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

They wanted us to help them enroll more employees into a coaching program. For them, the results were adding up: engaged, activated employees; wellness success stories; 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 by skeptics who deny that wellness offers any reliable return on investment. Still, when more than 80 percent of large employers nationally are offering wellness programs, something must be going right.

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

Coaching provides the personal, one-on-one guidance, inspiration and 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 look like? Here are the essential elements:

Health coaching should cover a broad health continuum

Too many wellness programs focus only on the prevention of future illness, when, in reality, the highest costs — current chronic conditions — are already draining the bottom line. A good health coaching program should include interventions that:

Manage the immediate high risk members who are already incurring high health costs from existing conditions and co-morbidities at all acuity levels, including: hypertension, coronary artery disease, heart failure, cancer, chronic low back pain, diabetes mellitus, asthma, hypercholesterolemia, metabolic syndrome, and chronic musculoskeletal pain;
Slow or derail the progress of members who display lifestyle health risk factors propelling them toward ill health, such as tobacco use, a lack of physical activity, poor nutrition, overweight or obesity, sleep deficit and stress.

This two-pronged approach provides a logical, systematic and progressive approach for corralling uncontained and voracious health risks, claims and costs.

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

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

The coaching program must be available to members in various modalities, from live telephone calls, to video or chat, to email and text messaging. As consumer technologies continue to advance, a good coaching program will keep abreast of these changes, implementing touch points that appeal across all generations, from millennials to boomers.

Health coaching should use a holistic approach

A holistic approach is built on the foundation that there is no one “right way” to coach an individual. Coaches must be able to “meet the member where they are” in order to understand how we can help them determine and achieve their goals.

One member may be just beginning to consider making lifestyle changes, while another may have tried and failed in the past, and need a very different type of support. Your coaching program should incorporate coaches trained to help each member find his or her own path.

Health coaching must be science-backed and evidence-based

Coaching as a discipline and science is very powerful. It's not just about creating a human connection. Coaches are just “friends” unless they have the proven tools and skills that produce positive outcomes. Some of the most effective tools used in evidence-based coaching today include:

Activation, a process to assess an individual's knowledge, skills and confidence for managing his or her own health and health care, and thus determine methods to further empower them.
Motivational interviewing, which theorizes that as much as someone may recognize good reasons to change habits, ambivalence is a factor in the change process. Resolving the ambivalence is a major part of helping someone change. Sustained change happens when people tap into their own reasons for change and marshal their strengths to make change happen. Motivational interviewing is designed to help people resolve the ambivalence that often holds them back. It's about transforming the “Yes, but …” into a convincing “Yes!”
Trans-theoretical model of behavior change, which assesses an individual's readiness to act on a new, healthier behavior and provides strategies to do so.
Social cognitive theory, which provides a framework for understanding, predicting and changing human behavior.
Positive psychology, or the scientific study of strengths and virtues that enable individuals to thrive instead of just survive.
Sustainability and relapse prevention, which is a cognitive-behavioral approach with the goal of identifying and preventing high-risk health behaviors.

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

Greater member activation: gaining the knowledge, skills and confidence to get involved with and play a more active role in their health.
Enhanced condition self-care: gaining the knowledge about their condition and steps for how to best improve it.
Medication adherence: understanding the important role their medication plays in their health maintenance or improvement and why adherence to the medication dosage is vital.
Adoption of lifestyle behaviors that enhance health and well-being.

Coaches must receive continuous training

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

Quality of education: Professional coaching programs hire coaches who understand the discipline and science behind coaching. They provide many hours of on-the-job training to reinforce concepts such as motivational interviewing and social cognitive theory. And they provide ongoing training and share successful techniques as a team.
Coach mentors: New coaches ramp up faster when they are mentored by the best of the best. It's a small but significant difference between good coaching programs and great ones.
Member safety quality assurance: Wellness coaching isn't just about whether Joe worked out at the gym five days this week, or Sally stopped smoking. Today's employees are dealing with stress, depression, lack of sleep, financial pressures and any number of other problems that can spiral out of control. Your coaching program had better be equipped to handle those crises. In any given week, our coaches may encounter three to four members who display behaviors that we consider “red flags,” which may signal a mental health or medical compliance crisis. A great coaching program has procedures in place to alert the appropriate mental health professionals or nurses who can make sure members with critical issues are given the right tools to cope. If your coaching program doesn't offer that safety net, you're missing an important 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 about coaching”?

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

Employees must buy into wellness, and to do that, they must first buy into the fact that they can change, they want to change, they are empowered to change, and they have an advocate in their corner who can cheer them on when they 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 to be a better parent — support is fundamental to our success. And a superior coaching program provides all that, with the science to back it up.

Instant Insights /

Could coaching be the cure for your wellness program?

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