Not long ago, a client said to me, “It's all aboutcoaching.”

They wanted us to help them enroll more employees into acoaching program. For them, the results were adding up: engaged, activated employees; wellness successstories; downward trending health costs; more productive employees;and a positive wellness program experience overall.

But not every employer has the same experience. Consequently,over the last decade, wellness programs have taken a beating byskeptics who deny that wellness offers any reliable return oninvestment. Still, when more than 80 percent of large employersnationally are offering wellness programs, something must begoing right.

Turns out, it's not about whether a wellness program can deliver results — plentyof big groups have published their data proving their own ROI —it's really about what kind of wellness program can deliver resultsfor your individual group's profile. And wellness programs thatoffer health coaching may have a leg up when it comes to gettingresults.

Coaching provides the personal, one-on-one guidance, inspirationand motivation that can help convert non-participants to active,empowered participants who, over time, can make real life changes.I've seen it happen time and again.

So what does an evidence-based health coaching program looklike? Here are the essential elements:

Health coaching should cover a broad healthcontinuum

Too many wellness programs focus only on the prevention offuture illness, when, in reality, the highest costs — currentchronic conditions — are already draining the bottom line. A goodhealth coaching program should include interventions that:

1. Manage the immediate high risk members who are already incurringhigh health costs from existing conditions and co-morbidities atall acuity levels, including: hypertension, coronary arterydisease, heart failure, cancer, chronic low back pain, diabetesmellitus, asthma, hypercholesterolemia, metabolic syndrome, andchronic musculoskeletal pain;

2. Slow or derail the progress of members who display lifestylehealth risk factors propelling them toward ill health, such astobacco use, a lack of physical activity, poor nutrition,overweight or obesity, sleep deficit and stress.

This two-pronged approach provides a logical, systematic andprogressive approach for corralling uncontained and voracioushealth risks, claims and costs.

Health coaching should target members based on stage ofdisease and care gaps, using a range of professionals andmodalities

A comprehensive wellness program engages members inmulti-dimensional health coaching appropriate to their needs and inline with their comfort levels. This may require lifestyle coaches,disease management coaches and/or nurse coaches, who each bring adifferent set of skills to the coaching dynamic.

The coaching program must be available to members in variousmodalities, from live telephone calls, to video or chat, to emailand text messaging. As consumer technologies continue to advance, agood coaching program will keep abreast of these changes,implementing touch points that appeal across all generations, frommillennials to boomers.

Health coaching should use a holisticapproach

A holistic approach is built on the foundation that there is noone “right way” to coach an individual. Coaches must be able to“meet the member where they are” in order to understand how we canhelp them determine and achieve their goals.

One member may be just beginning to consider making lifestylechanges, while another may have tried and failed in the past, andneed a very different type of support. Your coaching program shouldincorporate coaches trained to help each member find his or her ownpath.

Health coaching must be science-backed andevidence-based

Coaching as a discipline and science is very powerful. It's notjust about creating a human connection. Coaches are just “friends”unless they have the proven tools and skills that produce positiveoutcomes. Some of the most effective tools used in evidence-basedcoaching today include:

1. Activation, a process to assess an individual'sknowledge, skills and confidence for managing his or her own healthand health care, and thus determine methods to further empowerthem.

2. Motivational interviewing, which theorizes thatas much as someone may recognize good reasons to change habits,ambivalence is a factor in the change process. Resolving theambivalence is a major part of helping someone change. Sustainedchange happens when people tap into their own reasons for changeand marshal their strengths to make change happen. Motivationalinterviewing is designed to help people resolve the ambivalencethat often holds them back. It's about transforming the “Yes, but…” into a convincing “Yes!”

3. Trans-theoretical model of behavior change,which assesses an individual's readiness to act on a new, healthierbehavior and provides strategies to do so.

4. Social cognitive theory, which provides aframework for understanding, predicting and changing humanbehavior.

5. Positive psychology, or the scientific study ofstrengths and virtues that enable individuals to thrive instead ofjust survive.

6. Sustainability and relapse prevention, which isa cognitive-behavioral approach with the goal of identifying andpreventing high-risk health behaviors.

When such techniques are used, successful health coachingprograms can facilitate behavior changes such as:

• Greater member activation: gaining the knowledge, skills andconfidence to get involved with and play a more active role intheir health.

• Enhanced condition self-care: gaining the knowledge about theircondition and steps for how to best improve it.

• Medication adherence: understanding the important role theirmedication plays in their health maintenance or improvement and whyadherence to the medication dosage is vital.

• Adoption of lifestyle behaviors that enhance health andwell-being.

Coaches must receive continuous training

No matter how many puzzle pieces a coaching program offers tohelp members see the big picture, that picture can fall apart ifit's rattled or shaken. Your picture must have super-glue to keepthe pieces together—because life does rattle and shake us. Coachesare the super-glue. They not only connect the pieces for yourmembers and help them see the big picture, but they keep the piecesin place. What helps coaches to become this essential super-glue?Effective initial and ongoing training, which should include thefollowing:

• Quality of education: Professional coachingprograms hire coaches who understand the discipline and sciencebehind coaching. They provide many hours of on-the-job training toreinforce concepts such as motivational interviewing and socialcognitive theory. And they provide ongoing training and sharesuccessful techniques as a team.

• Coach mentors: New coaches ramp up faster whenthey are mentored by the best of the best. It's a small butsignificant difference between good coaching programs and greatones.

• Member safety quality assurance: Wellnesscoaching isn't just about whether Joe worked out at the gym fivedays this week, or Sally stopped smoking. Today's employees aredealing with stress, depression, lack of sleep, financial pressuresand any number of other problems that can spiral out of control.Your coaching program had better be equipped to handle thosecrises. In any given week, our coaches may encounter three to fourmembers who display behaviors that we consider “red flags,” whichmay signal a mental health or medical compliance crisis. A greatcoaching program has procedures in place to alert the appropriatemental health professionals or nurses who can make sure memberswith critical issues are given the right tools to cope. If yourcoaching program doesn't offer that safety net, you're missing animportant element of member safety.

Could coaching be the cure for your wellnessprogram?

Dare I quote our client again who said to us, “It's all aboutcoaching”?

From my perspective, there is a great truth in that statement.Employers must realize they cannot make employees live healthierlifestyles with incentives or penalties alone.

Employees must buy into wellness, and to do that, they mustfirst buy into the fact that they can change, theywant to change, they are empowered to change, andthey have an advocate in their corner who can cheer them on whenthey achieve, and inspire them when they fail.

That's all each of us really wants and needs in life, isn't it?Whether our goals are good health, a good performance review, or tobe a better parent — support is fundamental to our success. And asuperior coaching program provides all that, with the science toback it up.