coaching program to support hospital employees, named the Martin Family Coaching Program (more details at the end of the blog). Both Coach Meg and Erika Jackson are supporting the Beth Israel team of physician and nurse coaches. What happens when coaches and physicians come together? More well-being in healthcare. Onward and upward, Coach Meg MARTIN FAMILY COACHING PROGRAM DESCRIPTION A new workforce development program for staff and providers at BID Needham Collaborate, Cultivate, Partner, Foster Possibilities, Co-Discover, Broaden Thinking The Martin Family Coaching Program is a philanthropically-funded program and part of BID Needham's commitment to workforce development—one of the hospital's top strategic initiatives for 2022—with the goal to maximize your professional potential. This structured staff and physician coaching program provides you the opportunity to meet one-on-one with a professionally trained coach who is also a BID Needham employee or physician for up to six hours over the course of six months. A well-being coach is a trained facilitator of positive habits, change and growth who partners with you in a thought-provoking and creative process. This program is open to all staff—both clinical and non-clinical—and to physicians. Benefits of the coaching program · Increase self-awareness, insight and creativity as you set goals for your career development · Tap into your strengths and experiences to help address challenges · Become an expert in your wellness and personal path · Collaborate with a coach who understands your work environment · Increase quality of life at work through better use of internal and external resources Could a well-being coach help you? A coach will be your partner in professional development, helping you set goals and maximize your opportunities for growth. In addition, a coach can help you learn from difficult situations, as well as develop and practice tools to address workplace challenges. What you will gain Resilience, Engagement, Clarity, Meaning, Future, Connection, Strengths, Strategies, Vision, Confidence, Gratitude, Leadership, Flow, Purpose, Learning, Meaning, Fulfillment Connect with a coach today! If you would like to learn more about how you might benefit from the Martin Family Coaching Program, email BIDN-coaching@bidneedham.org.