Lifestyle coaching improves health, saves money

Also helps manage chronic disease

Providers and insurers are starting to add lifestyle coaching to the range of interventions they provide to help motivate people to take charge of their own health and make changes in the way they live that help them live healthier, more productive lives.

"Instead of just managing a disease, it's more effective to focus on the whole person and help people make changes in their habits and behavior to improve their overall health, and manage their chronic conditions at the same time," says Chelsea Anderson, manager health and wellness for Medica, a health insurance company with headquarters in Minneapolis.

Medica believes that patient engagement will be the cornerstone of healthcare in the future, Anderson says.

"Engaged, empowered members make informed decisions and develop the confidence to participate in their care. Coaching reinforces that behavior and may improve outcomes, lower costs, and increase member satisfaction," adds Maureen Ward, Medica's senior director of clinical integration.

"When people take action to manage their health, they live better, feel better, and have more energy as well as reducing healthcare costs," says Jennifer Sponholtz, CHES, wellness coordinator for Advocate Health Care, an integrated healthcare system with headquarters in Oak Brook, IL. "Research shows that people who have support in improving their health can reduce their risk of developing a chronic condition or experiencing an adverse medical event," she adds.

For example, a long-term study by researchers at Brigham and Women's Hospital in Boston concluded that lifestyle counseling, as part of routine care for people with diabetes, helped people lower their blood glucose levels, blood pressure, and blood cholesterol levels more quickly and keep them under control.

"This study shows that persistent lifestyle counseling can and should be a critical piece of any routine diabetes treatment plan. Clearly, it gets people to goals faster than when they are not given continued encouragement and information on how to increase physical activity levels, eat properly, and reduce lipids," says Alexander Turchin, MD, MS, senior researcher.

The researchers identified 30,000 people treated at Brigham and Women's Hospital and Massachusetts General Hospital over a 10-year period who received lifestyle counseling in the primary care setting as documented by their healthcare providers. They found that patients who averaged one counseling session every month lowered their hemoglobin A1c level 40% faster, their blood pressure 25% faster, and their cholesterol 30% faster than those who received less frequent counseling.

"We found that the more lifestyle counseling patients received, the sooner they achieved lower blood glucose levels, lower blood pressure, or better lipids control. Patients who received face-to-face counseling once a month or more took an average of 3.9 weeks to reach their target goals for hemoglobin A1c, blood pressure, and cholesterol as compared to 13.5 months for those who received counseling less frequently," Turchin says.

At Advocate Health, the health coaches focus on preventive care while the case managers are more disease-management oriented. "We refer back and forth depending on the needs of each particular patient," Sponholtz says. For instance, if case managers feel that patients have achieved their health goals they may refer them to a health coach for help in changing behavior. "Sometimes the coaches are working with patients with chronic conditions who could benefit from help from case management and they refer them up. The patients can continue to work with the lifestyle coach while working with the case manager," she says.

Medica's coaching program is one of the health plan's disease management solutions, Anderson says. "We are taking a different way of looking at behavior that drives the condition. We are partnering with providers and relying on them to treat the members' conditions and to educate the members on how to follow their treatment plan on a day-to-day basis. The coaches help them make lifestyle changes that will help them manage their conditions and lead healthier lives," she says.

The coaches work with the members to help them become advocates for their own healthcare. They encourage members to develop a good relationship with their primary care providers and teach members to ask probing questions and continue asking until they understand what the provider is saying.

Most people already know what they should be doing to improve their health but they don't necessarily know how to act on it, Sponholtz says. "Coaching gets the individual to the point that they are motivated to take the next step. Anyone, even highly motivated individuals, can benefit from health coaching because everyone needs support in one aspect or another and the coach can help them stay on track," she adds.

Coaches can help people dig deeper into what may be interfering with healthy behaviors and come up with ways to stick to their exercise regimen or diet. "When people work with a coach, they often experience a shift in thinking that motivates them to take control of their health," she says.

Lifestyle coaching takes a lot of intensive work, but it's very effective, even with patients who might not be enthusiastic about following their doctors' recommendations," Turchin says. In the study, the physicians did most of the lifestyle counseling, but the positive effects shown by this study may not be limited to interventions by physicians.

"It is more financially efficient if the lifestyle counseling is conducted by nurses, nurse practitioners, physician assistants or dieticians, as well as in group settings," he says.

The secret to being a successful health coach is to meet people where they are by listening and finding out their focus, Sponholtz says. "Coaches have to turn off their own goals for the conversation and concentrate on what the individual wants to do," she says.

Coaches shouldn't be tempted to start thinking about what they're going to say next while the person they are coaching is talking. "That's not listening actively. Coaches can't be concerned with their own thought processes. They need to trust that the individuals know what will work best for themselves and let go of their own ideas," she says.