Once the patient has seen the doctor, the coach and patient meet to determine whether the patient is confident about going after agreed-upon health goals, such as developing new health habits. The coach acts as the intermediary between the patient and the team, and creates accountability.

Human intervention plays a larger role than ever-more-expensive technology in interacting with patients, encouraging them to improve their own health rather than being passive recipients of care.

Iora assumes the full financial risk for its patients, and the whole health care team has a "morning huddle" to assess the health status of the clinic's population. They focus on the patients needing the most attention, prioritizing them over patients whose needs are less serious, on a "worry score" of 1–4. The 4s need immediate attention, with the coach stepping in right away; if they improve, their scores are lowered.

So is it working for chronic conditions? According to an unpublished Iora study, inpatient hospital admissions among a cohort of 1,176 Iora Medicare enrollees over an 18-month period fell by 50 percent, emergency department visits by 20 percent, and the total medical spend by 12 percent, in spite of that group of patients being sicker than average Medicare patients.

"What makes the model disruptive," the HBR experts write, "and able to get a foothold among mammoth incumbent provider organizations, is the combination of delivery and payment schemes (capitation is the predominant model); either alone would be unlikely to succeed."

To advance such initatives and outcomes, the HBR experts recommend three strategies:

For care providers: "Embrace the business model of extended care teams that include health coaches. We recommend starting with pilot programs under which hospitals and clinics take on financial risk for patients' health. This way, care teams are incentivized to help patients stay healthy.

For payers and insurers: "Private-public partnerships like Medicare Advantage(under which for-profit insurers administer plans paid for by the government) have become successful marketplaces that allow disruptive models. We recommend extending programs modeled on pilots like Independence at Home and the Diabetes Prevention Program across privately-funded insurance markets."

For legislators: "Work to enable new models of care that lower costs by incenting individuals, payers, and providers to improve wellness, rather than treat disease after it manifests. This requires fostering a robust individual insurance market in which payers reward providers for helping patients stay healthy."

Other pilot programs are reaping the benefits, with coaches and home visits substantially improving health and lowering costs. One study found that providers participating in Medicare's Independence at Home Demonstration saved $1,010 per beneficiary on average in the second year of the program, chiefly by cutting hospital use. Another program targeting diabetes saved Medicare an estimated $2,650 per beneficiary over a 15-month period by helping patients lose an average 5 percent of their body weight through diet and exercise changes.