Part 1: A history lesson on our healthcare system and how Coaching came to be
We, Megan and Laura, both come from the worlds of technology and healthcare. Megan is a National Board Certified Coach and she’s designed coaching interventions at the intersection of behavioral health & well-being for the last 10 years. Laura designed and led mental health coaching programs at One Medical for 4 years and has since helped other companies incorporate coaching services into their care models.
We’ve seen first-hand how Coaching can dramatically improve health & well-being outcomes and access to care. We know patients who were able to reverse their pre-diabetes because their coach helped them switch and stick to a plant-based diet. And we’ve heard countless patients say working with a health & well-being coach to better manage stress and anxiety transformed their lives. Story after story sticks with us: “I’m more in control over my life,” “I no longer feel like I’m walking on a tightrope every day,” “I’m better able to handle the highs & lows life throws at me,” “I can weather day-to-day storms with a greater sense of calm.”
Health & well-being coaches partner with and guide people to change behaviors that positively impact their physical and/or behavioral health outcomes and their quality of life. People develop a sense of self-efficacy and are empowered to set and achieve health-related goals. It’s no secret — health behavior change is hard! Think about it — in theory, we know what we need to do to lose weight, but we struggle with how to lose weight. Most of us need some help sticking to habits that help us reach our goals. And with mental health — we know that we work too much, are on our devices too much, and probably soothe ourselves too often with alcohol, but it’s hard to give those habits up, especially when stress levels are high.
Over the last 10 years, we see more healthcare companies and healthtech startups across the country are incorporating health & wellbeing coaching into their care models and digital offerings. There’s been a shift towards using the methodologies and philosophies of coaching for preventing and mitigating chronic disease as well as intertwined stress, anxiety, and depression. The evidence shows that coaching works well to help people make decisions that are better for their health and create longer-term healthy habits. Coaching also relieves overburdened healthcare providers who don’t have the time or resources to always help patients themselves. And, it’s much less expensive.
Coaching as a field has professionalized and scaled. Two gold-standard institutional bodies now offer coaching training and certification: The National Board for Health and Wellness Coaches (NBHWC) and the International Coach Federation (ICF). There are about 46,000 coaches with one or both of these certifications worldwide.
The rise of coaching
In the first half of the 20th century, the traditional American medical model emphasized treating disease. There was little to no focus on prevention or on public health.
Starting in the mid-20th century, some shifts occurred. In 1946, the World Health Organization defined health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” And the concept of “wellness” was first introduced in the late 1950s.
In the 1960s and 70s, a series of movements and philosophies paved the way for Coaching. The Human Potential Movement (HPM) promoted the idea that we each are holistic beings and have potential as humans in mind, body, and spirit. The 60s counterculture ushered in new views on human psychology, behavior change, and wellbeing as well as alternative and holistic medicine practices. In 1972, the Illness-Wellness Continuum proposed that “wellbeing” includes mental and emotional health and that individuals can move along a spectrum towards improved health & wellbeing with greater awareness, education, and growth.(1)
Source: Wellness Workbook: How to Achieve Enduring Health and Vitality
People became more proactive about improving health, performance, and quality of life and saw coaching as an important tool on that journey. The underlying assumption: many people know what they need to do to improve their wellbeing, but they don’t know how. Coaches can help with the how.
In the 1970s and 80s, a commercialized wellness industry blossomed as the economy boomed. People moved up to the middle class! Bought their first cars! A house with a white picket fence! They had the time to dream about how to spend their disposable income and then actually spend it. Conspicuous consumption galore! Wealthy, white Americans, in particular, found time to ponder how they could achieve a higher level of potential and functioning. Jane Fonda and Richard Simmons became inspirations. What better way to spend that extra $100 in your pocket than to buy flashy neon exercise tights? People with more disposable income vigorously pursued exercise and healthier foods as a means to fitness and wellness. Then simultaneously, of course, health disparities along racial and socio-economic lines worsened as access to healthy food and knowledge about healthy behaviors became less accessible in traditionally marginalized communities.
Then something crazy happened. The American government stepped in and started an anti-fat movement that, ultimately, backfired, making us fatter and sicker. The government thought that the way to fight the rise of cardiovascular disease was to promote carbs over fat. In 1977, the government published the first set of dietary guidelines, The Dietary Goals for the United States. Fat is the devil! Eat all your carbs! Low-fat Hostess cake? Better than a high-fat avocado! From 1980 to 1997, total fat intake decreased 41% and heart disease mortality declined, but sugar and trans fat intake increased, driving a rapid increase in rates of obesity and diabetes.(2) Cardiovascular disease remains one of the three leading causes of death and disability, alongside type 2 diabetes and cancer.(3)
The American healthcare system developed into a “sick care” system, treating a patient population plagued with chronic rather than acute disease. Our 100+ year old fee-for-service payment model isn’t designed to provide the highest quality care to patients with complex, chronic needs. The model can lead to unnecessary intervention — procedures, testing, drugs — that don’t benefit people’s health.(4)
Starting in the mid-1980s, preventive medicine became a more common approach. The U.S. Preventive Services Task Force, established in 1984, published their Guide to Clinical Preventive Services in 1989, the first national guide to evidence-based preventive health measures. Scientific evidence demonstrated that, in fact, carbs aren’t necessarily always good for you and fat isn’t always bad for you. Aha, nuance! We learn what kinds of carbs and fats are good and bad. And we learn about moderation. One important conclusion: these chronic conditions are lifestyle-related diseases that are, in many cases, preventable and, in some cases, reversible by behavior change. And behavior change = hard. Behavior change requires work. Specifically, in these four areas: eating better, increasing physical activity, stopping smoking tobacco, and drinking less alcohol.
The 2010 passage of the Affordable Care Act paved the way for more interest in value-based care models, which incentivize efforts to take on riskier patients and prevent poor long-term health outcomes. The reality is that the transition from fee-for-service is quite difficult. In the interim, health & wellbeing coaching is an attractive intervention for care delivery organizations to work to get right to fight and prevent chronic disease.(5) Much of a coach’s efforts historically centered on helping a person establish good habits with their diet, physical activity, sleep, and substance use; now, coaches do even more to facilitate behavior change that improves overall wellbeing, which includes mental health and physical health. Coaches are focused on helping patients take control of their own health and get the fundamental building blocks of their health in order, so that patients ultimately require less from the healthcare system.
Source: https://pittsburghuppercervical.com/sick-care-vs-health-care/
What we’re seeing now
Coaching has become a more attractive way to deliver care as the healthcare system continues to strain from supporting patients with chronic disease. Patients with depression, diabetes, heart disease, hypertension, obesity, and cancer utilize the healthcare system at a higher rate, and this inevitably leads to gaps in care because the system can’t keep up with care navigation, coordination, and follow-up. Patients ping-pong through the system, often falling through the cracks entirely. Traditional healthcare providers most often don’t have the training or time to offer the support and accountability that their patients need to create and sustain healthy habits to fight or prevent these diseases. And so we see coaches stepping in to maintain care continuity and facilitate positive health behavior change. (We’ll say much more about this in our 3 follow-on pieces.)
Coaching is not a cure-all, however, coaches do clearly have special superpowers that are valuable for disease prevention. They take a patient-centered approach to care, taking the time to discuss their client’s hopes, goals, beliefs, preferences, and values. They empower their clients to cultivate the self-efficacy and intrinsic motivation to create and stick to healthy habits. Over time, sustained behavior change reduces the risk of, or curbs, disease development and increases overall quality of life. Hallelujah!
Read Part 2 of our series to understand what Coaching actually involves.
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References
(1) “Illness” and “disease” are different things. “Disease defines a pathophysiologic process” and “illness is defined by the complete person — physical, psychological, social, and cultural. Illness represents an individual’s unique and personal experience of being unwell.” (Source)
(2) https://opencommons.uconn.edu/cgi/viewcontent.cgi?article=1482&context=srhonors_theses
(3) https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
(4) https://www.forbes.com/sites/robertpearl/2017/09/25/fee-for-service-addiction/?sh=15416706c8ad
(5) Learn more about the difficulty of value-based care model adoption here.
