by Mark Pettus MD, CMP Preventia Group

“Healthy living does not happen in doctor’s offices. Healthy living and road to healthy living is paved by the choices we make each moment; how we eat; how we move;, how we sleep;, how we interpret and respond to stress; how much we need to detoxify; how connected we are to others who love us; how we love ourselves; how much meaning we cultivate in our work, love, and play, how much time we spend with nature; etc.”

Population health as a model has become the focal point of health care transformation in the US. As I will suggest, while its context tends to be clinical and related to health care systems and the communities they serve, population health models can also be applied to workplace health and college/university student wellness. For generations, The US has spent more per capita than any other developed nation by far on the provision of health care. The US also has health outcomes that rank poorly on a global scale e.g., age of death, infant mortality, obesity, and diabetes. Over 4 trillion dollars was spent on health care in 2021. That is a staggering figure at almost 20% of our nations GDP.

Given the unsustainable cost trends, all stakeholders in health care have been shifting to population health models that are rapidly moving from volume-based reimbursements to value-based models that focus on quality-performance and reductions in costs of care. A major dilemma, worthy and necessary as the shift may be, is that 90% of the drivers of poor health, diminished quality of life i.e., health span, and longevity can be traced to lifestyle and the quality of the environment(s) we live and work in.

Central to the current model of population health (Robert Wood Johnson and University of Wisconsin) is the understanding that the social determinants that the individual confronts e.g., health literacy, food security, socioeconomics, cultural integration, secure housing, etc. are necessary to examine and address if more effective behaviors are to be ignited and sustained. It is in fact the SDOH and the behaviors that emerge in their context, that are the largest drivers of health outcomes:

As healthy living does not happen in doctors’ offices, the outcomes clinicians are now financially at risk for, cannot easily be influenced in clinical settings given the limited time of engagement and given the lack of resources necessary to influence behavioral change in a meaningful way. In every market, the demand for services is exceeding the resources available to effectively engage.

We all know how hard it is to fundamentally change human behavior. “Eat less, do more and take this once/day” is not a message likely to be translated and applied effectively. This requires more frequent and personalized “tough points” and an understanding of how an individual perceives their challenges and opportunities. Health coaches are uniquely trained and position to extend the reach of the clinical team, to the end of supporting the necessary change(s), while developing relationship and trust capital with the client. That is where the rubber meets the road. Limitations in current infrastructure make it extremely hard to develop sufficient capacity to meet demand and to assure the right alignment between the level of complexity of the client’s needs with the appropriate level of training and expertise of the clinician. Health coaches can not only foster patient-centric behavioral change, but they can also serve a critical navigation-triage function within the individual’s team-based network of providers.

With adequate infrastructure, health systems, colleges/universities, and self-insured organizations can assess their data and where to focus their resources. Identified cohorts where health coaching is integrated with the existing treatment teams and with integrated data and documentation might expect to see reduced costs of care e.g., avoidable ED visits; acute care readmissions; primary care or mental health cohorts e.g., improved glycemic control or depression screening.

It can be said the health of Americans has never been worse or more concerning. At the same time, it has never been more expensive and challenging to manage. Most of these health challenges are driven by lifestyle behaviors in need of transformation. There are many emerging roles for board certified health coaches to become central to the implementation of population health models.