Q&A: The long road of the national health and wellness coaching credential

Photo Cred: Toa Heftiba/Unsplash

By Liz Gold

As the need for additional patient care and support grows, more practitioners are turning to health coaches to fill in the gaps. Health coaching is a relatively new field; many integrative practitioners may not know the history behind the National Board for Health and Wellness Coaching (NBHWC) organization and coaching credential. It includes long hours from dedicated volunteers, partnerships with like-minded individuals and organizations, a patience for the process, and a vision for a way to establish the profession. Though there has been significant progress, there is still much to be accomplished, especially as this field grows and the demand for coaches increases.

We talked with Leigh-Ann Webster, NBC-HWC, executive director of the NBHWC, a nonprofit organization in San Diego, Calif. that partnered with the National Board of Medical Examiners (NBME) to create a training, educational standard, and national certification for the profession of health and wellness coaching. In this interview, Webster shared some of the history of how the organization came to be, its priorities, and what’s next for the field of health coaching.

Integrative Practitioner: What is the role of the NBHWC?

Leigh-Ann Webster: I always like to start with the history of the organization because it helps frame the conversation.

In 2007, I decided to become a health and wellness coach because I’ve always been passionate about health. At the time, there were no training and education standards in place for any health and wellness coach training programs out there. I found that when I was talking to people, there was a lack of knowledge about what a health and wellness coach does, and also a lack of respect because of the lack of standards. At that time, there was really no way to distinguish someone who had a passion for making smoothies and calling themselves a health coach versus somebody who had invested time, money, and resources into actually becoming trained in behavior change. It was very frustrating to me.

A lot of the [coaching] programs, were feeling frustration because of this, too. So, in 2010, subject matter experts in the area of health and wellness coaching started talking about the fact that there were no training and education standards in place. In 2012, they formalized and created a board of directors and an official nonprofit, and then got to work.

This extremely dedicated group of leaders in the field brought together a number of experts in the profession of health and wellness coaching and gathered in person. This was in 2013. They created the knowledge, tasks, and skills in the job task analysis. Then they sent that out to more than 1,000 practicing health and wellness coaches.

After several years of work led by this group of dedicated volunteers, I saw the opening for a position to help lead this initiative. I was the first paid employee hired in the spring of 2015. It was at that point, when they felt that they were ready to take that job task analysis and create the initial training and education standards for the field.

Anytime you’re trying to standardize and professionalize a field, you have to do it in stages, to allow for the training and education programs and the coaches to catch up with where you are. We started at a minimum bar of 30 hours of training and education. We launched program approval in July 2015. Our board of directors met every single Tuesday, for an hour and a half, for like seven years. When we launched program approval, we expected that there might be 10 to 15 programs that would apply for approval by our organization. Instead within a year, we had more than 60 programs apply for approval.

What the board of directors did not realize was that this issue of no standard to the industry was much bigger than they thought it was. It really brought the field together and we were able to see that there were so many more programs out there than we realized. We were able to bump the standards up to the next phase in September of 2018. Any program at this point that is approved by us has been approved under a set of standards, that’s now 75 hours of training and education and assessment as well.

There are a couple other important pieces to the story. In 2016, we began having conversations with the NBME. They were very interested in what we were doing to professionalize the field. Eventually, we signed a long-term affiliation agreement with them. That’s a really important piece to the story, because that has given us a lot of, for lack of a better word, clout in the field of healthcare. It’s a door opener for us to have those conversations with physicians and leadership in healthcare organizations because it really validates what we’re doing.

Integrative Practitioner: So, all this development is fairly recent?

Leigh-Ann Webster: It is. It’s really important to note that. There’s a lot of coaches who are just entering the field or people who are thinking about becoming health and wellness coaches. If they don’t understand the history, they wonder, why isn’t there reimbursement? Why aren’t there Category I CPT [Current Procedural Terminology] codes? Why won’t my health savings account cover this? Why am I not making $200 an hour? It’s because this really takes a lot of time. We’re not even in the [United States] Department of Labor listed as a profession yet. It’s a very long, arduous process.

Integrative Practitioner: What are the NBHWC’s top priorities?

Leigh-Ann Webster: There’s a couple that really stand out. One of them would be to      continue professionalizing the field. Even though it feels like we have accomplished a lot, we have over 6,500 people who have now earned the NBC-HWC credential, but there are still probably 100,000 coaches out there, who have not attended an approved training program, or who have attended but haven’t sat for the exam yet. There’s still a lot of work to do in terms of educating coaches about what we do, and the opportunity that we provide, but also educating the public about hiring a National Board Certified Health and Wellness Coach, or at minimum hiring somebody who has attended an approved training program. Outreach about the board certification is definitely a top priority.

Another top priority is building the career path for health and wellness coaches because we want to make sure that on the employer side, there is an actual job for the coach. One of my top priorities over the next two years is to do a lot of outreach to employers not only in healthcare, but also in employee wellness. In companies like Google and Apple and Walmart, where we’re starting to see them bring health and wellness coaches onto the staff, we want to make sure those coaches are board certified. Making sure that companies are respecting the coaches in their education and training and offering them livable wages that people can get excited about.

Another top priority is integrating the health and wellness coach onto that healthcare team. We’re doing a lot of outreach now to healthcare organizations and we’re working with physicians who understand what coaches do and how coaches can work with their patients for improved health outcomes.    

Another priority is moving from Category III to Category I CPT codes.

Integrative Practitioner: Can you explain where you are with CPT codes and what developments are coming?

Leigh-Ann Webster: The application for Category III CPT codes was first presented to the American Medical Association in the spring of 2019 by a physician from the Veteran’s Administration who we worked in partnership with. Category III CPT codes for health and wellbeing coaching were granted, and they became effective in January of 2020. Since then, we have been working with health and wellness coaches who work in healthcare and who are using the codes.

Today, we are in a formal IRB [Institutional Review Board] approved agreement with the University of California, San Diego (UCSD). UCSD is housing the data that we need to apply for the Category I codes. We hope to have enough data to apply for Category I codes by the spring of 2023.               

I don’t want to mislead anybody to think that just because there are codes for health and wellness coaching, they can use these codes and they’ll get reimbursement, it doesn’t work like that. There is language around the codes from the American Medical Association, and this language needs to be adhered to by health and wellness coaches who work with a physician. Acquiring reimbursement for the profession is a complex process, that will take time to iron out. 

Two other things are happening concurrently. One is that here in America, health savings accounts (HSA) are overseen by the Internal Revenue Service (IRS). We have a legal team who is supporting a lot of this work that we’re doing. We applied with that legal team to have health and wellness coaching count as a covered service for HSA accounts for the IRS’ rulebook. We are going back and forth right now with the IRS. This has been like a yearlong process, but we are making headway. So, we’ll be able to put out some information about that soon.    

Integrative Practitioner: Will a Category I code be for a coach who works at a hospital or a clinic? Is it also if an individual wants to hire an independent coach? Will that apply as well?

Leigh-Ann Webster: I don’t think it will apply to that. Though there’s the potential for that entrepreneurial coach, to partner with a physician. We’re not there yet. We really don’t know. But perhaps they might be able to get reimbursement if they’re working with the physician. We won’t know until we get there.

Integrative Practitioner: How is the field of health and wellness coaching evolving?

Leigh-Ann Webster: It’s evolving well. It’s changing for sure. We’re definitely building a following and a community in terms of backing the standards and the need for standards. It is professionalizing. We are seeing job growth. We are seeing an increase in pay. There are more studies; there’s more researchers who are devoting time to research to validate positive outcomes. We’re seeing physicians open their minds to the profession of health and wellness coaching and referring more patients to health coaches.

Integrative Practitioner: Is there anything you think is important about health and wellness coaching that you think integrative practitioners should know?

Leigh-Ann Webster: Credentialing matters. Whether you’re hiring a health and wellness coach or acupuncturist, or a holistic health practitioner, it really actually does matter that they went to a reputable school that adheres to industry standards. That they put in time and effort and have been properly assessed in order to be delivering whatever type of service it is. Value the credentials that they have earned. Just continue to spread the message that it actually does matter that somebody is properly trained to do whatever service they’re providing, especially in health.

Editor’s note: This interview has been edited and condensed.