The Coach Prescription for Weight Loss
Starting January 2020 in the US, physicians will be able to deliver health and well-being coaching services to their patients, putting to use what are called Category III CPT codes awarded by the American Medical Association (AMA). The CPT coding system is the basis for healthcare reimbursement in the US.
The AMA defines coaches as “non-physician healthcare professionals certified by the National Board for Health and Wellness Coaching (NBHWC) or the National Commission for Health Education Credentialing (NCHEC),” organizations responsible for unified national standards and certifications for health and wellness coaches and health educators respectively.
The US Department of Veteran’s Affairs led the application to the AMA so that the VA can immediately start delivering and tracking coaching services nationwide. The VA, NBHWC, and NCHEC are now collaborating on the path to reimbursement by the US government and health plans.
You will recall Gary Sforzo, Wellcoaches research advisor, is the lead author of two published compendia of health and wellness coaching (HWC) research, which now includes 100+ randomized controlled studies as of mid-2018. The compendia includes a primary care practice-based study of coaching for weight loss described in this article. Ben Crocker, Wellcoaches-trained physician at Massachusetts General Hospital, refers patients to the health and wellness coach on his team when they want support for weight loss, stress management, and managing chronic diseases.
In their study titled – Primary Care-Based Health Coaching Intervention for Weight Loss in Overweight/Obese Adults – Wellcoaches coach Ryan Sherman delivered an average of 11 coaching sessions for the participants in the coaching group in the first year. The first 60-minute session was in-person and the ongoing phone sessions lasted an average of 31 minutes.
Bottom line? The coaching intervention led to an average weight loss at 12 months of 7.24 percent of body weight—a mean of 15.4 pounds. At two years, average weight loss was well sustained at 6.8% of body weight.
Leveraging the Strengths of Coaching
The study included 271 overweight or obese adults already receiving care at the practice. Study groups were defined as such:
– Coaching group (98): eligible patients who received weight loss coaching for at least three months;
– Comparison group (121): eligible patients who did not receive coaching for weight loss;
– Drop-out group (21): coaching group members who didn’t complete three months of coaching for weight loss; and
– Non-weight coached group (29): eligible patients who received coaching for a reason other than weight loss, providing comparison for general motivation to change.
Those in the coaching group completed a self-assessment of their health behaviors, met with the coach in person initially, and continued with coaching sessions by phone. The coaching protocol included techniques based upon transtheoretical model, appreciative inquiry, self-determination theory, positive psychology, motivational interviewing, and relational flow.
From the study’s authors: “We believe that the intervention’s success is attributed to the specific use of a fully integrated coach. Health coaching techniques focus on patient empowerment, as opposed to standardized behavioral prescription and patient education. Eliciting from and supporting patients to leverage their unique strengths empowers them to choose their goals and create their own plan. Monitoring for obstacles to these goals and recognizing and celebrating achievements with patients develops self-awareness and builds self-efficacy. As a result of this behavioral change, health coaching may have a sustained effect on weight loss beyond the limited intensively active relationship with the patient.”
Spreading the Word
Monique Tello, MD, MPH, who also practices medicine at Massachusetts General Hospital, wrote about the study in Lean Forward, Harvard Medical School’s CME blog. She noted that the results were “impressive” and “incredibly important.” She linked the findings to the CDC’s National Diabetes Prevention Program (DPP); participants in the DPP program—which includes group coaching and comprehensive support of lifestyle change including nutrition and exercise—lowered their chances of developing Type 2 diabetes by 58 percent compared with those participating in a non-coaching intervention.
“Why aren’t we offering this sort of supported behavior change in every primary care doctor’s office across the country?” Tello asked. “The first argument is that it’s too expensive. After all, as the study authors point out, health coaching is not yet reimbursed by insurance companies. The study authors did a cost analysis and figured out that assuming a $60,000 annual salary of the coach, the cost per coached patient is about $289 per year (for all patients). For those who used the services more (and achieved minimum weight loss of 5 percent total body weight) the cost was $480 per patient per year.”
The cost is, she continued, “peanuts” compared to the expense of weight loss surgery or most commercial weight loss programs—and without the inherent risks or unreliable results.
Takeaways for Coaches
Combining this real-world practice-based study with the larger HWC literature base leads to takeaways for coaches:
1. Supporting sustainable behavior change and weight loss is an ideal role for coaches. More than 70 percent of Americans age 20 and older are overweight or obese, according to the CDC. “Because of the medical and financial impacts of obesity,” the authors wrote, “the U.S. health care system is in need of effective and cost-efficient weight loss interventions.”
2. The CDC Diabetes Prevention Program, a group lifestyle coaching model for pre-diabetes with a target of 5% body weight loss at 12 months, is now reimbursed by Medicare and many health plans, and provides a benchmark for reimbursement for coaching services in primary care. 85 million US adults have pre-diabetes, bringing an epidemic of diabetes to primary care physicians in the next decade or so.
3. Health and wellness coaches are encouraged to complete an NBHWC-approved program and the NBHWC certification so that they meet the standards for the new CPT codes and are ready to collaborate with physicians, under their supervision and billing.
Adapted from Research Dose published by the Institute of Coaching.
Sherman, R. P., Petersen, R., Guarino, A. J., & Crocker, J. B. (2017). Primary Care-Based Health Coaching Intervention for Weight Loss in Overweight/Obese Adults: A 2-Year Experience. American journal of lifestyle medicine, 13(4), 405–413. doi:10.1177/1559827617715218. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600613/