Healthy Hearts are a Hybrid Challenge

By Neal Moore

Image courtesy of Pixabay, licensed under Creative Commons

I had a conversation on a plane recently with an electrophysiologist in the medical device industry. It was enlightening. Being medical-engineering hybrid (the learning curves he’s climbed!) he was fascinating to me, Here’s someone who deeply understands the wiring of the heart and body, what issues like atrial fibrillation mean, and how to fix them, and he pursues his work passionately.

Yet his wisdom and humility beyond his technical scope was what stuck with me. It was clear to him that life’s work to improve health is limited by the beliefs of others. If we want people like him to succeed, we need to challenge the beliefs of patients, providers, and policy makers.

Much of the healthcare system in the US is built around targeted interventions. For Afib, that’s like surgical, pharmacological, RF, and pacemakers. All are costly and sometimes risky. The real secret to recovering from Afib? According to my rather accomplished fellow passenger, it’s not a secret at all. Exercise, sleep, and diet changes that reduce inflammation and help people lose excess weight. They can even reduce the need for targeted interventions. Eat well, move, and manage the stresses in your control, and maybe you won’t need the meds nor the knife. Some patients are even able to reverse their condition in a matter of months. Even the surgeons like that outcome.

It was great to hear a medical professional talk passionately about treating the brain, body, and mind as a whole person. Societally we’ve seen an increased interest in mindfulness, healthy habits, and holistic health. But why haven’t we all put these simple steps into practice?

It’s because behavior change is hard and motivation is an art as much as a science. No patient who is suffering wants to hear that they need to change their behavior before they get a targeted intervention. On the career side, we want to address their need instantly. Pragmatically, both parties know that better outcomes will take time and effort. Pills and/or a few days in the hospital feel like care, and costs are often externalized to insurers and those who pay premiums. A longer, gradual, committed course is shown to work better and last longer, but has challenges in acceptance across patients, providers, and payers — and in policy.

Motivation is an art as much as a science.

Human centered, integrated approaches use behavioral modifications to reduce the risks of these interventions and improve outcomes. But these modifications rely on beliefs. Problems like Afib benefit from attitudinal interventions, not just medical. Beliefs like having ‘skin in the game’ affect our motivation to change. We cannot build resilience, prevent disease and injury, preserve capability in our bodies without addressing the mind and brain. Feedback loops between behavior and belief reinforce our individual habits both good and bad. They also reinforce beliefs on a larger scale.

We cannot build resilience, prevent disease and injury, preserve capability in our bodies without addressing the mind and brain. Feedback loops between behavior and belief reinforce our individual habits both good and bad.

Beliefs about rewarding good habits and role of the mind in physical health frame our approach to population health and policy. Beliefs about generosity, willpower, and pragmatism influence the political and scientific debate. In reshaping the health system and choosing which interventions to fund, how we as a society hew to these beliefs will affect the electrophysiology of the heart of your fellow passenger.

How do we address individual, systemic, and societal beliefs and behaviors that affect health? Behavioral health (BH) initiatives are at the nexus of these problem.

One exciting trend is the rise of behavioral health startups that are focused on using mental health expertise, mobile technology, and evidence-based approaches to directly address these changes on individual and systemic levels. Often they’re using cognitive behavior therapy (CBT) as the underpinnings. Lyra, for example, lowers barriers to professionals with remote access, using smartphones. Another solution is Woebot is a chatbot that helps patients become more mindful using CBT prompts over via text. Silvercloud in the UK builds in social support, and is now being used by their national health system.

There are dozens of companies that have appeared to work on mental health and behavior modification for individuals or on behalf of employers and payers. Of course, it’s not just startups, with large companies like Humana and Kaiser running BH initiatives of their own if not partnering and acquiring newer companies. Which is good, because governmental spheres can’t move forward alone in their quest to shift public health. Heart health is one aspect Programs for mental health, homelessness, diabetes, obesity, and health insurance overall are all at stake. But there is tremendous opportunity for changes and new applications in behavioral health coming from the private sector, and we’ve seen the smartest companies sitting up and paying close attention.