The main drivers of avoidable health care costs are not medical, but behavioral: Up to 85% are due to lifestyle factors, treatment adherence, disease self-care, among others. Solutions that address the consequences of lifestyle and chronic disease are simply not enough. Front line practitioners, health coaches and care managers must be proficient in the brief, highly effective engagement and health coaching approaches that are not simply promising, but proven—in rigorous research trials and real-world health care settings. We have seen rigorously and independently measured health management engagement rates quadruple by staffing these programs with staff not simply knowledgeable, but highly proficient in best practice approaches such as motivational interviewing (MI) health coaching. Over the past ten years working with hundreds of organizations and evaluating and training thousands of health care practitioners in population health, lifestyle management, chronic care and motivational interviewing (MI) health coaching, HealthSciences has acquired substantial knowledge and data. This experience and data demonstrate that competency-based training, credentialing and workforce development can be remarkably cost-effective levers for improving the quality and affordability of health and health support services in a health care environment where chronic, not acute conditions and lifestyle issues are the main threats to health and sustainable health care costs.

In any field or industry, quality is routinely measured using some type of standardized assessment system. Additionally,training or workforce development programs must demonstrate outcomes and ROI before they are implemented, or implemented widely. Of note, "workforce development" is a term used widely by experts in organization and competency development in recognition of the fact that traditional training is only one component of building workforce skills. The type of assessment required to evaluate training or program quality is much more rigorous than the post-program evaluation forms used in health care continuing education which usually bear no relationship to the effectiveness of the program. The type of standardized measurement has helped HealthSciences build new programs and enhance our existing programs like CCP Health Coach for maximum impact. The development of our first assessment system, the HCPA, required a two-year effort. In 2010, HealthSciences convened a team of experts in organization development, health behavior change, motivation interviewing health coaching, psychometrics and health care services to develop a standardized system for assessing and quantifying the impact of health coaching and health management development programs. The system would draw on approaches to quality and performance improvement used in other industries to achieve breakthrough results. The system would also be specifically geared to brief health coaching encounters, incorporate the latest research on factors such as "change talk," and provide detailed feedback reports to individuals, as well as programs and organizations. In 2011, the Health Coaching Performance Assessment (HCPA) system was introduced. It has since been used by HealthSciences, and premier health systems, health plans and provider organizations including Mayo, Marshfield Clinic, Blue Cross Blue Shield of Michigan, Premera, among others.

While the HCPA has been remarkably effective, its main shortcoming is that it requires a relatively high level of expertise in MI and MI coding, as well as training in the HCPA, for accurate, reliable and meaningful results and feedback. (Coding in the MI field refers to a rigorous process of systematically assessing the adherence of practitioners to MI). The Motivational Interviewing Treatment Integrity Scale (MITI) is the gold standard on which the HCPA was based, and has similar user requirements. For organizations that do not have access to experts, but still need a standardized process for measuring and improving program effectiveness, there were very few options. Even if an organization has not invested in MI training, it is critical to have a validated, systematic process for measuring practitioner and patient behaviors empirically linked with behavior change outcomes. To bridge this gap, a new solution, the Health Coaching Quality Improvement (HCQI) system, was introduced in 2014. It was validated against the HCPA and developed for the use by supervisors, quality staff or mentors who are interested in transitioning from a traditional quality assurance (QA) approach to a standardized assessment and systematic quality improvement protocol and tools.

The HCQI is a cloud-based, standardized, validated system for assessing, benchmarking, reporting and improving patient-level outcomes. The training for HCQI users may be completed in approximately eight hours and includes a final proficiency test to support standardization, precision and inter-rater reliability. Additional training is available for mentors who have demonstrated expertise in MI, but are not yet trained in MI coding using the MITI or HCPA. The HCQI does not replace the HCPA, but provides an affordable system that can be licensed and implemented internally to align clinical and operational excellence efforts--for the joint aim of better customer results for medical home or accountable care teams, or health plan wellness, condition management or care management programs. For example, the HCQI would be used routinely during the monthly quality assurance cycle, while the HCPA can be used quarterly by internal or external experts, who would provide targeted feedback pm workforce development, e.g, sourcing and hiring, new hire orientation, rewards an recognition, annual review, and ideally workflow improvements, information systems or other best practice components that could improve quality in that setting, e.g., primary care, telephonic health management.