Health and Wellness Coaching: “How can we support more comprehensive approaches to health care?”

Reflecting on half a decade of certifying Health and Wellness Coaches

two health coaches talking on couch

Some physicians are advocating for more comprehensive approaches of delivering health care inside and outside formal care settings that take into account the wellness of patients. One potential and important solution to promote this type of care is the use of Health and Wellness Coaching (HWC).

A 2017 Compendium and 2019 Addendum review of HWC literature shows the positive impact the profession can have in the management of chronic conditions such as obesity, diabetes, and heart disease.

Leigh-Ann Webster, Executive Director for the National Board for Health and Wellness Coaching (NBHWC), describes health coaches as the bridge between the physician and the patient to help implement what has been said. “The challenge of implementation isn’t always that the person is unaware of what to do,” she said. “There are often roadblocks in the person’s life to making that sustained change. A good coach takes the time to help their clients figure out what’s getting in the way of success and works with the client to create relevant roadmaps to achieve that success.”

Until recently, there were no standards for the industry. This September marks the five-year anniversary of the first administration of the Health and Wellness Coach Certifying Examination.

“With the inaugural exam in September of 2017, we would have been happy if we had 400 potential coaches apply to take the exam,” Leigh-Ann explained. “We were shocked when more than 1000 applied.”

This wasn’t the first time, nor the last, that the NBHWC would be surprised at the enthusiasm shown for standards and board certification in their industry.

Developing standards for HWC

Founded in 2012 and once known as the International Consortium for Health and Wellness Coaching, the NBHWC started as a movement to provide evidence-based standardization and consistency for the emerging field of HWC. Shortly after forming, the Board of Directors worked with subject matter experts (SMEs) to establish a Job Task Analysis that would define the knowledge and skills needed to coach effectively.    

Leigh-Ann, who started coaching in 2007, was one of the coaches who helped to validate this analysis. While she didn’t have an exact understanding of where that work was heading, she remembered thinking, “Finally, there’s going to be some standards in place.”

In 2015, Leigh-Ann joined the NBHWC in a part-time role. Leigh-Ann described at that time, NBHWC’s Board of Directors were all SMEs who had been in the field for a number of years. Passionate about moving their work forward, they met every Tuesday for 90 minutes.

One of their first steps was launching an approval process for HWC programs, similar to accreditation. The NBHWC thought 10 to 15 programs would apply. Within a year, more than 60 programs applied and more than 50 were approved.

“What nobody realized, including our SMEs and people who had been in the field a very long time, was that the industry was much bigger than we thought it was,” Leigh-Ann said. “We thought it would be an uphill battle to get programs and coaches to come along in this process, but instead they were enthusiastic to join. This allowed us to build a strong HWC community quickly.”

Collaboration with NBME

In 2016, the NBHWC began collaborating with NBME to create a board certification examination based off the Job Task Analysis. NBME develops and scores licensing exams for physicians and other professions, such as veterinarians, as well as assessment tools for medical educators and students.

“The collaboration between NBME and NBHWC provided an opportunity to draw upon the unique capabilities of each organization to provide a high-quality assessment system for Health and Wellness Coaches,” said Aggie Butler, Vice President of Academic and Professional Programs at NBME.

The HWC Certifying Examination helps coaches demonstrate they have the knowledge needed to effectively work with clients. NBME sees the important role a good coach can have to improve outcomes for a diverse patient community.

“HWC empowers patients to collaborate with their providers, so that health decisions are best aligned to the patient’s goals,” said Christopher Feddock, Associate Vice President of Competency Based Assessment at NBME.  “This shared decision-making is key to high quality health care, both for the individual patient and the population as a whole.”

Building a path for HWC

Despite the growing evidence of the benefits coaches can have, the field has faced challenges to establish its place within the health care system. Some of these barriers include a lack of tracking and reimbursement for services.

To address these barriers, the NBHWC and the U.S. Department of Veterans Affairs (VA) successfully applied for the creation of new Category III Current Procedural Terminology (CPT®) Codes based on the NBHWC standards. Since their implementation in Jan. 2020, the VA has been using the codes to track coaching services delivered by VA-trained and board-certified coaches. Concurrently, the NBHWC has been tracking coaches and health care providers using these codes to gather data that will support the application for Category I CPT Codes, which will be submitted in 2023.

Another step forward in working toward reimbursement, the NBHWC successfully applied for a taxonomy code for coaches that became effective in April 2021. A taxonomy code is used when applying for a National Provider Identifier (NPI), a unique identification number for covered health care providers.

Within the NBHWC, the Coaching in Healthcare Physician’s Alliance consists of physicians across the country who work with health and wellness coaches and want to build those services into their practice. This group is gathering evidence for the value of coaching and helping to have conversations with Medicare and major insurance companies about reimbursement.

Since the certification exam’s inception, more than 7400 coaches have been board-certified. The NBHWC is working on establishing the career path for these coaches. Leigh-Ann explained that they have identified 350 organizations hiring coaches within the U.S.

“We’re building relationships and holding sessions with Human Resources departments and hiring managers so they can understand how this field has professionalized and why hiring board-certified coaches really matters.”

Medical education needs to support the advancement of skills and behaviors alongside knowledge, so students can develop as complete physicians, ready to take on patient care. We’re rethinking measurement to facilitate this evolution, but we can’t do it without new perspectives and ideas.