Podcast: Health Coaching with Nikki McGrath
In this episode of the Well-being Experts podcast, we’re discussing health coaching as part of a wellness program. We sat down with Nikki McGrath, Director of Member Experience at Onlife Health, to talk about her experience and what she likes about health coaching, why organizations choose to implement a health coaching program, and what a successful program looks like.
“If my employer is offering this program to me, that shows that my employer values me as an employee. It’s not just about saving money by improving my health, it’s my employer cares about me, wants me to be healthy, wants me to connect with these programs that are going to improve my overall well-being.”
Want to dive deeper into this Well-Being Experts podcast? Here's the full transcript from our discussion with Nikki McGrath, Director of Member Experience for Onlife Health.
Nikki McGrath: If my employer is offering this program to me, that shows that my employer values me as an employee. It’s not just about saving money by improving my health, it’s my employer cares about me, wants me to be healthy, wants me to connect with these programs that are going to improve my overall well-being.
Host: This is the Well-being Experts podcast. You just heard from Nikki McGrath, Director of Member Experience at Onlife Health. This episode is about health coaching. Nichole has been with Onlife close to eight years. She began her work in the industry as a registered dietitian and served in many different roles at Onlife.
Nikki: Not a lot of people know about health coaching or know how it works. I think there’s this perception that it’s a lot of just health education, I’m going to sit down with my coach and here’s information, here’s what you need to do. And it’s really so much more than that.
Host: For more content like this go to onlifehealth.com/resources. Enjoy the conversation!
Nikki: Hi there. My name is Nikki McGrath. I am Director of Member Experience here at Onlife, and what that means is that I help manage our health coaching center. I started here at Onlife about eight years ago as a health coach. My background is as a registered dietitian.
Host: So you have background in health coaching, that’s kind of where it all started. So let’s talk a bit about your passion with health coaching.
Nikki: What I love about health coaching, it’s very different from what most people come to the table or what they go to school to become. Most of us as health coaches have backgrounds as registered dietitians, exercise physiologists, health educators. And so we go to school with the desire to help people improve their health. We go to school to gain those tools and resources to help people make improvements in their health. But health coaching is so different because we’re working with members often times over the phone or over email and so we don’t always have that face-to-face interaction.
But still there’s great value in being able to do that and being able to interact with people on a regular basis throughout the course of the year. As things are changing they have the opportunity to call in and say, “I’m having this issue right now or I have this event coming up that I could really use your help on.” And so we have that opportunity to work with them to make those changes when it’s timely, it’s appropriate for them. And really meeting them where they are. So outside of a health care provider relationship, we have really more of a relationship with that member in a one-on-one experience. So really getting to know them, establishing this rapport with the member, and getting them to make those changes.
Host: I would love to ask, what are some of the general characteristics of organizations that are offering health coaching to members? What are they doing, what are they like?
Nikki: At Onlife we’ve certainly seen the full spectrum. We work with small clients, we work with big clients, we work with organizations that are just dipping their toes in the water of wellness and recognizing the importance of a wellness program but aren’t really sure where to start, and then also with those who have already had a full-blown wellness program in place for many, many years. And when you say the general characteristics of those organizations, it’s hard to describe.
One theme that I notice is that they have this culture, they have a culture that supports the health and well-being of their members. So wherever they are in that spectrum, whatever their budget is, they have a commitment from their leadership team and then again this underlying culture at the organization that really supports that health coaching program and the wellness program overall.
Host: It sounds like they have different backgrounds, they’re in different places. Now, what are the drivers of the decisions to offer health coaching? If they’re not already offering health coaching, what are the deciding factors that lead them to that?
Nikki: Well, there’s no mistaking the value of a health coaching program. We know the more high-touch a program is, the more engagement we get out of members. Not just in a coaching program, but our health coaching program – we see it as a concierge service, so we’re able to connect members to other resources and other programs that are in place. And so, there’s certainly that value. It isn’t just how in health coaching program in itself, but being able to lend itself to other venues.
Probably the biggest driver of that decision is going to be budget, though. There is a cost associated with health coaching, of course. And so it’s a matter of recognizing the value of health coaching and weighing that against the budget. And are we going to see that return on investment, if we put this dollars towards the health coaching program, what are we going to get out of it?
And that is difficult especially for less sophisticated programs. It’s difficult for some organizations to see that upfront. It really is, you know, “Let’s give it a try. Let’s see if this is going to work.” Fortunately, it is becoming more commonplace to have these health coaching programs in place. So it’s very easy to look at other organizations have successful programs and to be able to see that return on investment in a program. But the biggest driver, I would say in most cases, is going to be the budget associated with that.
Host: Yeah, of course. That’s the biggest pain point; it comes down to the money. It comes down to how we’re going to do this and why are we going to do this. In that decision-making process – so it sounds like the biggest barrier of course would be cost, but what are the value propositions that help make that decisions, “Yes, we need to have health coaching?”
Nikki: So certainly, there’s the outcomes of a health coaching program. And so, by that I mean literally just the clinical outcomes. It’s a member losing weight, a member quitting smoking, and so the value in that in and of itself. There’s also the engagement that I talked about. So if I’m engaged in my health coaching program, I’m more likely to be engaged in other programs that are available to me through my employer. But I think one that we tend to overlook, and is a huge value to a health coaching program, is just the overall member experience and the member satisfaction.
So if my employer is offering this program to me, that shows that my employer values me as an employee. It’s not just about saving money by improving my health, it’s my employer cares about me, wants me to be healthy, wants me to connect with these programs that are going to improve my overall well-being. So I think that’s the biggest piece. I think that’s a really important one and one that tends to be overlooked, is just the member satisfaction in a program and the overall positive member experience with health coaching.
Host: From the client perspective, what differentiates great coaching from average coaching? Is there a way to measure that?
Nikki: Yeah. I’ll tell you. We get a lot of feedback from our clients and, again, they’re always interested in outcomes. So many of our employees quit smoking over the past year or they’ve lost this much weight. And that’s great and that’s our primary goal with all these programs. But I think, again, it also comes down to that member experience, and those are the stories that really come back to us. When our clients are excited about something, it’s not just those clinical outcomes, it’s saying, “Hey, we heard this success story, we had a member stop in today and just said that they had a really great experience with their health coach, and this is why. The health coach was very positive and motivating and encouraging and helped me increase my confidence and my desire to want to make these changes.” So it’s that feeling. Again, it’s those clinical outcomes, but it’s the feeling that the member experiences in that coaching relationship.
Host: So what are some of the different ways to actually structure the coaching program? Now, this is from the company perspective. So what are the different ways that companies structure coaching? And that can include all the different options.
Nikki: Huge spectrum here. It could be from what we call digital coaching or for us we have self-directed coaching programs, which are when members can log onto the wellness portal and they can access these courses, these self-directed programs that utilize a lot of the same techniques and some of the same structure that a live coaching session would have, but it’s more adult learning principles, so self-directed, self-paced, can learn on my own speed kind of thing. So it goes from that all the way to the other end of the spectrum which would be a very high-touch coaching program, face-to-face, on-site coaching. And we’ve implemented that very successfully with a number of our clients as well, actually sending some coaches on-site to be there. Maybe they reside there, they have an office there so that they’re full-time, or we send them periodically throughout the year to sit with their members. Maybe that’s during health fairs or during other health events that they’re offering.
And in-between there is telephonic coaching. There is secure messaging or more like an email messaging. And so all of these options really are about meeting the member where they are and giving them those options to communicate with their coach in a way that makes the most sense for them. And it may change. I may like the anonymity of telephonic coaching initially. I know my coach’s name, we established this rapport. My coach learns about me, I learn about my coach, but they don’t see me. I don’t really have to share information, if I don’t want to, until I feel comfortable doing so. And then that may change to I want to sign-up for one of those on-site appointments. And now I feel comfortable. I know my coach and we can have that interaction face-to-face. So it really runs the spectrum. We work with our clients to determine what’s going to be the best model for them, and of course budget comes into play there as well.
Host: So it sounds like once you’ve started, then the employee can kind of navigate that journey. Now, when you first get started, though, how do clients actually choose the model to use? Is that challenging? Is that kind of intimidating? Or is it just you just roll it all out? How does that work?
Nikki: It is challenging. I think there’s this tendency to – not a lot of people know about health coaching or know how it works. I think there’s this perception that it’s a lot of just health education. I’m going to sit down with my coach, and here’s information. Here’s what you need to do. And it’s really so much more than that. But there is this tendency to – from clients to want to put structure in place, to say, “This is how many coaching sessions we – this is what we envision a coaching session or a coaching program to look like. It’s going to be – just for example’s sake – it’s going to be six sessions, and you’re going to meet with your coach every month.” And that isn’t really putting a lot of confidence or really respecting the coaching process or the coaching relationship.
So it is tricky because a lot of times our clients come to the table with this vision of how they see health coaching program being implemented. So from us, it’s a matter of working with them, identifying what their goals are, really understanding their population, and then based on our two decades of experience, being able to make those recommendations, to say, “This is what we’ve seen work well in the past for an organization like yours, and this is what we would recommend.”
Host: I like that. So it’s all about the relationship, and it’s all about doing what has worked best in the past, and coming up with a custom solution that works best for you.
Host: What would you say differentiates providers in how they approach health coaching?
Nikki: There are a number of different models of health coaching or behavior change theories underlying the health coaching process. I think you’ll see those are pretty consistent across providers. I think one of the biggest differences is really the health coaches themselves and what they bring to the table and their personalities and how they interact and how they communicate with the members, and I think our health coaches do a fantastic job here.
We have outstanding health coaches that, again, come to the table with great degrees and educational background. They have lots of experience. They already have the credentials and then we work with them to enhance that and train them further on motivational interviewing, which is really a technique of communication more than anything else on how to elicit behavior change and how to really get the member to make the decisions on their own to make those changes rather than us telling the member what they need to do. And again, our coaches do a great job in that, but it’s the education, it’s experience.
And we also take a lot of pride in our coaches, and see them as a great asset. And so, for us that means continuing education and giving them opportunities to get additional certifications to expand their knowledge base and their confidence in being able to talk about different topics, and that motivational interviewing is a big piece. We continue to train on that piece so that we know that we’re always up-to-date on those techniques.
Host: I like the different approaches that you’re talking about with health coaching. There’s not just one cookie-cutter template that you just stamp out on everything. It’s all very listening-based and then they’re saying the best way to implement that. I really like it.
Nikki: That’s right. I think that’s probably one of the biggest challenges that we face in the health coaching as well as we think about having these conversations with the clients. Because again, there’s this perception, if you don’t know health coaching, there’s this perception that it is cookie-cutter, that it is a program, it’s a course, it’s a curriculum that you follow, or education that you’re giving to the member, and it’s far from that. So again, we really work with our clients to – we want them to understand what health coaching is about, not just what the value is, but what that process and that relationship is going to be.
You could imagine two different members with the same goal. Maybe it’s – we’ll use tobacco cessation, they both want to quit smoking. One person could be extremely motivated, maybe they’ve been smoking for many, many decades. And maybe unfortunately they just lost someone because of lung cancer or other risks associated with smoking That person is extremely motivated and ready to make that change.
And you contrast that to someone, maybe a younger member, who has just been smoking for a couple of years, is totally healthy, and is being told by their physician, “You need to quit smoking or else. Some time down the road you’re going to get sick and this isn’t good for you.” That’s a very different conversation, a very different coaching program for those two members. The outcome is the same. We want these members to quit smoking, but the technique is going to be very different. The cadence of coaching calls, and coaching sessions is going to be very different. And so our goal is to help our clients understand that it’s going to be different.
When I talk about one of the challenges about coaching with our clients, it’s that a lot of times they want to put, the client wants to put these guard rails in place. I mentioned this before to say, “We want the program to be – it’s going to be six sessions, and they have to complete it in six months or else.” And so it’s our responsibility again, with our experience and knowing what works to help your client understand health coaching as much as the member to understand it.
Well-Being Experts is supported by Onlife Health. Onlife Health is a comprehensive wellness provider serving health plans and large employers nationwide. With over ten million members and 20 years of industry experience, Onlife takes a high-touch, high tech approach to wellness that creates real results for your population. Find out more at onlifehealth.com.
Host: In this theme of approaching health coaching, is health coaching the same as disease management? Totally different?
Nikki: It’s different. Health coaching is wellness focused, lifestyle focused. So we’re looking at things like nutrition and physical activity, stress management, tobacco cessation. So those lifestyle behaviors that could ultimately lead to disease later on down the road. So this is our opportunity to help people before they get sick, before they develop those diseases. So that’s really the scope of wellness or health coaching.
And then to contrast that to more of a disease management model, where someone is already sick, someone has diabetes, someone has even metabolic syndrome. So they have these risks, they have this diseases. And the interventions are very different. It might be around medication, it might be around certain treatment plan, and that’s not a part of health coaching necessarily.
We support disease management, and our coaches are very well-versed in being able to address diabetes, and being able to address metabolic syndrome and other conditions, but the focus is still around the lifestyle behaviors. So again, nutrition, physical activity lend themselves to almost any condition, almost any disease. So we work very nicely with disease management, but it is different.
Host: I’m curious to hear what you say here. So can you effectively run a well-being program without health coaching?
Nikki: I think you can. I think health coaching is a great program. It’s a great asset. We certainly see the most successful programs have health coaching in place. Theoretically, I think it could happen, though, if you had a very strong culture of health at that organization. Looking at leadership’s support of health and wellness initiatives that could be happening outside of health coaching. Certainly, you improve your chances with that health coaching program, but the culture is going to be that foundation and that’s going to drive things more than anything else.
Host: It’s the creating culture, preserving the culture. Now, let’s say you do have health coaching, are there instances that you can think of when health coaching was under utilized or over utilized, what did that look like?
Nikki: In terms of being underutilized, this tends to come to budget to some degree a little bit. We work with some clients that maybe only had a budget to focus on certain conditions. They want to limit it, we look at the population and they say, “Our highest risk factor here is blood pressure. We really want to focus on that.” And so they’ll limit coaching to just members with high blood pressure.
I smile because it’s tricky, because these risk factors hardly ever happen in a vacuum. If you think about blood pressure, there’s likely an opportunity to talk about nutrition and to talk about physical activity or stress management. And so, while you say, “We don’t want to talk about nutrition or physical activity, we just want you to talk about blood pressure,” yet these other behaviors always come into play. That’s a case where it might be underutilized.
When it’s over utilized, we’ve seen that as well. I think anybody on that spectrum of wellness can benefit from health coaching. The wellness spectrum, I think of someone who’s very unhealthy, very inactive – lots of opportunity to make changes in their health. To the other end of the spectrum, somebody who is out running marathons and is very motivated and very engaged in their health, we can work with anybody on that spectrum, if they want to, if they are interested in making changes or if they feel like they need some help just maintaining the positive behaviors that they are already engaged in.
But we have had clients who have asked that we work with their entire population. And so you could have some very low risk members who are doing great and just aren’t motivated. And I don’t think that’s a great use of resources. It comes down to coaches just checking in and, “How are things going? Oh, I’m doing great.” There isn’t really much that you can do. And so, what we’re happy to do that, and again there’s opportunity to work with anybody on the spectrum, they have to want it or they have to be engaged in that process. So that’s an example when it might be over utilized. I would say underutilized tends to happen more often.
Host: That makes sense, certainly. Now let’s talk about superior health coaching, and I’d love to hear your thoughts on what does a superior health coaching program look like in the real world?
Nikki: Our most successful programs are the more high-touch programs where we have the opportunity to set up the on-site fitness centers, where we have health coaches that are on site full-time. So that high-touch, high visibility health coaching program with lots of access to that health coach. It’s not a matter of having to call in or send a secure message, send in the email. It’s, “I want to talk to someone right now. I want to see them face-to-face. I’m going to walk down to the fitness center and I’m going to have that conversation with them.”
Again, we tend to see those in very sophisticated wellness programs and organizations that have a program in place for a very long time and have really seen the value over a long period of time. They’re very committed to it. But those are definitely the superior wellness programs. We’re on-site, we’re high-touch. We’ve had the opportunity to do that with a number of our clients.
Host: Are there any examples that come to your mind of what has been implemented really well with some really superior things that stand out to you?
Nikki: Yeah. We’ve talked about the on-site fitness centers, having an on-site coaching program. In a really great wellness program or an organization that has a really strong culture of health, you tend to see, because it’s the culture, you tend to see things throughout. And they may not even be evident or may not even be obvious that it’s part of that wellness program. But it’s things like organizations will have farmers markets come in and set up in the parking lot once a week, or even once a month. And so it’s having access to fresh fruits and vegetables and making it easily accessible. I don’t have to go to the grocery store, it’s right here in my work place. It’s having walking trails that are accessible but also attractive and appealing and it makes me want to get outside and I want to go for a walk.
Host: Like a standing meeting outside, you’re going to a little meeting.
Nikki: Yeah. I was just going to say that’s something that we like to do here at Onlife as well for some of our meetings and we certainly encourage it with our clients is, this is a work place, we need to work but can we take advantage of that time? Instead of just sitting around a table, can we go outside, can we go for a walk, can we get our steps in while we’re engaging in some really great conversation?
And so those are just some of the other components that we tend to see in our really superior and our sophisticated wellness programs. It’s not just the big things. It doesn’t have to be a beautiful fitness center and this established coaching program. It’s little things – gardens and farmers markets and bike racks outside. Things like that really support a culture to say, “I can ride my bike into work and I have a safe place, a secure place to store my bike.” It’s vending machines that offer healthy options, and that label them so that I know which ones are the healthy options. Those are just a few of the examples that we see in those programs.
Host: So one of the final questions I want to ask you about, so of course, we’ve been talking about health coaching and there’s a cost, of course, associated with adding health coaching. Any final thoughts on what holds companies back from investing in health coaching?
Nikki: The only thing that would hold them back is the lack of understanding that it truly is an investment. And this is becoming less prevalent now because there are so many wellness programs in place and we can see that it truly is an investment, not just monetarily, but also in those human resources that are so important to a company. So that again, member employee satisfaction and just having good morale and being engaged in the workplace. So I think it’s just not understanding all of those things that add to the value of a health coaching or just to a wellness program in general. Do a little research and it’s easy to see that value and to find a number of case studies that support that value.
But budget is always a part of that, and so it’s hard to put that money up front when you may not see the investment for awhile. It takes awhile to grow into a program. And, first of all, for members to see the value in that as well. Sometimes, if it’s not executed the right way, it can feel a bit draconian. And in some organizations, members will, employees will feel like the company is forcing them to participate in a program. I’ll use the word “big brother”. Why are they so interested in my health, or why do they need to see this values, the health assessment, or why are they doing this? It’s just the employees not understanding. But again, if you have that culture in place and you’re helping the member to really understand the value, then it goes a long way for the employee and for the employer as well.
Host: I like the focus on building up the culture of health and then that helping sustain, even push it further, and helping get maybe the folks who have not adopted yet into the program. It’s going to encourage them to participate as well.
Nikki: Yeah, it takes other employees. That’s going to be the biggest asset, is having other employees engaged in the program versus an employer administrator that’s saying, “We have these programs in place, come use them, they are really great.” When your peers are involved in those and they are benefiting from it and they are really engaged, that’s just going to increase that engagement even more.
Host: What are some of the things that come to mind that make a health coaching program successful?
Nikki: A health coaching program in it of itself is a really – it’s a great program for our members. What’s even better is when we have other resources that are in place that we can recommend for members so that they have the support outside of a coaching program or outside of their coaching sessions. So by that, I mean things like taking a health assessment before the health coaching program even starts so that the member has a baseline of where their health is or what changes they need to make so that the health coach has that information available to them so they can make the right recommendations.
Other components of our wellness program are things like the self-directed courses that I mentioned earlier. Biometric screenings can be a really great feature as well because that gives members some really great feedback, some validated feedback about their health. And being able to see for example, what is my weight, what are my cholesterol numbers and my blood pressure.
Also challenges, whether they are online challenges through our member portal or they are challenges that are being conducted at their workplace to really help me get engaged with my co-workers and being able to do some things throughout my work day. One of the things that helps improve the success of a health coaching program is when there are additional resources available to that coach to be able to make recommendations but also to the member to increase their engagement and to keep them motivated and to give them activities to do on an ongoing basis.
Host: Thank you so much for sharing your story here and I hope to be able to talk with you soon.
Nikki: Thank you.
Host: Thank you to today’s guest. And a big thank you to you for listening along with us.
Well-being Experts is brought to you by Onlife Health, a comprehensive wellness solutions company that has spent years working with health plans and large employers nationwide. Today’s podcast and additional perspectives from the Well-being Experts can be found at onlifehealth.com/resources. We welcome your comments, questions, feedback, all of the above, at firstname.lastname@example.org.