Half of all patients leave their medical visit without understanding what their physician said to them or what they’re supposed to do.

Health coaching helps patients understand their treatment and actively participate in their care. Coaches support patients in developing and following action plans for healthier behaviors. Health coaching has clinical and operational benefits and contributes to integrative primary care.

A nationally recognized expert in health coaching, Dr. Bodenheimer developed the AMA STEPS Forward™ Health Coaching Implementation module and the Center for Excellence in Primary Care’s health coaching curriculum.

The AMA STEPS Forward Health Coaching Implementation module uses a four-step process:

  1. Commit to health coaching
  2. Build the health coaching model
  3. Recruit, train and mentor the coaches
  4. Start coaching and track progress

The module includes answers to common questions about health coaching and tools for health coaching and progress tracking. Information from the Center for Excellence in Primary Care’s health coaching curriculum is also provided here.

Commit to Health Coaching

Implementing health coaching begins with a commitment from practice leadership and the care team to do this. To add health coaching to the practice, you need to:

  • Train everyone in the practice on health coaching and ensure protected time for some staff members to do health coaching
  • Develop the program
  • Create workflows where health coaching is part of the practice

Build the Health Coaching Model

Someone who understands health coaching and is available to provide mentoring and support must lead the health coaching program. This can be a nurse, nursing supervisor, nurse practitioner or physician. Any staff member in a practice can be a health coach as long as he/she is trained and has protected time for coaching.

The health coaching leader works with practice leaders to develop a feasible workflow for health coaching within the practice and to identify goals. This includes determining:

  • Which patients will receive health coaching
  • Number of patients per health coach
  • How patients are referred to the health coach
  • Health coaching scope (e.g., duration, frequency, method of contact)
  • Choice of staff as health coaches

When the physician refers a patient for health coaching, the health coach usually sees the patient right then in the exam room. If the patient is open to more health coaching, other sessions can be done over the telephone, in person or both. Health coaching continues until the patient no longer needs it.

Recruit, Train and Mentor the Coaches

Many types of people can be health coaches, including

  • Medical assistants
  • Nurses
  • Social workers
  • Health educators
  • Peers
  • Volunteers (pre-medical or pre-nursing students)

Health coaches usually do their job for part of the day and serve as health coaches for part of the day. The role of health coaches in your practice can help determine which staff to train as health coaches. If, for example, health coaches will provide clinical education, a nurse or social worker is appropriate. If the health coach will call patients to remind them to follow their action plan, a medical assistant could make a good health coach.

Peer health coaches, patients who have met their health goals, are a good choice for non-clinical health coaching once your health coaching program is well established. The peer health coaches should have the same chronic disease(s) and a similar background to the patients they are coaching.

Training Health Coaches

Training for health coaches should cover:

  • Expectations of health coaches
  • How coaching fits into a standard office visit
  • How and when the coach should interact with the rest of the care team
  • How to work with patients, including motivational interviewing, ask-tell-ask, teach-back and action planning
  • How to use the electronic health record to enter information, set up alerts and/or document the visit
  • Knowing the patient population receiving coaching, including diagnosis, treatments, lifestyle modifications, laboratory tests, and common medications
  • Medication non-adherence and how to help patients become adherent
  • Health literacy

To learn more about health coaching and the challenges in implementing health coaching, check out this primary care case study.