Part 3: In 2020–2021, Coaching gained greater product-market fit
We all know the state of American health is bad. Cigarette smoking rates are down, but there has been no other significant longitudinal behavior change seen on a population-wide level to impact the rates of the deadliest chronic diseases in recent decades.(1) We still eat too much food that isn’t good for us, don’t get enough exercise, sleep terribly, and drink too much alcohol. One out of every five Americans has a diagnosed mental health condition, and plenty more go undiagnosed.(2) And yeah, Covid has only exacerbated all these problems. Oy vey.
In the last two years, coaching has gained traction as an intervention that helps people break these bad habits that are leading to health decline. To recap — health & wellbeing coaching is about making and sustaining behavioral changes to 1) improve health outcomes and 2) increase quality of life and wellbeing.
So what’s the evidence?
We know health coaching for physical health conditions works to prevent and mitigate chronic disease: We see statistically-significant effects in HbA1c reduction, BMI reduction, increase in physical activity, and increase in sense of self-efficacy.(3) Coaching interventions demonstrate clinically-significant improvement across diabetes, obesity, heart disease, and hypertension:(4)
- Diabetes: 78% of diabetes studies indicated positive impact on HbA1c
- Obesity: 87% of studies measuring weight changes found a reduction in weight and/or BMI
- Heart disease: 91% of heart disease studies reported positive impact on heart disease risk with measurement focused on factors including LDL levels, total cholesterol levels, blood pressure, diet, and exercise
- Hypertension: 67% of studies on hypertensives revealed lower blood pressures
And more institutions offering behavioral or mental health coaching are showing sustained improvement in their patients across measures of stress, mental wellness, and symptoms of anxiety & depression.
Healthcare systems, providers, payers, employers, and consumers alike are turning to coaching to solve three other huge problems too:
- Care access: Booking an appointment with a therapist, notoriously, can take weeks or months. Coaches are not bound by the jurisdictional limitations of licensure and are more likely to work virtually. So they can support patients across state lines, which increases the pool of providers that a patient can choose from and how quickly patients can begin receiving care. We’re also seeing more stepped care models, in which the most effective yet least resource-intensive treatment is delivered to patients first. In this model, patients who otherwise would not have received care or who would have been waiting for therapy to become available get care more quickly. Patients are only ‘stepped up’ to more intensive care as clinically-required.
- Care cost: Coaches have a narrower scope of practice: in the same way that you wouldn’t go to a dentist for a root canal (you’d go to an oral surgeon), coaches are less specialized than therapists. As a result, coaching is less expensive, which also means coaches are paid lower salaries. And, while most coaching services are not yet covered by insurance, some hospital-based coaching programs are offered for populations with specific chronic diseases, e.g., diabetes, and, notably, three major insurers — UnitedHealth Group, Aetna, and Blue Cross Blue Shield — offer free health coaching to many of their patients.
- Stigma: The historical medical model emphasized identifying a problem with a patient, then diagnosing and treating that problem. It was assumed something was wrong with you, which, of course, generated a lot of shame. Coaches are collaborative partners and allies, even cheerleaders at times. A neutral, more peer-based power dynamic means people find them rather approachable.
In clinical settings, coaching is most often woven into a team-based care delivery model, with clinical and non-clinical team members collaborating to support a patient. Coaches can partner with PCPs, care navigators/coordinators, and, if needed, specialists. When this works well, coaches can be the backbone of the model, providing ongoing support that primary care providers — who typically see 32 patients a day(!) — cannot.
Even though most behavioral health needs could be managed by a primary care physician, most PCPs need help. The reality is, they simply don’t have enough time in typical 15–20 minute office visits to go in-depth on lifestyle management and they often lack training and confidence to fully manage behavioral health. For example, Motivational Interviewing is a tool missing from their toolbelt. Coaches have a unique zone of competence. PCPs can lean on coaches to support patient accountability in making and sustaining new health habits. Coaches can dedicate all of their time to getting to know patients’ current behaviors, circumstances, and priorities. They help clients find their intrinsic motivation and come up with an actionable plan for, say, going to bed earlier or taking their medication.
What the tech market looks like
Coaching is now a popular component to many digital health and digital therapeutics products gaining traction with employers looking to strengthen their benefits plans and expand access to mental health care. (It seems like every month we’re hearing of another healthtech company launching a coaching program.) Employers find themselves responsible for both attracting the best employees and helping them optimize their contributions & experience at work. HR/Benefits teams are buying point-solutions and integrated offerings like the ones in the market map above to replace Employee Assistance Programs, notorious for low engagement rates, and as a supplement to whatever in-network therapy option is available through their insurance package.
At One Medical, I (Laura) heard this phrase time and again from primary care providers: “Mental health is 80% of what I deal with.” Patients are seeing their providers for all sorts of physical health issues but, the reality is, mental health is inextricably linked to physical health. So if you’re a healthtech company and you’re in the business of health, you will encounter mental health. We’re seeing companies who started off doing chronic disease prevention and management, such as Noom and Omada, buying or building coaching programs to expressly address mental health. And more companies are becoming full-stack care delivery solutions as they realize how necessary it is to smoothly coordinate care across different kinds of healthcare providers.
We’re also seeing a trend of digital health point solutions (single-service offerings, e.g., a meditation app) expanding to become care delivery organizations, which often includes coaching (think of the Headspace<>Ginger merger). This signals a few things:
- There’s recognition of the importance of human interaction when it comes to changing behaviors that improve health.
- Some of these point solutions have become true front doors to the healthcare system. A customer who may not otherwise be using the healthcare system may now choose to try coaching because they’ve been exposed to it through another app.
- And, if incorporating coaching into your product means you can show clinically-significant improvement in health outcomes, even better!
The execution risk here lies in these organizations’ ability to integrate coaching sustainably into their existing care delivery models, hiring people who provide high quality care, expanding access, and achieving strong clinical outcomes.
We’ve got a long way to go in shifting more care delivery models in the U.S. to be integrated, team-based, and patient-centered with a core focus on prevention. Leveraging coaches to deliver evidence-based, measurement-based care throughout healthcare and healthtech can move us in the right direction.
Read our fourth and final piece in the series to get a deeper understanding of how exactly coaches promote sustainable change in health & well-being.
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References
(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125027/
(2) https://www.nimh.nih.gov/health/statistics/mental-illness
(4) https://journals.sagepub.com/doi/full/10.1177/1559827617708562
