Abstract
In 2020, a consortium composed of three national coach credentialing organizations, four medical societies, and 72 healthcare organizations led by National Board for Health and Wellness Coaching (NBHWC) was formed to advocate for the reimbursement of Health and Wellness Coaching (HWC) services in the U.S. healthcare system. Building on that, the NBHWC and the Veterans Health Administration (VHA) initiated a pivotal collaboration in 2023, with a target audience comprised influential reimbursement policymakers, notably the American Medical Association’s Current Procedural Terminology (CPT®) Panel and the Centers for Medicare & Medicaid Services (CMS). This concerted effort led to CMS announcing the temporary inclusion of HWC services on the 2024 Medicare Telehealth list. This ongoing advocacy work is crucial while understanding its key components is imperative for wider participation. This paper aims to distill the essence of the advocacy to date into a coherent narrative. By doing so, we seek to share with stakeholders—health and wellness coaches, medical professionals, healthcare organizations, patient advocates, and policy experts—a robust framework to support advocacy for reimbursement to both government and private insurers, at local and national levels. This initiative marks a significant milestone in healthcare policy, reflecting a growing recognition and impact of HWC.
Keywords: health and wellness coaching, healthcare reimbursement, health policy, advocacy, delivery of health care, health promotion, health care costs
“Underpinned by rigorous standards from NBHWC, NCHEC, and AHNCC, the field now comprises over 28,000 qualified coaching professionals with diverse health expertise.”
Background on Health & Wellness Coaching (HWC)
According to the Centers for Disease Control and Prevention (CDC), in 2020, 40% of United States (U.S.) adults had ≥2 chronic conditions, 1 many of which are effectively prevented and treated by lifestyle behaviors. 2 The economic and clinical rationale for lifestyle behavior change as effective interventions in chronic disease prevention and treatment has galvanized the new field of lifestyle medicine. Traditional healthcare systems remain inherently disease centered and provide mainly prescriptive patient education support that is insufficient to empower and guide individuals in lifelong health-promoting behaviors, a necessity for chronic disease management; thus, leaving patients to independently make health-related decisions for the majority of the year.3,4 Social, environmental, and behavioral factors are pivotal, influencing about 70% of overall health, overshadowing the 20% impact attributed to clinical factors.5,6 This is compounded by the reality that patients spend a minimal amount of time with healthcare providers, leaving them to navigate approximately 5000 hours each year for independent lifestyle choices.7,8 The post-pandemic era has further exacerbated the scarcity of physicians 9 and behavioral health professionals 10 to support patients as population mental and physical health declines.
In response to the growing need among individuals with or at risk of chronic conditions, the emerging field of health and wellness coaching (HWC) has developed, embodying US federal priorities (CMS, VHA, National Academies) of holistic, whole-person, whole health, and patient-centered approaches.11-13 HWC integrates into healthcare, enhancing patient autonomy and facilitating sustainable health or lifestyle behavior changes. Health and wellness coaches are increasingly recognized as effective in guiding clients towards better health. They focus on growth and sustainable change, covering areas such as physical activity, nutrition, stress reduction, sleep, and overall life satisfaction and quality, while working within their professional credentials and referring to specialists when needed. 14
The National Board for Health & Wellness Coaching (NBHWC), 15 in collaboration with the National Board of Medical Examiners (NBME), 16 set a benchmark in the field by establishing minimum training and education standards by 2015, leading to a national board certification for health and wellness coaches launched in 2017. This initiative has contributed to significant research and integration of HWC into healthcare practices and policies. As of the end of 2023, nearly 125 training and education programs for health and wellness coaches have been approved by the NBHWC, contributing a workforce of approximately 10,000 NBHWC-certified coaches. 17
In its core practice Health and Wellness Coaching (HWC) is defined as an integrative health modality that creates a partnership between the coach and the coached person (client, patient) through a person-centered process. HWC is rooted in the sciences of behavioral change, lifestyle and well-being, neuroscience, and health education and promotion. HWC approaches includes several evidence-informed components, including patient-determined goals, self-discovery and active learning, behavioral change, motivation, and accountability, health education and promotion processes, and establishing an ongoing meaningful partnership with a trained coach.11,18
This article aims to review and present the key components of the collaborative path to reimbursement in the field of HWC. We provide stakeholders—healthcare professionals and organizations with a strategic framework to effectively promote financial reimbursement from government and private insurers. Additionally, we highlight the significant role of unified efforts in advocating for the value of evidence-informed HWC in healthcare policy. The term “Health and Wellness Coaching” has been referenced or used in various forms across publications and health policy announcements, including as “Health and Well-Being Coaching.” In this publication, these two terms are used interchangeably.
The Evolution of Health and Wellness Coaching and ITS Reimbursement
HWC in the Real World
Recent empirical research underscores HWC’s effectiveness, demonstrating significant impacts on clinical and patient-centered outcomes across diverse healthcare settings. In their 2024 published toolkit (introduction; page 2), 19 the American Medical Association (AMA) describes HWC as:
“a team-based approach that helps patients gain the knowledge, skills, and confidence to become active participants in their care. The old saying, ‘Give a man a fish, and he eats for a day. Teach a man to fish, and he eats for a lifetime’, demonstrates the difference between rescuing a patient and coaching a patient. Patients with chronic conditions need to learn how to fish. Health coaching can be supplemented with health literacy strategies and effective communication techniques, such as ask–tell–ask, teach-back, and/or action planning to ensure patients understand their care plans and help them achieve their goals.”
Within healthcare settings, HWC aligns with a care-coordinated, team-based approach, empowering patients to actively participate in their healthcare. This shift is vital for patients with chronic conditions, often resulting from deeply ingrained behaviors in challenging environments. The emphasis is on mastering clinically important health or lifestyle behavior change and self-management skills for effective health care engagement, crucial for those with multiple chronic or complex health conditions. In this care model, physicians delegate personalized care planning to coaches as care team members to support lifestyle and behavioral change-focused approaches, enhancing patient engagement with health goals. Coaches proactively partner with patients and care partners as needed. 11
HWC has shown effective impact through integration across various healthcare specialties, aiming to address key patient needs such as self-direction, management, continuity of care, team-based care, and tailored access to community resources to address social determinants of health (SDOH).11,20-32 Examples of current HWC-inclusive care models include but not limited to:
i. The VHA system at 100+ sites. 33
ii. Primary care (e.g., Mayo Clinic, Massachusetts General Hospital (MGH), University of California at San Diego/UCSD.)
iii. Population health with physician referral to network of qualified coaching professionals (e.g., University of Pittsburgh Medical Center (UPMC) and Ohio State University (OSU.)
iv. Lifestyle Medicine and Integrative Medicine & Health (e.g., Mayo Clinic, UCSD)
v. Other specialty clinics, including cardiology-pulmonary rehab clinics, pain medicine, obesity medicine, infectious diseases (post-covid clinic), rheumatology, and sleep medicine.
vi. Value-based care, including Medicare Advantage and Patient-Centered Medical Homes (e.g., Lifestyle Medicine physician practices, intensive risk factor management for chronic conditions).
Through collaborative work within the past decade, several healthcare organizations, institutions, and entities have proposed and advocated for the reimbursement of HWC services for four critical reasons that are supported by evidence11,12,34,35:
i. Improving care quality, outcomes, and experience: Employment of qualified HWC professionals supports the accurate tracking, reporting, and evaluation of ongoing program parameters, optimizing the adherence, effectiveness, and efficacy of coaching services.
ii. Bidirectional workforce support: Integration of qualified coaches enables clinicians to work at the top of their licensure, effectively distributing patient workload, reducing burnout, and addressing clinician shortages to address positive behavioral change and healthy lifestyle-centered related matters. 36 HWC professionals can directly support healthcare professionals to also enact their own self-care.37,38
iii. Cultivating Health Equity: HWC as a cost-effective service can enhance health equity by integrating HWC professionals who are trained and equipped to, explore, identify, and engage in culturally and socially sensitive conversations. Coaches help empower individuals and communities towards meaningful and sustainable approaches or action plans for healthier lifestyle changes. Thus, HWC can significantly support underserved populations, including those with low income and other deficiencies in SDOH.20,35,39
iv. Support for non-patient populations: HWC can be a modality used to support populations—partners/stakeholders—that are crucial to healthcare delivery when their well-being is not sufficiently supported, including healthcare professionals/workforce, medical learners, and patients’ own informal caregivers or care partners (e.g., family members, friends).11,19,37,38,40-43
The Veterans Health Administration Model
The Veterans Health Administration (VHA) has significantly transformed U.S. healthcare through its Whole Health System (WHS) of care, initiated in 2010 with the establishment of the Office of Patient-Centered Care and Cultural Transformation (OPCC & CT).33,44 The WHS, aimed at enhancing Veterans’ health and well-being, has progressively expanded across the country. It reached full-scale deployment in 18 flagship sites in 2017 and was extended to an additional 37 sites by 2020. Implementation efforts have continued across all VHA medical facilities and community clinics since then. 45 Central to the WHS model is its emphasis on empowering Veterans in their health journey. This approach integrates various therapeutic methods, supported by a diverse team of clinicians, well-being instructors, HWCs, Veteran Partners, and complementary and integrative health (CIH) providers. A critical aspect of WHS is the role of HWCs in facilitating long-term health or lifestyle behavior changes through individualized coaching. This has alleviated the burden on healthcare providers and contributed to better patient care, safety, and satisfaction. 46 As such, HWC, as a core component of WHS, has become required at all VHA facilities, reflecting its importance in team-based, interprofessional, whole health care. 46 The VHA whole health model was endorsed by the National Academies of Science, Engineering and Medicine in 2023.12,47
The Path to Reimbursement
As VHA OPCC & CT was defining the WHS of care and the role of a HWC, a clear need emerged in 2019 to improve infrastructure for coding and tracking delivered coaching services, not possible with then-existing CPT codes. Specifically, HWCs were not able to record their workload for inclusion in the VHA payment model, which is a capitated resource allocation system based on complexity of care. 46 This represented a significant challenge, not only for tracking delivery of HWC but also the potential to effectively hire HWCs and evaluate implementation and effectiveness of coaching over time. VHA was able to create internal codes; however, these codes had limitations in applicability and use.
In a significant development in 2019, the U.S. Department of Veterans Affairs (VA), with support from the NBHWC, successfully applied for the establishment of coaching-specific Current Procedural Terminology (CPT) codes, adhering to NBHWC standards. 48 As a result, three Category III CPT codes (0591T, 0592T, and 0593T) were approved by the AMA CPT Panel in May 2019, with an effective 5 year period from January 1, 2020, to December 31, 2024. 49
Initially, in 2019, the CPT Panel recognized NBHWC and the National Commission for Health Education Credentialing, Inc. (NCHEC) 50 as the credentialing organizations for coaches in the context of these CPT codes: “The coach is a non-physician health care professional certified by the NBHWC or NCHEC.” 49 Subsequently, in 2020 and 2021, the NBHWC, NCHEC, and the American Holistic Nurses Credentialing Corporation (AHNCC) 51 engaged with the AMA CPT Panel to refine the coach credentialing standards while aligning with the Panel’s conventions of not specifying credentialing organizations. This collaborative effort culminated in 2021 with the CPT Panel finalizing the current language for the CPT codes stating, “the health and well-being coach is qualified to perform HWC by education, training, national examination, and when applicable, licensure/regulation, and has completed a training program in HWC whose content meets national standards established by an applicable national credentialing organization.”
Furthermore, the NBHWC provided the CPT Panel with detailed descriptions of coaching and coach training and education. These descriptions were based on a comprehensive 2013 systematic review of 284 articles, 18 which helped to establish a defined understanding of HWC process and training and process: “HWC is a patient-centered approach wherein patients determine their goals, use self-discovery or active learning processes together with content education to work toward their goals, and self-monitor behaviors to increase accountability, all within the context of an interpersonal relationship with a coach.” And “Coaches’ training includes behavioral change theory, motivational strategies, communication techniques, health education and promotion theories, which are used to assist patients to develop intrinsic motivation and obtain skills to create sustainable change for improved health and well-being.”
This evidence-based definition as recognized in the CPT codes was subsequently integrated by the NBHWC into the National Provider Identifier (NPI) description for the health and wellness coach approved in April 2021 (code 171400000X).
In January 2024, the Category III CPT codes were renewed for 5 years (2025-2029), ensuring continued use by HWC. 52 The historic approval and renewal pave the way for tracking the tremendous growth of HWC for Veterans and patients outside the VHA across the country. These codes allow VHA to further evaluate implementation and effectiveness of HWC as an integral part of the WHS of care, 46 thus enabling a significant step toward whole health or whole person care. 46 Within the VHA, including HWC as part of its WHS comprehensive approach to care underpinned by inclusivity and health equity, not only improves Veterans’ quality of life but also strategically aligns with the VHA’s payment model. The WHS’s focus on collaborative care and personalized health planning represents a paradigm shift in addressing the complex health needs of Veterans.
The Evidence for Reimbursement
The existing evidence supporting HWC reimbursement demonstrates its efficacy as a cost-effective and sustainable approach for managing chronic diseases, regardless of delivery via telehealth or in-person.29,39,53-56 Studies show significant outcomes in preventing and managing conditions such as diabetes mellitus, hypertension, heart disease, stroke, weight management, chronic pain, and cancer, both independently and in combination with other interventions. 57 Table 1 highlights seven key studies, chosen from over 100 randomized controlled studies (RCTs) conducted between 2000 and 2022, which align with the 2013 systematic review definition of coaching. These include 5 telehealth studies, four of which are large-scale RCTs with participant numbers ranging from 375 to 1,761, and one study in a primary care setting. These studies cover both non-Medicare and Medicare populations, demonstrating sustained improvements in chronic disease management over periods of 12, 24, and 48 months.
Table 1.
Coaching Intervention Characteristics in Seven Cited Studies.
Citation, Condition | Coach Background | Coach Training | Delivery Mode | Coaching Sessions & Duration | Positive Outcome Sustained | Participant Age |
---|---|---|---|---|---|---|
Remote/Virtual | ||||||
Appel 2011, 69 Obesity | Varied Allied Health backgrounds | SCT and MI 2 weeks training (oral confirmation by author) | Compared Remote and In-person groups | Remote - 30 telephone sessions over 24 months | Weight loss sustained for 24 months | 54.0 +10.2 |
Nguyen 2022, 70 Hypertension | Registered dietitians | MI, Goalsetting | Remote only | Remote - 6-16 telephone sessions over 12 months | Improved BP control sustained at 48 months | 61 +12 |
Sherifali 2021, 71 Diabetes | Nurse/diabetes educator | MI, behavioral design, self-management | Remote only | Remote - Mean of 12 telephone sessions over 12 months | AIC reduced and sustained at 12 months | 57+11.69 |
Sherman 2019, 54 Obesity | Exercise physiologist | Coach training program met NBHWC standards | Remote after initial in-person office visit | Remote - 11 telephone sessions over 12 months | Weight loss sustained for 24 months | 46 + 12 |
Benzo 2023, 72 COPD | College grads, health admin, nurse | MI, Mindfulness | Remote only | Remote - 12 telephone sessions over 3 months | COPD patient improvements sustained at 6 months | 69 + 9 |
HYBRID (in-person + remote/virtual) | ||||||
Katzmarzyk 2020, 73 Obesity | Degrees in Nutrition, Exercise, Behavioral Medicine | 1.5 days coach training | Hybrid - Remote plus In-person | Hybrid - 22 In-person; 12 telephone over 24 months | Weight loss sustained for 24 months | 49.4 +13.1 |
Willard-Grace 2015, 74 Diabetes and Hyperlipidemia | Medical assistants | 40 hours health coach training | Hybrid - In-person first visit, follow-up in-person + phone | Hybrid - 4 in-person and 8+ telephone sessions over 12 months | AIC, LDL decreases sustained at 12 months | 52.6+10.7 |
The findings consistently affirm HWC’s clinical effectiveness, when administered by a diverse range of trained coaches with backgrounds as allied health professionals or licensed clinicians, highlighting HWC’s adaptability in various healthcare settings and for a range of conditions. Table 2 lists ten meta-analyses of coaching interventions demonstrating statistically significant outcomes in diabetes, hypertension, chronic pain, COPD, cancer, chronic disease, and mental health. While the authors of these meta-analyses did not apply the 2013 systematic review-derived coaching definition, the studies are significant given the consistently positive outcomes.
Table 2.
Summary From Published Evidence From Meta-Analyses of Health and Wellness Coaching (HWC) for Chronic Disease Treatment.
Meta-analysis I.D. | Condition Focus | Outcomes Summary |
---|---|---|
Almulhim 2023 21 | Diabetes Mellitus | 20 RCTs used an average of 4.5 behavior change techniques and showed significant reductions in HbA1C levels. |
Title: Behavioral Change Techniques in Health Coaching-Based Interventions for Type 2 Diabetes: A Systematic Review and Meta-Analysis | ||
Pirbaglou 2018 75 | Diabetes Mellitus | 22 studies showed HWC reduced HbA1C levels from 3-18 months duration. |
Title: Personal HWC as a type 2 diabetes mellitus self-management strategy: a systematic review and meta-analysis of randomized controlled trials | ||
Racey 2022 76 | Diabetes Mellitus and Hypertension | 9 studies showed significant reduction in HbA1C levels. |
Title: Diabetes health coach in individuals with type 2 diabetes: A systematic review and meta-analysis of quadruple aim outcomes | ||
Meng 2022 77 | Hypertension | 12 RCTs showed significant reductions in diastolic and systolic BP, dietary behaviors, and self-efficacy. |
Title: Effect of HWC on blood pressure control and behavioral modification among patients with hypertension: A systematic review and meta-analysis of randomized controlled trials | ||
Mills 2018 36 | Hypertension | 29 studies that included HWC showed that significantly reduced systolic and diastolic BP. |
Title: Comparative effectiveness of implementation strategies for blood pressure control in hypertensive patients: a systematic review and meta-analysis | ||
Prior 2023 78 | Chronic Pain | 17 studies showed significant decreases in mid-term pain, short-term and mid-term disability. |
Title: Health and Wellness Coaching for Low Back Pain and Hip and Knee Osteoarthritis: A Systematic Review with Meta-Analysis | ||
Long 2019 28 | COPD | 10 RCTs showed significant improvements in quality of life and significant reductions in COPD-related hospital admissions. |
Title: Does HWC improve health‐related quality of life and reduce hospital admissions in people with chronic obstructive pulmonary disease? A systematic review and meta‐analysis | ||
Barakat 2018 79 | Cancer | 12 Studies showed improved quality of life, mood, and physical activity. |
Title: Does HWC grow capacity in cancer survivors? A systematic review | ||
Boehmer 2023 24 | Mental Health | 30 studies showed improvements in quality of life, self-efficacy, and depression. |
Title: The impact of HWC on patient-important outcomes in chronic illness care: A systematic review and meta-analysis | ||
Kivela 2014 80 | Various Chronic Conditions | 13 studies showed that HWC improves the management of chronic diseases, patient education, and willingness to change their lifestyle and to support the patient’s home-based self-care. |
Title: The effects of HWC on adult patients with chronic disease. A systematic review | ||
Key words: RCTs: Randomized Controlled Trials; HbA1C: Glycated Hemoglobin; BP: Blood Pressure; COPD: Chronic Obstructive Pulmonary Disease; HWC: Health and Wellness Coaching |
Evidence-Informed Coaching Dose
The term “Coaching Dose” reflects session duration, frequency, program length, and total dose in number of sessions and hours. Evidence-informed coaching dose guidelines enable HWC to be more standardized and measurable, thus enabling ongoing evaluation of coaching dose-related outcomes and value along with evidence-based evolution of the dose guidelines, in support of ongoing reimbursement.
The CPT codes for HWC services specify session durations that are well-aligned with empirical research. These codes describe a 60-minute introductory session for the initial intake and planning, and follow-up or ongoing sessions of 30 minutes. This guidance is supported by a peer-reviewed analysis of 88 coaching intervention studies, focusing on obesity and diabetes (51 on obesity and 37 on Type 2 Diabetes). 58 These studies were selected from a comprehensive review of HWC literature published between 2000 and 2018, including a 2017 compendium 30 and a 2019 addendum. 20 All selected studies conformed to the coaching definition established in the 2013 review.
Our example of evidence-informed dosing is based on coaching interventions for persons living with and managing type 2 diabetes mellitus or obesity conditions. These studies employed various modalities to respond to patient needs and preferences. Notably, about 60% of these studies use telephone-based modalities. The remainder comprised either in-person only or a hybrid of remote and in-person approaches. The evidence-informed coaching dosing, as derived from these studies, includes:
i. An average session duration of 35-40 minutes, often with an extended initial session lasting up to 60 minutes.
ii. A total of 12-15 coaching sessions.
iii. A session frequency of 1-2 times per month.
iv. A total coaching program duration of 7-9 months.
While this approach can be used as a framework, it is important to note that optimal dosing continues as a work in progress. Further exploration is needed to define coaching methodologies more strictly, refine study inclusion and search criteria, and expand dosing research to other conditions and populations.
Establishing Coaches as Qualified Health Professionals
NBHWC, NCHEC, and AHNCC are three preeminent national credentialing organizations. They set the benchmarks for US national training and education standards for HWC professionals, culminating in a national certification examination. Collectively, these organizations represent a cadre of over 28,000 qualified coaching professionals.
The NBHWC since its inception in 2012 as a nonprofit affiliate of the NBME has been at the forefront of establishing national education and training program standards and a national certification for health and wellness coaches. These standards ensure a foundational level of coaching competencies and approaches to assess the knowledge, tasks, and skills essential for effective HWC. The certification examination, modeled on NBME’s processes for physician licensing exams, reinforces these standards. To date, NBHWC has approved 125 academic and private coach training and education programs, with over 10,000 health professionals certified as Health and Wellness Coaches, working across more than 400 healthcare organizations. Notably, approximately 23% of these National Board-Certified Health and Wellness Coaches (NBC-HWC) also hold state clinical licenses in various health professions.
The NCHEC, 50 established in 1989, administers renowned health educator certification programs, which include HWC competencies: (1) the Certified Health Education Specialist (CHES®); and (2) the Master Certified Health Education Specialist (MCHES®). NCHEC's eligibility criteria mandate a minimum of a bachelor’s degree, with many candidates holding master’s degrees, encompassing health education and health coaching competencies. 59 The certifications are based on rigorous practice analysis studies, updated every five years to reflect contemporary practice. Over 270 accredited higher education institutions qualify individuals for NCHEC certifications, with more than 16,500 professionals currently certified.
The AHNCC in 2012 established the Professional Nurse Coach Role, setting national standards and competencies for certified Nurse Coaches in alignment with the Standards and Ethics of Nursing defined by the American Nurses Association. AHNCC's certification is available to registered nurses with a baccalaureate degree or higher, with over 1,300 nurses certified as nurse coaches to date.
As such, qualified coaching professionals credentialed by these organizations come from diverse health professional backgrounds, combining licensed and non-licensed practitioners. This includes registered nurses, dietitians, other licensed clinicians, health educators, exercise physiologists, allied health professionals, and non-degreed medical assistants, serving various populations and in different healthcare and wellness settings.
The 2013 systematic review of 284 peer-reviewed articles, 18 which established a HWC definition that we cited above, reports the following varied health professional backgrounds among trained coaches:
i. Medical professionals—including physicians, nurses, pharmacists, physician assistants, and medical assistants.
ii. Licensed healthcare professionals—such as registered dietitians, psychologists, social workers, therapists, counselors, physical and occupational therapists.
iii. Allied health professionals—encompassing exercise physiologists and specialists, health educators/health promotion professionals.
iv. Professional coaches—specifically health and wellness coaches.
Table 1 (core HWC evidence) also summarizes the baseline characteristics of the health and wellness coaches, their backgrounds, mode of delivery, outcomes studies, and dosing from seven studies.
Utilization of Coaching Services in US Healthcare
NBHWC gathered confidential data on the utilization of coaching services in healthcare from 72 organizations, including the VHA, for the period 2015-2022. From 2020-2022, ten organizations reported NBHWC-certified coach use of a variety of CPT codes (135,000 visits) as summarized in Table 3. These data include:
• 98972—online digital evaluation and management service
• 99401/99402/99403/99404—preventive medicine services
• 98967—telephone assessment and management service
• G0447—behavioral counseling for obesity
• 99439/98487/99489/99490—chronic care management
• 99453/99454/99457/99458—remote physiological monitoring
Table 3.
Utilization of NBHWC-Certified Coaching Services and CPT Codes by Healthcare Organizations, 2015-2022.
Year | 2015-2019 | 2020-2022 | Total |
---|---|---|---|
Volume of HWC visits a | 2,302,421 | 2,390,439 | 4,692,860 |
Number of coaches in 2022 | NR | 1364 | 1364 |
Number of HWC sites and practices in 2022 | NR | 620 | 620 |
aCoaching visit volume provided to NBHWC in January 2023 by 71 healthcare organizations, including VHA, to support the 2023 Category I application for the HWC CPT codes. It includes 125,226 visits using the HWC CPT codes from 2020-2022, of which 112,955 were delivered by the VHA.
In the VHA, HWC is now offered across 118 medical centers and additional community-based clinics, with a total of 149,584 coaching encounters by national board-certified health coaches using one of the three established Category III CPT codes [data from January of 2020 to October of 2023]. 60 This represents 40,673 unique veterans who have accessed HWC services from HWC, which is a combination of veterans receiving the coaching dose guidelines of 12 sessions and other veterans completing 1-2 coaching sessions. 45 This growth shows not only the need for dedicated time for such services, but it has also been connected to improved outcomes when delivered as a part of whole health, patient-centered care. Notable effects of the WHS of care include improved patient activation, engagement, connection with meaning and purpose, and reduction in opioid utilization for chronic pain.45,46
It is crucial to note that, even with the issuance of Category III HWC CPT codes since 2020, these codes are generally not reimbursed by public and private payers. Currently, this is the main challenge and opportunity for the integration of HWC services using these codes in healthcare settings. This reimbursement gap also constrains the collection of the comprehensive evidence required by CMS of HWC for permanent inclusion on the Medicare Telehealth Services List. Addressing this gap is essential to advancing the adoption and effectiveness of HWC services, including the negotiation of reimbursement with Medicare contractors and other payers to fund the evidence-gathering code use, policy revisions, or alternative funding strategies to support initial implementations and facilitate evidence-gathering.
CMS Adds HWC Services to Medicare Telehealth Services List
In November 2023, CMS announced its decision to include HWC services on the Medicare Telehealth Services List on a temporary basis in 2024. In discussing eligibility for future permanent approval, CMS outlined that the HWC field must now demonstrate the positive clinical outcomes of HWC services in clinical practices using the HWC CPT codes, including on a virtual basis and in Medicare-eligible populations. This requirement is understandable and fiscally responsible, given the high need for sustained health behavior change of the estimated over 65 million people are identified as Medicare covered beneficiaries. 61
Within this update, CMS noted regarding national standards that (1) the professional qualifications required for a Health and Wellness Coach certification are acknowledged; (2) the varied backgrounds of health coaches are recognized, and the intention was not to question their standards and training; and (3) many eligible health practitioners are likely to furnish these services to Medicare beneficiaries if they remain permanently on the Medicare Telehealth Services List.
In the final Physician Fee Schedule rules for 2024, 62 CMS provided guidance for transitioning the Category III codes for HWC services towards permanent approval on the Medicare Telehealth Services List, provided here with slight edits for clarity:
i. The clinical value of the service is not under question for inclusion on the Medicare Telehealth Services List. The potential clinical benefits of providing these services via telehealth are acknowledged.
ii. The specific clinical benefits of HWC services as telehealth services for the target population require further study, including scientific research focusing on the use of these codes in telehealth and clinical practice.
For future evidence, CMS expects verifiable, peer-reviewed evidence that compares clinical benefit using sufficient sample sizes, distinguishes between in-person only and virtual-only HWC, and is generalizable to the Medicare population. Such evidence should include analysis of utilization data of the HWC codes.
In February 2024, NBHWC and other parties submitted a request to extend the temporary approval of the HWC CPT Codes on the Medicare Telehealth Services List from 2025-2027 in order to gather and publish evidence on clinical outcomes using the HWC CPT codes for Medicare beneficiaries.
Proposed Reimbursement models
The sustainable financing of coaching services within the healthcare system can be navigated through several emerging pathways in the U.S.:
i. Patient Billing by Medical Practices: Medical practices have the option to bill patients directly for coaching services, offering a straightforward self-payment route.
ii. Value-Based Care Funding: In instances where medical practices receive monthly value-based care payments for patient care, these funds can be allocated to finance coaching services. This method ties coaching directly into the broader spectrum of patient care and value-based healthcare models.
iii. Utilization of CPT Codes: Medical practices can bill for coaching services using specific CPT codes delivered by HWC under physician supervision. This includes chronic care management-related CPT codes for Medicare beneficiaries and preventive medicine counseling CPT codes for non-Medicare patients. This approach aligns coaching services with established coding and billing practices.
iv. Negotiations with Payers: Another viable route is for medical practices to engage in negotiations with Medicare Administrative Contractors, Medicare Advantage plans, or private payers to secure reimbursement of the health and well-being coaching CPT codes.
v. Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA): HWC services may qualify for reimbursement under HSAs or FSAs when they are prescribed by a physician as a necessary treatment for specific medical conditions. This is in accordance with Internal Revenue Service (IRS) guidelines, which consider expenses for treating a disease as deductible medical care. The inclusion of HWC under HSA/FSA for reimbursement hinges on the physician’s recommendation, making it a potentially viable option for patients seeking integrative approaches within their healthcare plans. However, current IRS language restricts this option to cases where HWC is part of a medically necessary treatment, emphasizing the need for clear medical justification to access these funds. 63
Each of these pathways presents a unique approach to integrating and financing HWC within the healthcare system. They reflect the evolving landscape of healthcare financing and the increasing recognition of the value of coaching in patient care.
Next Steps: The Revolution—Challenges and Opportunities
The considerable progress achieved over the past decade in HWC includes the development of national education, training, and credentialing standards, evidence-based practices, early implementation in diverse healthcare settings, and the creation of new reimbursement pathways.
From existing policy advocacy and partnership, published evidence, and stakeholders (patients, coaches, institutions, and credentialing entities) feedback from the AMA CPT codes and the CMS applications processes,62,64 we outline key opportunities for HWC going forward include:
i. Ensuring standardized HWC Credentialing, Training, and Research conducting and reporting: The CMS 2024 Fee Schedule recognized the professional qualifications of Health and Wellness Coaches, supporting their continued eligibility to deliver Medicare Telehealth Services if permanently listed. CMS also detailed steps toward permanent approval of Category III HWC codes, acknowledging their clinical value and highlighting the need for published clinical outcomes data to confirm their efficacy as telehealth services using the CPT codes for the Medicare population. These developments align with the mission of the NBHWC in partnership with the NBME, other credentialing entities, VHA, and other medical practices and healthcare organizations, to advance HWC through ongoing evidence-gathering and evidence-informed standards.
ii. Clinical and Financial Outcomes: Tracking and reporting of outcomes delivered by qualified coaching professionals using the HWC codes, both pre and post coaching interventions, with multi-year follow-up is vital to the field’s future. This includes measuring behavioral-centered outcomes (e.g., readiness for change, lifestyle changes, mental well-being), healthcare outcomes (e.g., quality of life, treatment adherence, surrogate, and clinical), and cost of care related outcomes (e.g., per capita cost measurement, cost-effectiveness analysis) to evaluate and optimize the return on coaching investments.
iii. Health Disparities, Equity, and Inclusion (DEI): There has been a significant work in studying HWC among underrepresented populations. Nonetheless, there remains a significant opportunity to enhance diversity, equity, and comparison in sociodemographic representation by ascertaining methodology and outcomes address economic, SDOH, mental health, and other challenges within disparate communities.65,66
iv. Coach, Coaching, and Patient Factors: There is an opportunity to identify and document factors that contribute to positive outcomes, including patient readiness to change, coach training and experience, coaching dosage and timeframe, team support, combinations with other interventions, and the skills and profiles of coaches.56,67
v. Technology: The importance of digital health interventions integration, particularly as advancements in artificial intelligence (AI) continue to evolve, in providing timely, customized, and enhanced health and wellness coaching (HWC). This presents significant opportunities for enhancing the cost-effectiveness and reimbursement landscape of healthcare services. AI-driven tools can automate routine tasks, review personalize treatment plans, and monitor patient progress more efficiently, potentially reducing labor costs and improving patient outcomes. These advancements could lead to more consistent and demonstrable health improvements, making a stronger case for insurance providers and government programs to recognize and reimburse HWC services.23,68
Conclusions
The evolution of HWC over the past decade represents a transformative shift in healthcare. Underpinned by rigorous standards from NBHWC, NCHEC, and AHNCC, the field now comprises over 28,000 qualified coaching professionals with diverse health expertise. Empirical evidence, notably from telehealth and in-person studies, highlights HWC effectiveness in managing chronic conditions like obesity, hypertension, COPD, and diabetes. The introduction of CPT codes for coaching services is a testament to this progress, harmonizing coaching practices with evidence-based findings and educational standards. The field’s momentum is further bolstered by Medicare’s temporary inclusion of HWC on the Telehealth Services List for 2024, signaling its growing acceptance in mainstream healthcare, supported by submitted requests to CMS to extend the temporary approval from 2025-2027.
The requirement by CMS and AMA to furnish additional evidence for clinically significant outcomes opens avenues for substantial advancements. First, much of the evidence deploys coaching interventions not fully aligned with the description of the HWC CPT codes, particularly coach qualifications and coaching session duration (often 10-20 minutes). Second, comprehensive, ongoing outcome tracking is needed. Third, there is a substantial opportunity to support health equity through HWC with its demonstrated ability to enhance patient health by empowering autonomy; to reduce disparities by addressing social determinants of health; promote health equity by improving personalized and accessible cost-mindful care; and to improve healthcare system efficiency by optimizing patient-centered resource use and coordinated care. This trajectory not only reinforces HWC’s importance but also presents opportunities for its strategic standardization and enhancement within the healthcare landscape.
Footnotes
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Abu Dabrh and Dr. Beech are volunteer board members of the National Board for Health and Wellness Coaching Ms. Moore was a volunteer board member of the National Board for Health and Wellness Coaching, and a current Founder, CEO, Wellcoaches Corporation as disclosed. No payments or influence were sought to produce this paper/work. The paper is a reflection of the National Board for Health and Wellness Coaching efforts as stated.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
ORCID iDs
Abd Moain Abu Dabrh https://orcid.org/0000-0002-2481-483X
Margaret Moore https://orcid.org/0000-0002-2801-2287
References
- 1.Center for Disease Control and Prevention . About Chronic Diseases. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/about/index.htm. Accessed January 14, 2024. [Google Scholar]
- 2.Vodovotz Y, Barnard N, Hu FB, et al. Prioritized research for the prevention, treatment, and reversal of chronic disease: recommendations from the lifestyle medicine research summit. Front Med. 2020;77:585744. doi: 10.3389/fmed.2020.585744. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Frates B, Moore M. Health and well-being coachiing: skills for lasting change. In: Rippe J, ed. Lifestyle Medicine. CRC Press; 2013. chap 27. [Google Scholar]
- 4.Li Y, Xia P-F, Geng T-T, et al. Trends in self-reported adherence to healthy lifestyle behaviors among US adults, 1999 to March 2020. JAMA Netw Open. 2023;6(7):e2323584. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Shah NR, Rogers AJ, Kanter MH. Health care that targets unmet social needs. NEJM Catalyst. 2016;2(2). doi: 10.1056/CAT.16.0864. [DOI] [Google Scholar]
- 6.McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff. 2002;21(2):78-93. [DOI] [PubMed] [Google Scholar]
- 7.Volpp KG, Mohta NS. Patient engagement survey: far to go to meaningful participation. NEJM Catalyst. 2016;2(5). doi: 10.1056/CAT.16.0765. [DOI] [Google Scholar]
- 8.Tai‐Seale M, McGuire TG, Zhang W. Time allocation in primary care office visits. Health Serv Res. 2007;42(5):1871-1894. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Zhang X, Lin D, Pforsich H, Lin VW. Physician workforce in the United States of America: forecasting nationwide shortages. Hum Resour Health. 2020;18(1):1-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.HRSA Health Workforce . Behavioral health workforce; 2023. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/Behavioral-Health-Workforce-Brief-2023.pdf. Accessed January 14, 2024.
- 11.Perlman AI, Abu Dabrh AM. Health and wellness coaching in serving the needs of today's patients: a primer for healthcare professionals. Glob Adv Health Med. 2020;9:2164956120959274. doi: 10.1177/2164956120959274. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.National Academies of Sciences E, Medicine . Achieving Whole Health: A New Approach for Veterans and the Nation. National Academies Press; 2023. [PubMed] [Google Scholar]
- 13.CMS physician payment rule advances health equity the centers for Medicare & Medicaid services (CMS); 2023. https://www.cms.gov/newsroom/press-releases/cms-physician-payment-rule-advances-health-equity
- 14.Moore M, Jackson E. Health and well being coaching. In: Cox E, Bachkirova T, Clutterbuck DA, eds. Complete Handbook of Coaching. Sage Publications; 2023:346-363. Chapter 23. [Google Scholar]
- 15.National Board for Health & Wellness Coaching (NBHWC) . National Board for Health & Wellness Coaching National Board for Health & Wellness Coaching; 2019. https://nbhwc.org/ [Google Scholar]
- 16.The National Board of Medical Examiners (NBME) . The National Board of Medical Examiners. The National Board of Medical Examiners; 2024. https://www.nbme.org/ [Google Scholar]
- 17.National Board of Health and Wellness Coaching . NBHWC content outline. https://www.nbme.org/sites/default/files/2022-05/NBHWC_Content_Outline.pdf. Accessed January 14, 2024.
- 18.Wolever RQ, Simmons LA, Sforzo GA, et al. A systematic review of the literature on health and wellness coaching: defining a key behavioral intervention in healthcare. Glob Adv Health Med. 2013;2(4):38-57. doi: 10.7453/gahmj.2013.042. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.American Medical Association . Health coaching: help patient take charge of their health. https://edhub.ama-assn.org/steps-forward/module/2702562. Accessed January 14, 2024.
- 20.Sforzo GA, Kaye MP, Harenberg S, et al. Compendium of health and wellness coaching: 2019 Addendum. Am J Lifestyle Med. 2020;14(2):155-168. doi: 10.1177/1559827619850489. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Almulhim AN, Hartley H, Norman P, Caton SJ, Doğru OC, Goyder E. Behavioural change techniques in health coaching-based interventions for type 2 diabetes: a systematic review and meta-analysis. BMC Publ Health. 2023;23(1):95. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Barakat S, Boehmer K, Abdelrahim M, et al. Does health coaching grow capacity in cancer survivors? a systematic review. Popul Health Manag. 2018;21(1):63-81. doi: 10.1089/pop.2017.0040. [DOI] [PubMed] [Google Scholar]
- 23.Bevilacqua R, Casaccia S, Cortellessa G, et al. Coaching through technology: a systematic review into efficacy and effectiveness for the ageing population. Int J Environ Res Publ Health. 2020;17(16). doi: 10.3390/ijerph17165930. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Boehmer KR, Álvarez-Villalobos NA, Barakat S, et al. The impact of health and wellness coaching on patient-important outcomes in chronic illness care: a systematic review and meta-analysis. Patient Educ Counsel. 2023;117:107975. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Chew HSJ, Rajasegaran NN, Chin YH, Chew WSN, Kim KM. Effectiveness of combined health coaching and self-monitoring apps on weight-related outcomes in people with overweight and obesity: systematic review and meta-analysis. J Med Internet Res. 2023;25:e42432. doi: 10.2196/42432. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Kivela K, Elo S, Kyngas H, Kaariainen M. The effects of health coaching on adult patients with chronic diseases: a systematic review. Patient Educ Counsel. 2014;97(2):147-157. doi: 10.1016/j.pec.2014.07.026. [DOI] [PubMed] [Google Scholar]
- 27.Kwok ZC, Tao A, Chan HY. Effects of health coaching on cardiometabolic health in middle-aged adults: a systematic review and meta-analysis. Am J Health Promot. 2023;37(4):555-565. doi: 10.1177/08901171221137332. [DOI] [PubMed] [Google Scholar]
- 28.Long H, Howells K, Peters S, Blakemore A. Does health coaching improve health‐related quality of life and reduce hospital admissions in people with chronic obstructive pulmonary disease? A systematic review and meta‐analysis. Br J Health Psychol. 2019;24(3):515-546. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Racey M, Jovkovic M, Alliston P, Ali MU, Sherifali D. Diabetes health coach in individuals with type 2 diabetes: a systematic review and meta analysis of quadruple aim outcomes. Front Endocrinol. 2022;13:1069401. doi: 10.3389/fendo.2022.1069401. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Sforzo GA, Kaye MP, Todorova I, et al. Compendium of the health and wellness coaching literature. Am J Lifestyle Med. 2018;12(6):436-447. doi: 10.1177/1559827617708562. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Sieczkowska SM, de Lima AP, Swinton PA, Dolan E, Roschel H, Gualano B. Health coaching strategies for weight loss: a systematic review and meta-analysis. Adv Nutr. 2021;12(4):1449-1460. doi: 10.1093/advances/nmaa159. [DOI] [PubMed] [Google Scholar]
- 32.Turan TN, Al Kasab S, Nizam A, et al. Relationship between risk factor control and compliance with a lifestyle modification program in the stenting aggressive medical management for prevention of recurrent stroke in intracranial stenosis trial. J Stroke Cerebrovasc Dis. 2018;27(3):801-805. doi: 10.1016/j.jstrokecerebrovasdis.2017.10.017. [DOI] [PubMed] [Google Scholar]
- 33.Kligler B. Whole health in the veterans health administration. Glob Adv Health Med. 2022;11:2164957x221077214. doi: 10.1177/2164957x221077214. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Matthews JA, Moore M, Collings C. A coach approach to facilitating behavior change. J Fam Pract. 2022;71:eS93-eS99. [DOI] [PubMed] [Google Scholar]
- 35.Nguyen-Huynh MN, Young JD, Ovbiagele B, et al. Effect of lifestyle coaching or enhanced pharmacotherapy on blood pressure control among black adults with persistent uncontrolled hypertension: a cluster randomized clinical trial. JAMA Netw Open. 2022;5(5):e2212397. doi: 10.1001/jamanetworkopen.2022.12397. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Mills KT, Obst KM, Shen W, et al. Comparative effectiveness of implementation strategies for blood pressure control in hypertensive patients: a systematic review and meta-analysis. Ann Intern Med. 2018;168(2):110-120. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Breslin L, Dyrbye L, Chelf C, West C. Effects of coaching on medical student well-being and distress: a systematic review protocol. BMJ Open. 2023;13(8):e073214. doi: 10.1136/bmjopen-2023-073214. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Dyrbye LN, Shanafelt TD, Gill PR, Satele DV, West CP. Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial. JAMA Intern Med. 2019;179(10):1406-1414. doi: 10.1001/jamainternmed.2019.2425. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 39.Lumpkin JRTL, Hattori A, Jedele JM. Impact of food delivery and health coaching on outcomes and costs of care: a payer’s perspective. NEJM Catalyst homepage. NEJM. 2023;4:4. doi: 10.1056/CAT.22.03. [DOI] [Google Scholar]
- 40.Khan NNS, Todem D, Bottu S, Badr MS, Olomu A. Impact of patient and family engagement in improving continuous positive airway pressure adherence in patients with obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med. 2022;18(1):181-191. doi: 10.5664/jcsm.9534. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.McLeod H, Perlman AI, Salinas MG, Abu Dabrh AM. Caring for caregivers-a new integrative care path for advanced lung cancer patients and their caregivers. J Alternative Compl Med. 2021;27(5):377-378. doi: 10.1089/acm.2020.0396. [DOI] [PubMed] [Google Scholar]
- 42.Perlman AI, McLeod H, Salinas MG, Schafer JL, Ventenilla J, Dabrh AMA. Bridging intention and action for employee well-being using the intentional action (INACT) process: workshop-lecture series. Glob Adv Health Med. 2021;10:21649561211015653. doi: 10.1177/21649561211015653. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Adelman SALJ. Coaching to enhance individual well-being, foster teamwork, and improve the health care system NEJM Catalyst homepage. NEJM; 2017. [Google Scholar]
- 44.U. S. Department of Veteran Affairs . Whole Health. https://www.va.gov/wholehealth/ [Google Scholar]
- 45.Bokhour BG, Hyde J, Kligler B, et al. From patient outcomes to system change: evaluating the impact of VHA's implementation of the Whole Health System of Care. Health Serv Res. 2022;57:53-65. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46.Kligler B, Khung M, Schult T, Whitehead A. What we have learned about the implementation of whole health in the veterans administration. J Integr Complement Med. 2023;29(12):774-780. doi: 10.1089/jicm.2022.0753. [DOI] [PubMed] [Google Scholar]
- 47.Meisnere M, South-Paul J, Krist AH. Achieving whole health: a new approach for veterans and the nation. In: Meisnere M, South-Paul J, Krist AH, eds. Achieving Whole Health: A New Approach for Veterans and the Nation; 2023. [DOI] [PubMed] [Google Scholar]
- 48.U.S. Department of Veterans Affairs (VA) . Success with health and well-being coaching codes. U.S. Department of veterans affairs (VA). Updated December 31, 2019 2024. https://www.va.gov/WHOLEHEALTH/features/Health_and_Well_Being_Coaching_Codes.asp [Google Scholar]
- 49.The National Commission for Health Education Credentialing (NCHEC) . NCHEC Certifications Recognized in New CPT Codes Approved by AMA the National Commission for Health Education Credentialing (NCHEC); 2019. https://www.nchec.org/news/posts/cpt [Google Scholar]
- 50.The National Commission for Health Education Credentialing IN . NCHEC’s Vision and Mission. The National Commission for Health Education Credentialing, Inc. (NCHEC); 2023. https://www.nchec.org/vision-and-mission [Google Scholar]
- 51.The American Holistic Nurses Credentialing Corporation (AHNCC) . The American Holistic Nurses Credentialing Corporation (AHNCC). The American Holistic Nurses Credentialing Corporation (AHNCC); 2023. https://www.ahncc.org/ [Google Scholar]
- 52.National Board for Medical Examiners (NBME) . Health and Wellness Coaching Supports More Comprehensive Approaches to Health Care. National Board for Medical Examiners (NBME); 2024. Updated May 16, 2024 2024. [Google Scholar]
- 53.Sforzo GA, Kaye MP, Todorova I, et al. Compendium of the health and wellness coaching literature. Am J Lifestyle Med. 2018;12(6):436-447. doi: 10.1177/1559827617708562. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 54.Sherman RP, Petersen R, Guarino AJ, Crocker JB. Primary care–based health coaching intervention for weight loss in overweight/obese adults: a 2-year experience. Am J Lifestyle Med. 2019;13(4):405-413. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 55.Wayne N, Perez DF, Kaplan DM, Ritvo P. Health coaching reduces HbA1c in Type 2 diabetic patients from a lower-socioeconomic status community: a randomized controlled trial. J Med Internet Res. 2015;17(10):e224. doi: 10.2196/jmir.4871. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 56.Ahmann E, Saviet M, Conboy L, Smith K, Iachini B, DeMartin R. Health and wellness coaching and sustained gains: a rapid systematic review. Am J Lifestyle Med. 2024;18(2):162-180. doi: 10.1177/15598276231180117. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 57.Sforzo GA, Kaye MP, Harenberg S, et al. Compendium of health and wellness coaching: 2019 addendum. Am J Lifestyle Med. 2020;14(2):155-168. doi: 10.1177/1559827619850489. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 58.Sforzo GA, Kaye MP, Faber A, Moore M. Dosing of health and wellness coaching for obesity and type 2 diabetes: research synthesis to derive recommendations. Am J Lifestyle Med. 2023;17(3):374-385. doi: 10.1177/15598276211073078. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 59.National Commission for Health Education Credentialing Inc. NtSfPHE, Inc. (SOPHE) . A Competency Based Framework for Health Education Specialists, 2020. Core Competencies. National Commission for Health Education Credentialing, Inc (NCHEC); 2020. [Google Scholar]
- 60.(AMA) AMA . CPT® Editorial Summary of Panel Actions May 2023. CPT® Editorial Summary of Panel Actions; 2023. June 1, 2023 https://www.ama-assn.org/system/files/cpt-summary-panel-actions-may-2023.pdf [Google Scholar]
- 61.The Centers for Medicare & Medicaid Services (CMS) . CMS Program Statistics. The Centers for Medicare & Medicaid Services (CMS); 2024. https://data.cms.gov/collection/cms-program-statistics. Accessed Dec 12, 2024. [Google Scholar]
- 62.The Centers for Medicare & Medicaid Services (CMS) . Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule the Centers for Medicare & Medicaid Services (CMS). Accessed Dec 12, 2024.
- 63.National Board of Health and Wellness Coaching (NBHWC) . HSA and FSA Accounts for Health and Wellness Coaching (HWC) Services; 2023. https://nbhwc.org/wp-content/uploads/2023/07/hsa-and-fsa-update-package.pdf [Google Scholar]
- 64.American Medical Association (AMA) CPT® Editorial Panel . CPT® Editorial Summary of Panel Actions May 2023. Summary Report. CPT® Editorial; 2023. June 1, 2023 https://www.ama-assn.org/system/files/cpt-summary-panel-actions-may-2023.pdf [Google Scholar]
- 65.Ghorob A, Willard-Grace R, Bodenheimer T. Health coaching. Virtual Mentor. 2013;15(4):319-326. doi: 10.1001/virtualmentor.2013.15.4.stas2-1304. [DOI] [PubMed] [Google Scholar]
- 66.Renneberg B, Schulze J, Bohme S, West SG, Schuz B. Effectiveness and equity evaluation of an insurance-wide telephone-counseling program for self-management of chronic diseases: the Health Coach Study. Appl Psychol Health Well Being. 2022;14(2):606-625. doi: 10.1111/aphw.12322. [DOI] [PubMed] [Google Scholar]
- 67.Harenberg S, Sforzo GA, Edman J. A rubric to assess the design and intervention quality of randomized controlled trials in health and wellness coaching. Am J Lifestyle Med. 2024;18(1):82-94. doi: 10.1177/15598276221117089. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 68.Obro LF, Heiselberg K, Krogh PG, et al. Combining mHealth and health-coaching for improving self-management in chronic care. A scoping review. Patient Educ Counsel. 2020;104(4):680-688. doi: 10.1016/j.pec.2020.10.026. [DOI] [PubMed] [Google Scholar]
- 69.Appel LJ, Clark JM, Yeh H-C, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011;365(21):1959-1968. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 70.Nguyen-Huynh MN, Young JD, Ovbiagele B, et al. Effect of lifestyle coaching or enhanced pharmacotherapy on blood pressure control among Black adults with persistent uncontrolled hypertension: a cluster randomized clinical trial. JAMA Netw Open. 2022;5(5):e2212397. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 71.Sherifali D, Brozic A, Agema P, et al. Effect of diabetes health coaching on glycemic control and quality of life in adults living with type 2 diabetes: a community-based, randomized, controlled trial. Can J Diabetes. 2021;45(7):594-600. [DOI] [PubMed] [Google Scholar]
- 72.Benzo R, Hoult J, McEvoy C, et al. Promoting chronic obstructive pulmonary disease wellness through remote monitoring and health coaching: a clinical trial. Ann Am Thorac Soc. 2022;19(11):1808-1817. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 73.Katzmarzyk PT, Martin CK, Newton RL, et al. Weight loss in underserved patients—a cluster-randomized trial. N Engl J Med. 2020;383(10):909-918. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 74.Willard-Grace R, Chen EH, Hessler D, et al. Health coaching by medical assistants to improve control of diabetes, hypertension, and hyperlipidemia in low-income patients: a randomized controlled trial. Ann Fam Med. 2015;13(2):130-138. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 75.Pirbaglou M, Katz J, Motamed M, Pludwinski S, Walker K, Ritvo P. Personal health coaching as a type 2 diabetes mellitus self-management strategy: a systematic review and meta-analysis of randomized controlled trials. Am J Health Promot. 2018;32(7):1613-1626. [DOI] [PubMed] [Google Scholar]
- 76.Racey M, Jovkovic M, Alliston P, Ali MU, Sherifali D. Diabetes health coach in individuals with type 2 diabetes: a systematic review and meta analysis of quadruple aim outcomes. Front Endocrinol. 2022;13:1069401. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 77.Meng F, Jiang Y, Yu P, et al. Effect of health coaching on blood pressure control and behavioral modification among patients with hypertension: a systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud. 2023;138:104406. [DOI] [PubMed] [Google Scholar]
- 78.Prior JL, Vesentini G, Michell De Gregorio JA, Ferreira PH, Hunter DJ, Ferreira ML. Health coaching for low back pain and hip and knee osteoarthritis: a systematic review with meta-analysis. Pain Med. 2023;24(1):32-51. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 79.Barakat S, Boehmer K, Abdelrahim M, et al. Does health coaching grow capacity in cancer survivors? A systematic review. Popul Health Manag. 2018;21(1):63-81. [DOI] [PubMed] [Google Scholar]
- 80.Kivelä K, Elo S, Kyngäs H, Kääriäinen M. The effects of health coaching on adult patients with chronic diseases: a systematic review. Patient Educ Counsel. 2014;97(2):147-157. [DOI] [PubMed] [Google Scholar]