An estimated 35,000 health coaches in the U.S. forge personal relationships with patients to identify goals, change behaviors and improve health. And their numbers are rising. According to the U.S. Department of Labor (and reported by the Wall Street Journal in early 2016), wellness professions focused on preventive health are set to increase by 21 percent over the next six years, faster than all other occupations.

Who coaches are and how they help

Professional health coaches — including nurses, dieticians, respiratory therapists and other health care professionals — work one-on-one with patients to help them understand and prioritize their needs, empowering them to better manage their own health care.

Coaches provide support for individuals with chronic conditions including cardiovascular disease, diabetes, obesity, chronic obstructive pulmonary disease (COPD) and hypertension. Coaches also provide acute care support, shared decision making (SDM) guidance and medication adherence support.

As experts in transferring knowledge, health coaches give patients the information they need to select and navigate the most appropriate type of care for their particular condition. They drive behavioral change by tailoring their approach to each individual's unique health status, lifestyle, personal preferences and potential barriers.

Diabetes, one of our most devastating diseases, is the poster child for prevention through healthy behavior change. Despite advances in medical science and technology, diabetes remains the seventh leading cause of death in the U.S.

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On average, health care costs for people with diabetes were 2.3 times higher than those without the disease. Unfortunately, more clinical knowledge is not translating to better outcomes because patient behavior is not being properly addressed.

Sustained lifestyle changes aimed at weight management, for example, can help patients reduce their risk for developing diabetes.

Health coaches educate patients and assist with adherence to glucose monitoring and glucose control medications. Individual support can help diabetes patients better manage their disease, resulting in increased productivity and decreased absenteeism.

Coaching also plays a vital role in overall wellness improvement from weight loss to tobacco cessation and more. Successful coaching focuses not only on the health benefits of a lifestyle change but also on an individual's thoughts, feelings and perceived importance of that change.

Understanding what motivates someone is critical, and personalization is essential.

Effective health coaches work with patients to:

1. Respect their knowledge and experience – They know what to do but typically don't know how to achieve their specific health goals.

2. Acknowledge their time constraints – Balance health goals with career, family and other commitments.

3. Identify their values and sources of motivation – Help them identify personal motivation such as self-image, playing with their grandchildren or vacationing with family.

4. Create realistic, incremental goals – Instead of creating a goal of "increase exercise," create a goal of "walk with my spouse after dinner every night for 20 minutes" or "park at least three blocks from my grandson's weekly soccer game."

5. Support small changes – Provide positive reinforcement for achieving incremental changes that fit into their lifestyle, then reassess and create new, achievable goals.

Health coaches' training and experience matters

When choosing a health coach, it is important to consider breadth and depth of experience as well as the type of training a coach has received.

Effective health coaches have worked in health care for many years and have been rigorously trained in behavior change methodologies, cultural sensitivity, patient education and motivational coaching. An increasing number of coaches are bilingual to meet the needs of a wide variety of patients.

Personalized coaching is the key to a productive coach/patient relationship.As health coaches learn of special needs a patient may have, they are trained to record that information to make sure the patient's experience is positive.

Every interaction should be personalized to achieve four objectives:

1. Understand the individual's health situation and guide him or her to the appropriate level of care.

2. Educate the individual on health topics and discuss care steps and other available services.

3. Empower the individual to make informed decisions and successfully navigate the health care system.

4. Deliver a consumer-centric and positive experience.

Increasing access to coaches

In 2015, the Patient-Centered Outcomes Research Institute (PCORI) awarded nearly $14 million to Penn State College of Medicine for a three-year study — the largest of its kind — that will enroll 2,000 adults 65 years and older who have had a fall-related fracture and wish to resume exercise.

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The study seeks to validate findings of six smaller studies, which show that exercise assisted by a health coach reduced the risk of fracture in older adults by two-thirds. Penn State selected Health Dialog, a leading provider of population health management solutions, to train the health coaches working with study participants.

The company has 20 years of experience providing rigorous training to health coaches, ensuring the quality of the Penn State study. PCORI researchers plan to use this study's findings to encourage Medicare and private insurance companies to provide coverage for health coach-assisted exercise programs for this special population.

Coaches can work face-to-face with patients, but many work with patients remotely via phone, both with inbound and outbound calls, as part of instant-access 24/7 nurse help lines. Others develop long-term, regular relationships focused on disease management and wellness.

As online patient engagement platforms grow in popularity, people will have an even broader range of opportunities to interact with their health coach using digital tools.

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Retail-based 'convenient care' clinics continue to grow and expand their footprint throughout the country, providing consumers with easy access to high-quality, affordable health care. They offer an ideal setting for coaching programs.

Many of today's convenient care clinics are moving beyond acute treatments to address longer-term health issues, screening patients for gaps in care and lifestyle issues such as smoking, drinking and obesity.

Coaching programs in this setting are demonstrating success in helping people achieve success with weight loss, diabetes and hypertension control as well as medication adherence. Their location in a retail setting makes them more accessible and affordable for a larger group of people.

Efficacy of health coaching

Several studies indicate health coaches have significant, positive impacts on patients' health:

• A study on type 2 diabetes found that after six months, patients who worked with a health coach showed improvement in medication adherence. Coaching also had a positive effect on patients' knowledge, skills, and confidence for self-management; the coached patients had improved exercise frequency, stress level and perceived health status, while a non-coached control group did not show any improvement.

• A study on coronary heart disease indicated that patients who worked with a health coach had a significantly greater decrease in total cholesterol than the non-coached patients, with a considerable reduction in LDL-C. The patients who received coaching also had improvements in secondary outcomes such as weight loss, increased exercise, improved quality of life, less anxiety and improvement in overall health and mood.

• A Journal of the American Medical Association study, published in 2014, compared different weight loss programs and found only slight statistical variations in success rates between diet types. The results show that in addition to exercise, behavioral support led to more successful weight loss. The researchers' findings suggest the motivation from behavioral support services increases one's ability to adhere to any weight loss program's diet and exercise regimen and is a key ingredient of successful weight loss. Another study found that body mass index decreased significantly — from 32.1 at baseline to 31.4 at 3 months, 31.0 at 6 months, and 30.6 at 12 months — in patients who participated in a health coaching program.

• A study on the effectiveness of a telephone-based health coaching tobacco cessation program found that at 12 months, health coaching program participants achieved a 32 percent quit rate, compared to 18 percent for nonparticipants. The quit rate was highest (44 percent) among people who indicated they were ready to quit.

The consistency and highly individualized care provided by health coaches is increasingly essential as we move toward a consumer-centric, value-based health care model. By identifying personal motivation and receiving ongoing, tailored support from a dedicated coach, patients are not only achieving their personal health goals — they are improving their value to our entire health care system.