Episode 50 | Sep 14, 2023

Health Coaching in Primary Care: An Overview of Studies

Where can health coaches look to for resources when looking to partner with primary care physicians? Research studies, of course. Dr. Sandi shares three significant studies she recently read that discuss the benefits of health coaching within primary care practice. The first focuses on the care of patients with chronic fatigue syndrome (CFS), while two others look at how health coaching within primary care can help patients with weight loss goals.

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Episode Transcript

Welcome to another edition of Health Coach Talk. Today is a solo episode because I want to share with you some research studies as well as some reports that I think you are going to find particularly interesting and helpful for your career if you are a health coach or perhaps you’re thinking of entering the field of health coaching or hiring a health coach for yourself or your patients if you are a medical practitioner.

So let’s begin. The first that I want to share with you has to do with a chronic medical condition that is tough to treat. And that is chronic fatigue syndrome. This report appeared in the Frontiers of Neuroscience, and it is titled “Coaching to strengthen critical success factors in integrative care for chronic fatigue patients: the Patient Needs-Resources Model.” And note, what’s the first word in the title? Coaching, yes. And what do they say? Well, first of all, they’re advocating for an integrative approach. They’re saying it’s particularly important for chronic disorders as we know and multiple long-term conditions, such as chronic fatigue. So, chronic fatigue syndrome, referred to as CFS, this is an example of a multisystemic illness, and it’s got a whole wide diversity of symptoms and diagnosing it is often complex.

Now, the prevalence of this CFS-like syndrome has expanded and grown as a result of the COVID-19 pandemic. They are seeing an increase in disorders and many of what’s called long-term COVID actually a lot like CFS syndrome. So, they are highlighting in this article attention to the possibility of strengthening an integrative approach.

Now let’s dig into what they mean by an integrative approach because this is where I think it is particularly important for you as coaches interested in coaching. So, they’re talking about providing a more comprehensive diagnostic and personalized treatment strategy and a multidisciplinary team and patient engagement. So, the multiple multidisciplinary team is going to enhance patient engagement, and coaching is identified as a potential unifying and reinforcing element. I’m going to say that again. Coaching, identified as a potential unifying, reinforcing element. Coaching has a wide spectrum of manifestations. It’s a holistic approach, and it is offering support for patient engagement. And that’s what they’re highlighting is so important.

So, you work with a coach. That’s going to increase patient self-efficacy, patient engagement. So, here’s what they say. Coaching may assist patients to identify and prioritize their goals, become aware of their personal resources, develop strategies for managing their symptoms, and building skills to increase their self-efficacy. Now, that term, self-efficacy, it’s frequent in the research literature. We often hear, what’s the effect of coaching? Self-efficacy. When we did our own research at FMCA, that was one of the findings. In patients, self-efficacy increases. They’re actively engaged in the treatment process. So, what’s the conclusion? The authors emphasize coaching as a prospective element of optimization of patient care.

So, here’s a quote that you can take with you when you are building your coaching business, when you are seeking referrals from medical practitioners, or you want to work with a practitioner. You bring in reports like this. And that will be very, very helpful because people want to see reports like this that have been published. So, that’s the first one has to do with chronic fatigue syndrome.

So, now I’m going to move on to another one that is often associated with use of coaching, and that has to do with weight loss So, this study is one that…it’s actually been conducted, but it’s not been peer-reviewed yet by a journal. So, it’s in PubMed, and we will provide the resources for these reports and studies in the show notes, but it is worth, I think, looking at this study, and again, another one that you can use. You put it in your briefcase, so to speak. You pull it out when you are talking to a doctor. This one has to do with primary care. Here’s the title, “Primary care delivery of behavioral weight loss services for adults with cardiovascular risk factors: development of pragmatic practice components and results of a randomized feasibility trial.” So, primary care and weight loss go together. And we know there is, first of all, a shortage of primary care practitioners. That is growing. It’s getting worse. And also, primary care practitioners are often rushed in consultations. People are saying they don’t have enough time with their primary care doctor. Many people don’t even have a primary care doctor. And yet, primary care is very, very important. I personally believe and working hard to see that health coaches will be the new primary care. They will be front and center in a primary care model working hand in hand with primary care physicians.

So, this study is looking at intensive lifestyle intervention. How could that improve weight loss? And of course as you prove weight loss, the cardiovascular risk factors will decrease. But it’s challenging as we all know. How do you implement these types of lifestyle interventions? So, they had a method in this study where they went into a single urban primary care office, and this was something that they did between December 2019 and January 2020. So, it was right during the pandemic. I think it was interrupted during the pandemic. And they first assessed from these patients who would be interested in support for a weight loss program. And they did have a significant number of people who affirmed interest in weight loss, and so they were enrolled. Now this was randomized, and some got what they called basic lifestyle services. What was that? They got a scale that was able to transmit their data to the health record using cellular network. They got a coupon to enroll in lifestyle coaching that was through a partnering fitness organization. And then they got periodic messages through the electronic health record, reminding them of their goals. Now, another group got what they called the Customized Lifestyle Service. That was weekly email messages that was adapted to their individual rate loss programs and progress. They got telephonic coaching by a nurse for those who were facing challenges. So, again, this group got a little higher level of intervention with telephonic health coaching.

And what they found, they collected weight measures and the results. So, this was over six weeks. They had a high interest. So, 425, 428 patients were given the invitation to participate, and 80% were interested. So, right off the bat, we got to say, that’s good, and people are at least showing interest in a weight loss program. And they had good results. So overall, 62% of the participants lost weight, and they did not find a statistically significant difference between these two groups. But here’s what was a cool finding. And that is the ones who got the more customized, the ones who got more of the coaching through telephone coaching, they participated more in daily self-weighing, and they also were really… They ost an equal amount of weight basically, but I think that was really the key point here, and that is the group that got a little more custom approach went a little farther.

But here’s the conclusion. It’s a preliminary study. It demonstrates the feasibility of implementation strategies for primary care offices to offer and coordinate lifestyle intervention core components. So, that’s the takeaway. The takeaway is that this can be done. Now looking at this study, I thought that there were a number of flaws. In other words, where was the intense coaching? So, we don’t know these nurses who engaged in the coaching over the phone. What kind of coaching really was that? Were they really engaged? Were they building rapport with these individuals? Were they using a true coach approach like we teach at FMCA or they have a checklist in terms of asking, “Are you weighing yourself daily? Are you following the program?” So, what was the level of engagement? And so I would like to see a follow-up study where there is true coaching. Were these nurses certified health coaches or were they people who just did one workshop about motivational interviewing, for example? So, those are the unanswered questions. But significant in that is they did have a study out of a primary care practice. And that’s where, again, I think the great need is for health coaches in primary care practices.

So, I want to turn to another study, which I think was very significant. And this one is titled, it’s the same theme, “Health Coaching for Weight Loss Among Overweight and Obese Individuals.” This was in Saudi Arabia. This is a retrospective analysis. So, this is what they said, and it was very complimentary for health coaching. So, and I quote, “Health coaching, an increasingly used strategy to help in adopting lifestyle changes for weight loss. Saudi Arabia has one of the highest obesity prevalences worldwide but research on this type of lifestyle intervention with coaching is limited.” So, that was the goal. They wanted to investigate the effectiveness of health coaching for weight loss amongst the Saudi population in real-world primary, again, primary care settings. It was a retrospective observational study. And so they’re looking…they’re gathering data from a program where obese and overweight, and I think that’s probably according to BMI, they were 15 years old and older. They had weight-related goals. They completed 12 weeks of coaching. The primary outcomes were weight change, and weight change percentages from the initial weight.

So, they looked at different ways that they could be coached. It was virtual, in-person, or a hybrid, and these were…they had mostly females who participated, and the follow-up was 127 days later. The number of coaching sessions, the mean number of sessions, was three. So, there was a significant change in weight, and the adjusted means for weight were not significant in terms of whether they were coached in person, or remote, or a hybrid. So, the interesting finding was that the men seemed to do better and five or more total coaching visits. So, the longer duration, longer follow-up duration, longer visits were more successful.

And so here’s the conclusion. This is what I think is the takeaway. I always love the takeaways. Conclusion: We found statistically significant weight change among clients who completed 12 weeks of coaching in primary care settings. Because weight loss is hard. You can’t do this with just two or three sessions. But over 12 weeks, this was successful, again, in primary care. The findings of this paper contribute to the importance of lifestyle intervention for weight loss amongst the Saudi population. So, again, another study that you can gather along with your others in your arsenal, and you take these to a primary care physician, and you present a compelling reason why they should work with you for the health of their patients because we are hearing a lot about weight loss. No doubt you’ve heard of the GLP-1 agonists like Ozempic, Wegovy, and people are getting on these medications. But are they doing lifestyle change? Are they doing resistance training, for example? Because we’re finding out that a great percentage of the weight lost with these medications is in muscle. They’re losing muscle mass. Well, this is where the health coach comes in and really starts to share education about the importance of strength training, the importance of learning how to eat in a way that’s not going to cause gaining all the weight back. And so this is where we are training health coaches to be on the front lines, helping people who are on these medications. And I predict there’s going to be a big, big need. We are already seeing it.

This was a report that came out. The date was August, August 21st. This is an item that I saw in the Miami Herald. It was about a company. HMR supports individuals using GLP-1s to enhance weight loss and health outcomes. So, HMR is a leading provider of medically supervised weight management programs and lifestyle intervention programs, and they are announcing through this release their support for individuals using weight loss medication. So, they’re following up. They have helped people in the past while adding in the lifestyle change component for improved health and overall quality of life.

And here is what they are doing. They have been offering two comprehensive treatment options: in-person medically supervised programs and health solutions at home. So, they’re using supportive technology and health coaching. So, say that again. This is a company that is coming in to contract with people who are in the organizations where they’re in perhaps a primary care setting and companies coming in to offer this and they’re offering health coaching as part of this package.

So who would be these organizations? So, the HMR program is available at premier hospitals and medical centers nationwide. So, that’s where they’re offering this. And so there is precedent again for health coaching and another area that is growing where you are seeing health coaching as part and parcel of this offering. So, I think that is really significant.

And speaking of significance, so that’s what I wanted to share regarding the world of research and what I have found, but I want to share a report that just came out, and I think it is really significant. So, this is a proposal, and I’m going to quote, “We want to ensure the people we serve experience coordinated care focused on treating the whole person, considering each person’s unique story and individualized needs: physical health, behavioral health, and oral health, and social determinants of health, and are inclusive of all caregivers, which are all so important to providing care. Do you know who said that? Medicare. The times, they are achanging. Hopefully, it just bodes so well for what is to come.

So, they’re talking the language of functional, integrative, root cause medicine, right? A whole-person approach considering needs, behavioral health as well, social determinants of health. And here’s what’s exciting. So, these are report for a proposal for what will change in 2024. And this is what’s most relevant for health coaching. And I’m going to quote, they’re going to add health and wellness coaching services using the Category III coaching CPT codes, adding those to the Medicare telehealth services list on a temporary basis for 2024.

So, the Category III codes are what currently exist for health and wellness coaching. They are considered transitional, temporary codes. They are not the Category I reimbursable codes that would guarantee insurance reimbursement. And the promising thing here, though, is that now you’ve got Medicare getting into the act. They are taking these codes. They’re not saying that they’re going to be definitely reimbursing, but they’re listing them.

And this is something we will be monitoring very closely. We will be talking with billing specialists. I am certainly not a billing specialist or an authority, an expert in this subject area, but I do know and I have been told that this is a very significant step. So, we’ll monitor closely and bring you all the news about it as it is rolled out. But just again, to repeat, this is very significant that Medicare is saying that these temporary codes for health coaching are going to be part of the Medicare telehealth services list. So, I think that’s a wow, and that’s a big win for our profession. And it’s just another step on the road to full reimbursement with the Category I codes.

And of course, I should add the caveat that when we’re talking about health insurance, nothing is ever guaranteed. It depends on what plan each individual has and what your deductible is, for example. So, there are so many areas to look into, which is why most medical practices need full-time billing consultants to help them sort all this out. But we will be bringing you all of this news when it is available.

So there you have it. We talked today about the role of a health coach, helping people with chronic fatigue, which as a condition is growing and we’re seeing so many chronic fatigue-like symptoms with long COVID. You can play a big role there. And of course, weight loss. A lot of data coming out that when you have a health coach, it’s effective in terms of your weight loss, especially long-term coaching. You just can’t have one or two sessions. And also that this will be a growing area for health coaches with the popularity of the current weight loss drugs that are out there.

So, that’s it for now. Thank you all for listening.