Not long ago, a client of ours with 7,000 members enrolled inhealth coaching said to me, “It’s all about coaching.”

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

But not every employer has the same experience. Consequently,over the last decade, wellness programs have taken abeating by skeptics who deny that wellness offers any reliablereturn on investment. Still, when more than 80 percent of largeemployers nationally are offering wellness programs, something must begoing right.

Turns out, it’s not about whether a wellness program can deliverresults — plenty of big groups have published their data provingtheir own ROI; it’s really about what kind of wellnessprogram can deliver results for your individual group’s profile.And wellness programs that offer health coaching may have a leg upwhen it comes to getting results.

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 health continuum

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 interventionsthat:

a) Manage the immediate high risk members who arealready incurring high health costs from existing conditions andco-morbidities at all acuity levels, including:hypertension, coronary artery disease, heart failure, cancer,chronic low back pain, diabetes mellitus, asthma,hypercholesterolemia, metabolic syndrome, and chronicmusculoskeletal pain;

b) Slow or derail the progress of members whodisplay lifestyle health risk factors propelling them toward illhealth, such as tobacco use, a lack of physical activity, poornutrition, 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 of diseaseand care gaps, using a range of professionals and modalities

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 coachingprogram must be available to members in various modalities, fromlive telephone calls to video or chat, to email and text messaging.As consumer technologies continue to advance, a good coachingprogram will keep abreast of these changes, implementing touchpoints that appeal across all generations, from millennials toboomers.

Health coaching should use a holistic approach

A holistic approach is built on the foundation that there is noone “right way” to coach an individual. Coaches must be ableto “meet the member where they are at” in order to understand howwe can help them determine and achieve their goals. One member maybe just beginning to consider making lifestyle changes, whileanother may have tried and failed in the past, and needs a verydifferent type of support. Your coaching program should incorporatecoaches trained to help each member find his or her own path.

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. Good coaches are just“friends” unless they have the proven tools and skills that producepositive outcomes. Some of the most effective tools used inevidence-based coaching today include:

a) Activation, a process to assessan individual’s knowledge, skills and confidence for managing hisor her own health and health care, and thus determine methods tofurther empower them.

b) Motivational interviewing, whichtheorizes that as much as someone may recognize good reasons tochange habits, ambivalence is a factor in the change process.Resolving the ambivalence is a major part of helping someonechange. Sustained change happens when people tap into their ownreasons for change and marshal their strengths to make changehappen. Motivational interviewing is designed to help peopleresolve the ambivalence that often holds them back. It’s abouttransforming the “Yes, but…” into a convincing “Yes!”

c) Trans theoretical model of behaviorchange, which assesses an individual's readiness to act ona new, healthier behavior and provides strategies to do so.

d) Social cognitive theory, whichprovides a framework for understanding, predicting and changinghuman behavior.

e) Positive psychology, or thescientific study of strengths and virtues that enable individualsto thrive instead of just survive.

f) Sustainability and relapseprevention, which is a cognitive-behavioral approach withthe goal of identifying and preventing high-risk health behaviors.

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

• Greater member activation (gaining theknowledge, skills and confidence to get involved with and play amore active role in their health);

• Enhanced condition self-care (gaining theknowledge about their condition and steps for how to best improveit);

• Medication adherence (understanding theimportant role their medication plays in their health maintenanceor improvement and why adherence to the medication dosage isvital);

• Adoption of lifestyle behaviors that enhancehealth and well-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!Coaches are the super-glue. They not only connect the pieces foryour members and help them see the big picture, but they keep thepieces in place. What helps coaches to become this essentialsuper-glue? Effective initial and ongoing training, which shouldinclude the following:

• 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 wellness program?

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 that they cannot make employees livehealthier lifestyles with incentives or penalties alone.

Employees must buy into wellness, and to do that they must firstbuy into the fact that they can change, they wantto change, they are empowered to change, and theyhave an advocate in their corner who can cheer them on when theyachieve, 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.