Our patients regularly encounter an abundance of addictive ultra-processed, hyper-palatable, energy dense foods, and many also lead very sedentary lives. Expecting patients to restrict food and start exercising simply because they’ve been advised to assumes they have a level of self-regulation few people possess and many did not develop early in life.
Connecting patients with health and well-being coaching (HWC) can help them overcome barriers to change and give them a leg up as they work to adopt and sustain healthy habits.
HWC fills a gap between traditional and lifestyle medicine by effectively promoting healthy behaviors to assist in the prevention or treatment of lifestyle-related disease, such as obesity, diabetes, hypertension, and pulmonary and vascular diseases. The need is great. According to the CDC, in 2020, 40% of US. adults had ≥ 2 chronic conditions, many of which can be effectively prevented and treated by lifestyle behaviors.
Recognizing that unmet need, a consortium 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 in 2020 to advocate for the reimbursement of HWC services in the US healthcare system, as described in the American Journal of Lifestyle Medicine (AJLM) article Health and Wellness Coaching Services: Making the Case for Reimbursement. The Veterans Health Administration (VHA), which offers HWC services to veterans, also partnered in the initiative to establish Current Procedural Terminology (CPT) codes for HWC services.
Lead co-authors of the AJLM paper, Moain Abu Dabrh, MB, BCh, MS, Mayo Clinic, Jacksonville, and Margaret Moore, MBA, McLean Hospital, Institute of Coaching, Belmont, Massachusetts, described “our five-year path of evidence gathering, coalition building, and advocacy efforts.” They added, “this coalition documented over 4 million delivered HWC sessions in making the case for reimbursement to CMS and the AMA.”
These advocacy efforts contributed to the creation and implementation of Category III CPT codes that enable the tracking of and billing for HWC services , and the decision by the Centers for Medicare & Medicaid Services (CMS) to add the codes on a provisional basis to the Medicare Telehealth list starting in 2024.
The codes are: 0591T, health and well-being coaching face-to-face; individual, initial assessment (at least 60 min); 0592T, health and well-being coaching; individual, follow-up session, at least 30 min; and 0593T, health and well-being Coaching group (two or more individuals), at least 30 min.
HWC is a patient-centered approach that includes patient-determined goals and the use of self-discovery or active learning to work toward those goals. Behavior change is facilitated by self-monitoring techniques, patient accountability, and health education — all within the context of an interpersonal relationship with a trained coach.
Professional health and well-being coaches are qualified by education, completion of certified training, national examination, and when applicable, licensure/regulation. The NBHWC established national HWC standards and certification in partnership with the National Board of Medical Examiners, as noted in the AJLM article.
Certified training includes behavioral change theory, motivational strategies, communication techniques, and 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.
Since the VHA implemented the HWC CPT codes in 2020, 73,351 unique veterans have had 322,655 sessions with an NBHWC-certified coach, said Kavitha Reddy, MD, associate director of employee whole health in the VHA Office of Patient-Centered Care and Cultural Transformation, St Louis.
Within VHA, more than 300 NBHWC-certified whole health coaches are now in place across the enterprise.
“I frequently refer my patients to work with a coach,” Janet Clark, MD, physician lead of the VHA HWC program, told me. “Our coaches are extremely effective with the veterans we serve, fostering sustainable engagement in healthy lifestyles and treatment plans, crucial for most chronic disease and symptom management.”
Sara Noyes, NBHWC-certified HWC, leads the VHA HWC program with Clark and has written about the power of HWC. “HWC can enhance the health and well-being of service members and veterans as they are better equipped and empowered to live lives to the fullest,” Noyes said. A study examining the VHA Whole Health Coaching program supports Noyes endorsement of HWC.
Massachusetts General Hospital (MGH) contributed data to the AJLM article. Jacob Mirsky, MD, medical director of the Healthy Lifestyle Program at MGH, heads a team that includes four NBHWC-certified coaches who are paired with a physician or nurse practitioner for reimbursed patient visits. Their approach combines shared virtual lifestyle medicine appointments with virtual 1-on-1 HWC sessions.
Mirsky has published multiple papers on lifestyle medicine using HWC sessions, demonstrating improved self-reported health behaviors and positive chronic disease outcomes. “The coaches and their relational, goal-striving style are key to patient success," said Mirsky, who is also an assistant professor of medicine at Harvard Medical School, Boston, Massachusetts.
The temporary approval of HWC CPT codes has been extended through 2029. Currently, payment for HWC services is challenging; however, the AJLM article outlined five emerging paths to reimbursement:
Medical practices should look into whether any of the existing reimbursement pathways can work for their practices and with their patients. Advocates continue to work on formal HWC reimbursement pathways, including urging CMS to integrate HWC CPT codes into Medicare’s chronic care management program as permanent G codes. Their efforts emphasize that broad access to HWC services would help realize the government's goal to Make America Healthy Again and the vision of CMS Administrator Mehmet Oz, MD. The hope is patients needing HWC will have access to it and providers are reimbursed for these invaluable services.
The evolution of HWC along with lifestyle medicine presents “a transformative shift in healthcare, ” the AJLM article noted. HWC is a long-awaited bridge between recommending healthy behavior change to patients and patients actually making those changes, thus improving their health. All qualifying patients should have access to HWC with physician oversight and referral.
Mirsky is owner of Lifestyle Medicine Consulting LLC. Moore is CEO of Wellcoaches Corp.
Sforzo is research advisor to Wellcoaches Corp.
