Health coaches offer personalized health plans

Approach focuses on behavioral changes

Duke Integrative Medicine in Durham, NC, takes health coaching to a new level by providing coaching by highly trained health care personnel who work closely with their clients to help them follow their personal health plan.

"What we do is more than just motivate people to change. It's helping connect their behavior to their values and to what matters most to them," says Julie Kosey, MS, CPCC, ACC, integrative health coaching manager at Duke Integrative Medicine.

It is the first major academic medical center to develop a specified role for the health coach on the clinical team. The program's success was demonstrated in a study of 154 outpatients with one or more known cardiovascular risk factors who received a personalized health plan and worked with a health coach to set and achieve goals. At the end of the 10-month study, participants experienced a reduction in risk for coronary heart disease as measured by the Framingham risk score.

A health coaching program tailored for a subset of high-risk Duke employees and their dependents resulted in fewer hospitalizations and lower emergency department costs for those who would have qualified for the program but did not participate, says Ruth Wolever, PhD, director of research at Duke Integrative Medicine and assistant professor of psychiatry at Duke Medical Center.

Kosey says, "Health care has long been about treating disease to return a person's body and mind to an acceptable state of health, and separately, people have sought the support and guidance of coaches to help them move to new levels. Health coaching brings these two worlds — health coaching and personal coaching — together."

Integrative medicine combines state-of-the art medical treatments and evidence-based complementary therapies and focuses on the whole person, rather than a disease or condition to help the patient achieve optimal health. In addition to traditional therapies, participants in integrative medicine programs may receive services including physical therapy, nutritional therapy, movement and exercise, health psychology, stress reduction and mind-body interventions, botanicals, and acupuncture.

Wolever says, "Our mission at Duke Integrative Medicine is to be a catalyst to shift the way that health care is practiced, to move to a more patient-centered approach."

During what is called an "immersion experience," each patient collaborates with physicians and other health care professionals and develops a plan tailored to his or her needs, then works with the health coach to reach the goals set out in the plan. The depth of the program is what distinguishes Duke Integrative Medicine's health coaching from those offered by other entities, Wolever says.

"I presented at a teleconference with several disease management entities. At the end, someone asked the typical caseload of each program. One said 250, another said 500. Our health coaches work with no more than 30 people at a time," she adds.

Often people have a lot that they need to do to become healthy, Wolever says. "They want to work on some of [those things], and they don't want to work on others," she says. "One thing the integrative health coaches do better than traditional health care providers is stay focused on what is important to the client."

The multidisciplinary team at Duke Integrative Medicine includes physicians, nutritionists, exercise physiologists, and health coaches as well as ancillary services such as psycho-social services, acupuncture, and massage therapy.

Participants in the integrative health coaching program become involved in a number of ways. During the immersion experience, participants work with a variety of disciplines over a three-day period, then work closely with a health coach to follow the personalized health plan the multidisciplinary team recommends.

There are multiple pages of suggestions, Kosey says. "This is overwhelming for most people. Together we create a plan that helps them choose what is most important to them out of the whole big picture. The plan shifts and changes as they try out different things," she says. The integrative medicine center offers enrollment programs that include consultations with the health care team, coaching sessions, and personal health plans as well as personalized group programs for businesses, families, and groups as well as day and half-day programs.

"The concept of this program is to empower the patient through education and skill building. It's a holistic program that gives patients access to providers with different views who can help them create a health plan," Wolever says.

When participants enroll in the health coaching program, the coaches help the participants identify what they want to work on, be specific, and look at how the changes they want to make would influence their life as a whole, Kosey says.

In most situations, the participant and the health coach develop specific goals in each session and discuss what worked and what didn't the next time they talk.