Inspiring people to change behavior, particularly when it comes to their health, is still a huge challenge. After years of throwing technology at the problem, the digital health ecosystem has come full circle. We are now emphasizing relationships, not information, as the key to change. The technology-enabled 1-on-1, whether with a peer, trained professional, nurse, clinician or friend, is becoming a key part of mHealth offerings.
In many cases, this relationship-based service is labeled "Coaching." But what coaching actually means is very company-specific. Having talked to a number of different coaching Team Leads and others in the industry, here's my understanding of what "coaching" can mean.
Coaching for behavior change
Most common in consumer-facing apps, coaching for behavior change supplements a consumer-facing tool, generally designed to collect information (e.g., a food diary) and/or deliver content (e.g., online therapy). These programs are about engagement and accountability. Someone else is monitoring my progress, making sure I'm interacting, and cheering me on.
When it works, it can be a great user experience. I've been using Rise, an nutrition app that has a dietitian monitor my photo food diary for the past few weeks. I find that my coach's assessments and suggestions for improvement keep me engaged. And, as I'm not the only one liking these interactions, a number of healthcare startups that use a B2B2C model are also starting to incorporate coaching as an intervention into their products. Mental health startup Big White Wall is a great example, as they've added a LiveTherapy program for their corporate clients.
The big questions here are who can be a coach, what qualification is required, and when does coaching become medical care? I'm using Rise to better manage my diet, and hopefully achieve some benefits around fitness and energy. Does my coach need to be a registered dietitian, or could she be someone who's gone through a training program, or done a good job with her own health? What if I was pre-diabetic, and weight loss was a medical imperative? Omada, an online version of the group-based Diabetes Prevention Program, does not require a professional health background for their coaches and is still seeing great results in their clinical trials.
A parallel exists in the mental health space, where Lantern, Joyable, and others are now pairing coaching via phone or text with Cognitive Behavioral Therapy (CBT) courses. It's a different model than 7 Cups of Tea, which is also coaching but offers help (not therapy) through peer coaches described as listeners. While all of these models rely on relationships to help individuals who feel in need of connection, there need to be distinctions between who is able to provide what. Licensing and reimbursement guidelines will have to evolve to reflect the many places people look for care.
Concierge as Coaching
Another example of the reintroduction of the personal relationship back into the consumer healthcare experience is the idea of coach as concierge to help you navigate the healthcare system to get the care you need. Better's Personal Health Assistants are a great example, as they focus on helping people with the logistics part of receiving care. This subscription service is coaching for insurance and appointment scheduling - the stuff that gets in the way.
The idea isn't new - case managers, patient navigators, social workers and others have been playing versions of this role throughout the health care system for years. The question is whether consumers will pay for this as a standalone service. It may become something that is wrapped into other coaching products, or that is picked up by third parties.
Coaching the Clinician
Consumers are not the only ones receiving help in navigating a complex health care system. Startups doing panel management have found that an " air traffic controller" or "triage manager" can vastly improve the efficacy of an app + dashboard platform. These people identify patients in need and "coach" busy clinical staff on where to intervene. They help nudge physicians, therapists and others to change their behavior to better use these platforms. In a recent interview, Dr. John Moore of Twine Health described how their solution included a coach/care coordinator who sits between clinician and patient. At Ginger.io, we found that more time coaching our partners and matching our notifications to work flows improved the effective use of our information.
Defined care management roles do have precedent in less technology-dependent care models. A recent study out of Minnesota, building on the work of the DIAMOND and IMPACT trials, found that having strong care management and a care manager role that was well defined improved the overall outcomes for the collaborative care efforts. As digital health tools become more accepted enablers for care, it will be interesting to see how roles evolve and adapt.
Does my definition and taxonomy of coaching resonate? How is your startup using relationships to drive behavior change?